Spinal Cord Injury Management and Rehabilitation: Highlights and Shortcomings From the 2005 Earthquake in Pakistan

Rathore, Farooq Azam; Farooq, Fareeha; Muzammil, Sohail; New, Peter W; Ahmad, Nadeem; Haig, Andrew J.

doi:10.1016/j.apmr.2007.09.027

Cited by 121 publications

(83 citation statements)

References 22 publications

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“…At that time the health-care system in that part of Pakistan and Azad Kashmir was totally destroyed in the aftermath of the disaster. 7 And even now, there are issues with quality health-care delivery and medical setups. Most of these patients were living in tent villages without suitable toilet facilities for many months.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Because of these problems, patients with chronic SCI tend to spend more time in the toilet while evacuating their bowels, use suppositories, laxatives and supplemental dietary fibre more frequently to improve bowel evacuation and require manual removal of faeces much more frequently when compared with their matched control population. 4 Research on SCI in Pakistan is limited, [5][6][7][8] and there are no data available on chronic SCI or bowel-related problems of patients having chronic SCI .The earthquake on 8 October 2005 in Pakistan resulted in hundreds of SCI patients, most of whom were young paraplegic females with complete injury. 5 In view of an increased burden of SCI in Pakistan in the past few years, our team is conducting research on different aspects of chronic SCI, and this study is the first preliminary report in the series.…”

Section: Introductionmentioning

confidence: 99%

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How do patients with chronic spinal injury in Pakistan manage their bowels? A cross-sectional survey of 50 patients

et al. 2010

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Study design: A cross-sectional survey. Objectives: To document bowel care practices of chronic spinal cord injury (SCI) patients in Pakistan. Settings: Outpatient Department, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. Methods: A total of 50 adult patients (18-65 years) with SCI of duration 412 months were sampled by convenience sampling. Medical record was reviewed, detailed neurological examination was performed and face-to-face semistructured interviews were conducted. Data were collected and analysed using SPSS v10. Frequencies and descriptive statistics were calculated for the various variables. Results: Most of the patients (29) were males. The mean age was 33 ± 11 years. Majority of the patients (76%) had thoracic-level injury. In all, 43 patients gave a history of occasional or regular faecal incontinence. In addition, 17 patients reported the regular use of laxatives whereas 22 used bulkforming agents on a regular basis. Majority of the patients (56%) had at least one bowel evacuation daily. In addition, 31 patients required 16-30 min to complete the bowel evacuation. Approximately half (54%) required assistance in bowel evacuation. Conclusion: A large number of patients with chronic SCI in Pakistan had faecal incontinence. A majority of patients used methods such as suppositories, laxatives and bulk-forming agents to control the frequency and duration of the bowel programme. Adherence to standard bowel care programme and practices are influenced by sociocultural factors and lack of education on the part of the patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How do patients with chronic spinal injury in Pakistan manage their bowels? A cross-sectional survey of 50 patients

et al. 2010

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“…Inappropriate pre-hospital 47 and hospital care of spinal cord injury patients led to the development of pressure sores 39,54 and urinary tract infections 44,54 whilst the use of interventions inappropriate to the resource setting by some newly arriving international specialist staff led to unnecessary post-operative complications 26,29 . International staff tended to depart after the initial response leading to difficulties in providing ongoing post-operative care for patients they had treated 26,55 .…”

Section: Thematic Analysismentioning

confidence: 99%

“…The medical capacity and expertise to manage such cases was however, often limited and positive outcomes were not assured 3 with one study reporting mortality as the most likely outcome for quadraplegics 43 . Countries had to develop rehabilitation services 39,[44][45][46][47] to deliver rehabilitation over the long term 3,43,47 .…”

Section: Thematic Analysismentioning

confidence: 99%

The changing health priorities of earthquake response and implications for preparedness: a scoping review

2017

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“…Many of these SCI patients are neglected and mismanaged because of multiple reasons (delayed evacuations, priority given to bleeding wounds, poor assessment techniques, non-availability of dedicated SCI centres). 5 Many a times it is not possible to provide adequate mechanical and pharmacological thromboprophylaxis to all of them (financial constraints, lack of storage facilities for heparins or simply an oversight). In such situations, the availability of adequate number of care givers and volunteers in resource-poor countries, such as Pakistan, is invaluable.…”

mentioning

confidence: 99%

Physical therapy versus heparin for prevention of deep venous thrombosis

Rathore

Farooq²

2010

Spinal Cord

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We have read with interest the article by Agarwal et al. 1 and the letter by Frisbie. 2 They both have highlighted a very important and largely neglected aspect in the prevention of deep vein thrombosis (DVT) in spinal cord injury (SCI) patients, that is, the role of physical therapy. Agarwal et al. have presented more scientific evidence against the routine use of pharmacological thromboprophylaxis in resourcepoor South Asian countries, which cannot be arranged in many instances because of the cost issues.We would like to refer to our prospective study on prevalence of DVT in a cohort of 187 earthquake 2005 survivors with SCI. 3 We primarily relied on clinical suspicion and carried out duplex scan only in suspected cases. Only nine cases (4.8%) had confirmed DVT on duplex scan. This was despite the fact that mechanical and pharmacological thromboprophylaxis was not available to most of the patients. One of the possible explanations that we considered was thrice daily range of motion exercise of the lower limbs along with massage of the paralyzed extremities. This was made possible because of availability of an adequate number of attendants and volunteers. This is a very important suggestion that needs to be revisited in the light of the new scientific evidence presented by Agarwal and Frisbie, although it is not meant to downplay the established role of heparin in the prophylaxis of DVT.Experience has shown that disasters, especially earthquakes, result in a large number of SCI patients. 4 These disasters overwhelm the healthcare resources and many of them happen in resource-poor developing countries. Many of these SCI patients are neglected and mismanaged because of multiple reasons (delayed evacuations, priority given to bleeding wounds, poor assessment techniques, non-availability of dedicated SCI centres). 5 Many a times it is not possible to provide adequate mechanical and pharmacological thromboprophylaxis to all of them (financial constraints, lack of storage facilities for heparins or simply an oversight). In such situations, the availability of adequate number of care givers and volunteers in resource-poor countries, such as Pakistan, is invaluable. The regular range of motion exercises and compression massage of paralyzed extremities is a useful DVT prevention intervention (and even alternative, where no other option is available). It is also cost effective and can be carried out by anybody after a demonstration by a physical therapist. Keeping in view the increasing frequencies of natural disasters around the globe, it is important that this mode of DVT prevention be studied in detail, preferably in a multicenter randomized controlled trial comparing various forms of mechanical and pharmacological DVT prophylaxis and its economic implications. ISCoS can take the lead and make a difference in the SCI management in disasters in future.

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Spinal Cord Injury Management and Rehabilitation: Highlights and Shortcomings From the 2005 Earthquake in Pakistan

Cited by 121 publications

References 22 publications

How do patients with chronic spinal injury in Pakistan manage their bowels? A cross-sectional survey of 50 patients

How do patients with chronic spinal injury in Pakistan manage their bowels? A cross-sectional survey of 50 patients

The changing health priorities of earthquake response and implications for preparedness: a scoping review

Physical therapy versus heparin for prevention of deep venous thrombosis

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