The impact of personal and environmental factors on the rehabilitation of persons with neglected spinal cord injury in Malaysia

Abstract

Introduction Managing neglected spinal cord injury (SCI) patients in a rural setting can be challenging due to a lack of resources and the unique personal and environmental contextual factors that may hinder rehabilitation. This article aims to identify the contextual factors and their impact on successful rehabilitation. Case presentation A middle-aged man from a rural area had suffered a neglected traumatic SCI and was first seen by the rehabilitation team 17 years post injury. He had a T7 AIS A paraplegia and was bedridden with multiple secondary complications. He was admitted with goals of optimizing his health, initiating basic spinal rehabilitation and improving his functional status. By 1 month, the patient made gradual improvement of his mobility and ADL but requested discharge despite not having achieved his rehab goals. We identified the factors that contributed to his poor motivation to be more functionally independent. Personal factors include poor educational level, his background personality and erratic healthseeking behaviour. Environmental factors included poor family and financial support, physical barriers, lack of work opportunities and facilities for people with disability, poor community support and acceptance and poor healthcare facilities and expertise. Discussion The patient's personal and environmental factors affected the delivery of SCI management, spinal rehabilitation and management of secondary comorbidities. Awareness of early spinal rehabilitation among the rural community and healthcare authorities is crucial to promote better implementation of policies, services or programs to support people with SCI.

Consequences of neglected traumatic spinal cord injuries

“…In contrast, other studies have reported premature discharge during the first admission or inadequate management as predominant causative factors in developing countries, and missed diagnosis as the predominant cause in Western countries. 3 , 9 , 23 , 24 The mean duration of neglect was 43 days in our study, whereas most patients included in the study by Chhabra et al. presented after 168 days.…”

Understanding barriers to spinal cord injury rehabilitation services in Nepal: A qualitative study of rehabilitation professionals’ perspectives.

“…Nepal is home to many ethnic groups, each with its own distinct cultures and religious practices (Malla et al, 2015). Consistent with the findings of Hanapi et al (2019), traditional medical practices are still extensively used in most parts of Nepal. The utilization of Ayurveda or medicinal herbs, oil massages, and the application of heated bricks to relieve pain are common practices in Nepal (Shankar et al, 2006;Thapa et al, 2018).…”

“…Early rehabilitation not only prevents future complications but enhances the quality of life for PwSCI by maximizing their independence, promoting participation in life activities, and improving psychological well-being (Dhakal et al, 2022;Hachem et al, 2017;Nas et al, 2015). However, several challenges hinder effective rehabilitation services for PwSCI, especially in resource-limited countries (Burns & O'Connell, 2012;Hanapi et al, 2019;Uddin et al, 2022).…”

“…Only a study evaluating the perspective of rehabilitation professionals on rehabilitation in Switzerland reported conflicting opinions among medical professionals, a lack of rehabilitation-specific education and training opportunities, a lack of research and funding in rehabilitation research, limited provision of multidisciplinary and interprofessional approaches, a lack of awareness among public and policymakers, and inadequate integration of rehabilitation services into primary health care, as common barriers to effective rehabilitation services for people with disabilities (Spiess et al, 2022). A case study from Malaysia also highlighted similar barriers, with the addition of personal factors such as education, cultural values, social upbringing, and personal attitudes of PwSCI (Hanapi et al, 2019).…”

Environmental barriers and participation restrictions in community-dwelling individuals with spinal cord injury in Jiangsu and Sichuan Provinces of China: Results from a cross-sectional survey

“…Two small qualitative studies conducted in Mongolia and Malaysia showed that participation restrictions were associated with insufficient accessibility of the natural and built environments, transportation, and lack of health care services. 13 , 14 A study by Reinhardt and colleagues compared environmental factors reported in low and high resourced settings and found that fewer facilitators and more barriers were experienced in lower-resourced countries. 15 More recently, Reinhardt and associates compared environmental barriers experienced by people with SCI across 22 countries including China using data from the International Spinal Cord Injury Community Survey (InSCI) on which also the present study is based, In this study, more barriers were experienced in countries with greater overall income inequality and lower average household income of those with SCI, among others.…”