The COVID-19 pandemic has upended life as we knew it, hitting people with Spinal Cord Injury (SCI) particularly hard. A lack of resources, unavailability of transport and social-distancing measures have made daily activities more difficult for them. As we come to the end of India’s maiden National Injury Prevention Week, we partnered with Indian Spinal Injuries Center (ISIC), Delhi, for our latest Practo Connect webinar.
Exclusively meant for doctors and healthcare professionals, it was led by experts Dr Ankur Nanda, Consultant, Spine Surgeon (ISIC), and Dr Gaurav Sachdev, Consultant, Physical Rehabilitation (ISIC).
“The aim of this special week is to prevent injury through education, research, and advocacy,” says Dr Ankur. Adding to that, Dr Gaurav says, “We must also create more awareness among the general public and administrators that would help uplift people suffering this condition and support their social reintegration.”
Managing spinal cord injuries
Every year, about 3 to 5 lakh people suffer from spinal cord injuries globally. However, the majority of these are preventable and caused due to accidents and falls. In severe cases, it may result in paralysis, which can completely change people’s lives, impacting their physical, mental and vocational wellness.
“Given that the mortality risk increases with injury level, which is influenced by the availability of timely, quality medical care, it is critical to correctly manage problems due to spinal cord injury,” says Dr Ankur.
According to him, management of acute spinal cord injury has three components:
- Pre-hospital management
- Hospital management
The first one is critical and starts at the site of the accident, shaping the entire treatment course of the patient. It includes extrication and immobilization of the spine and the patient, first aid, and transfer to a medical health facility.
“The natural response of most people at an accident site is to help. However, if not handled properly, this could lead to further injury,” he says, adding, “It should ideally be done by a trained team – be it police personnel or other first responders – and can make a huge difference in the long-term outcome of the patients.”
At this stage, the first step is to anticipate if there is a spinal cord injury. In fact, the correct approach would be to presume it in cases where the patient has undergone major trauma, and thereafter, take the steps to carefully extricate the patient and immobilize the spine.
“There are various techniques employed by professionals, from something as seemingly basic as application of a cervical collar,” he says. This is followed by first aid, which includes a primary survey of checking the patient’s airway, breathing, circulation, disability and exposure. Once a patient has been stabilized, they have to be carefully assisted into an ambulance and transferred to a nearby hospital.
According to Dr Ankur, emergency room protocol is similar to accident site protocol. “There is a systematic review of the patient from head to toe. Additionally, to assess neurological injury, we use International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), which allows us to measure the sensory levels, motor levels, and neurological levels of injury,” he explains.
Post emergency room protocol, patients have to undergo radiological examination and surgical intervention in some cases. But their medical journey does not end even after they are discharged. Once the acute management at the hospital is over, they have to prepare to integrate themselves back to society.
Rehabilitation of people with SCI
According to writer Jeffrey Kruger, spinal cord injuries can be one of the most devastating ailments as everything plays out in absolutes: they are instantaneous, utterly disabling and horribly permanent. But he missed one crucial point.
“SCI often affects young individuals, many of whom may be the only earning member in a family, affecting the well-being of not just the individual but the whole family,” says Dr Gaurav. “This makes rehabilitation efforts critical in helping them become as independent as possible in daily living, and get them back to a near-normal lifestyle,” he adds.
The majority of motor recovery occurs within the first 6-9 months, and it typically plateaus around 12-18 months post-injury. That is why early rehabilitation is important.
According to Dr Gaurav, this cannot be a single department’s responsibility, and involves a team of medical physicians, other specialties like urologists, orthopaedics, neurologists, physiotherapists, social workers, occupational therapists, clinical psychologists, peer counselors, as well as the patient’s family.
There are three types of approaches that is typically used at this stage:
- Multidisciplinary approach
- Interdisciplinary approach
- Transdisciplinary approach
In the first one, different professionals assist and treat the patient separately with their discipline-specific course. However, lateral communication among them is minimal. That is better in the second approach, where an overall group assumes responsibility for the patient. In the third, there is a crossover of different professionals for flexibility in functioning, and is generally used in centers where there are limited resources, and where all professionals are not available.
“It is not that one approach is better than the other. What is important is that all members perform their respective roles and responsibilities well,” he says.
Broadly speaking, physicians diagnose the underlying pathology and initiate the rehabilitation plan; nursing staff monitor day-to-day needs of the patient; physiotherapists identify and treat key physical impairments; occupational therapists provide strategies and environmental adaptations to facilitate independence; social workers promote participation and community integration; dieticians assess and promote adequate nutrition; clinical psychologists perform detailed assessment of cognitive, perceptual and emotional problems, and develop strategies to manage these issues with patients and their families; and peer counsellors give them support and encouragement in their reintegration process.
“Rehabilitation of people with SCI should start from day one of hospitalization to prevent complications in the long-term,” he says, adding,. “It also does not end with discharge, and continues till they have been reintegrated into the community they left. At the end of this period, they should have gained self-esteem, and the ability to secure decent employment, among other things.”
Join us every month as we partner with leading industry and doctor associations for our educational webinar series, Practo Connect. Watch this, as well as previous webinars, here.