“SANCHETI SPINAL CORD INJURY REHABILITATION SUPPORT GROUP”

Author of Article: DR. Gajanan Bhalerao (PT).

 

What is support group??

  • Support group is a common platform for people to give and receive both emotional and practical support as well as to exchange information.
  • Learning to cope with a spinal cord injury may be the biggest challenge ever faced by an SCI patient and his or her family. It is good to know that you are not alone in such a difficult situation. SCI support groups provide the opportunity to make friends with people undergoing similar challenges and also offer the opportunity to learn more about SCI and how to deal with it.
  • Support groups are made up of people with common disabilities and experiences.Support groups can be a great place to find practical tips and resources.Information and support sharing between group members, caregivers, health care professionals, and guest speakers will be facilitated to educate individuals with SCI and their families, as well as the public on all aspects of spinal cord injury care, availability of services, and how to maximize the potential for full participation in all areas of life.
  • Benefits of joining a support group are:
    • Information about medical treatments,
    • Information about research and strategies (through brochures, booklets, websites, telephone help lines, and person-to-person sharing in the group meetings). 

Need for support group:

  • A person with spinal cord injury must be facing new problems and challenges in life but they may not always get attention and tackled with therapeutic assistance.
  • There is immense need to give attention to this target population who are living with disability and requires constant support and guidance throughout their life.
  • To get all the patients of this special population of community together so as to take note & comprehend their daily need and problems in life
  • The patient needs to know that there are many people sailing in the same boat.
  • Such a group will help them to share their experiences about coping up with their disabilities.

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Salient features of Camp:

  • Thorough neurological and musculoskeletal examination
  • Teaching functional strategies for better quality of life
  • Taking patients to highest level of independence
  • Orthopedic and neurological consultation as per requirement
  • Expert orthotic advice
  • Care givers training
  • Importance of treatment
  • Complication prevention
  • 10- 50% discount on investigations if required

Faculty in the Camp :

Dr. Ketan Khurjekar, Chief Spine Surgeon

Dr. Shailesh Hadgaonkar, Consultant Spine Surgeon

Dr. Gajanan Bhalerao, Incharge Neuro Rehab Department

Dr. Vivek Kulkarni, Neurophysiotherapist

Dr. Vasanti Joshi, Neurophysiotherapist

Dr. Vinit Patil, Neurophysiotherapist

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SPINAL CORD INJURY REHABILITATION

Spinal cord injury refers to any injury to the spinal cord caused by trauma. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence.

Activities of daily living can be difficult for individuals with spinal cord injury; however through rehabilitation process, individuals with spinal cord injury may be able to live independently in the community with or without full time attended care depending upon the level of injury. Rehabilitation and further intervention focuses on support and education of the individuals and the care givers. This includes an evaluation of the limb function to determine what the patient is capable of doing independently, teaching the patient self-care activities. Independence in daily activities like eating, bowel bladder management and mobility is the goal, as obtaining competency in self-care activity contributes significantly to an individual’s sense of self-confidence and helps in reducing his dependence on care givers thus improving his Quality of life.

Pressure sore is reddening and breaking down of skin caused due to too much pressure for too long period of time. Pressure blocks the blood supply to the skin thus reducing the oxygen supply and nutrient  resulting in death of the tissue. Areas on the body where the bones are very close to the skin surface are more prone to developing pressure sores..

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BLADDER MANAGEMENT

How is the bladder affected by SCI?

Urine passes into the bladder in the normal way.Messages to and from the brain via the spinal cord are interrupted, therefore:

1.Inability to feel the need to urinate

2.Inability to control when the urine comes out.

SPASTIC Bladder

  • Bladder Empties automatically at certain filling pressure
  • May be triggered by certain techniques like“tapping” etc.
  • Bladder can be trained to empty on its own

FLACCID Bladder

  • Messages don’t travel between higher centers and bladder
  • Bladder loses ability to empty automatically
  • Bladder will continue to fill (may leak urine when it gets too full)
  • Cannot be trained to empty on its own
  • Will have to catheterize regularly to empty bladder

REASONS FOR REQUIRING A BLADDER MANAGEMENT PROGRAM

 

A bladder management program will allow someone with a spinal cord injury to

  1. Empty their bladder in a way that is socially acceptable
  2. It will allow them to carry out day to day activities
  3. Be socially active without having to worry about incontinence issues.
  4. complications involving the bladder can be reduced,
  5. increased quality of life
  6. reducing the risk of bladder infections,
  7. Reduces kidney damage,
  8. Reduces skin sores

THE METHODS OF TRAINING ARE:-

Intermittent Catheterization:

  • limit fluid intake
  • A daily record chart of Intake and output should be maintained.
  • Drain your bladder several times a day by inserting a small rubber or plastic tube
  • The tube does not stay in the bladder between catheterizations.
  • It is important that you do not let your bladder get
  • Limit to 125mL every hour you are awake
  • same as 500ml(2cups)every 4 hours
  • 16 hours = 2 L if you are having 4 catheters/day
  • Water is the fluid of choice

Indwelling Catheterization

This method is adopted when one cannot feel the sensation of a full bladder. There is a need to empty the bladder before overflow leakage or stretching of the bladder occursAn indwelling catheter is one that is inserted into the bladder and stays in place for extended periods. The catheter continuously empties the bladder into a collection device

Scheduled (timed) voiding for bladder training

Establish  pattern by using a bladder diary (fluid volume chart) to record number and volume of urine output, incontinence episodes, and fluid intake.

If frequency is more than every 60 minutes, void every 60 minutes; if less than 60 minutes, start with 30-minute intervals. Continue this process until frequency is reduced to every 3 to 4 hours

Various techniques can be used to assist bladder emptying.

  1. Tapping on your bladder before catheterization. This is should be done until urination begins.
  1. Credé’s Manouever

Method to empty the bladder by manually applying pressure to your lower abdomen  with a closed fist, in order to manually push urine out In effect, this squeezes the urine out of the bladder.

  1. Valsalva

Use  the abdominal muscles as if having a bowel movement. This puts   pressure on the bladder, and forces  urine out

Bladder retraining describes the techniques used to help you control your bladder. As mentioned previously, the goal of bladder retraining is to develop a healthy and manageable way for you to empty your bladder.

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BOWEL MANAGEMENT

Changes in bowel control may occur after injury. You may experience constipation or diarrhea. A bowel training program including diet, medicines and digital stimulation may be used.

After a spinal cord injury, messages from the rectum do not get through to the brain and you do not get the urge to have a bowel movement. As a result of not feeling the urge, the coordination to have a bowel movement is lost. The brain is unable to send a message to the sphincter to either relax or hold on until later

The goals of the bowel program are:

  • To have a bowel movement at a predictable time
  • To promote stool consistency that allows for easy passage

The factors of a successful bowel program are:

  • Choose foods high in fiber (roughage), such as fresh fruits, vegetables, and whole grain foods.
  • Drink enough liquids to keep the stool a soft formed consistency and/or use a stool softener. Prune juice is a great natural laxative.
  • Eat yogurt and probiotics (acidophilous) to promote healthy intestinal flora.
  • Avoid foods which cause constipation, or very hard stools, such as meats and dairy products which are low in fiber or roughage.
  • Avoid foods which cause diarrhea, or very loose stools, such as spicy, greasy foods, onions, etc.
  • Be as active as you can. The lack of activity can cause constipation.
  • Drink a cup of hot fluid (tea, coffee) to help initiate bowel movement.
  • Use a commode chair or toilet.

 

Aims of bowel management

The aim of bowel management following SCI is to achieve regular and predictable emptying  of the bowel at a socially acceptable time and place.

The major goal of a bowel programme for the patient with a spinal cord injury is establishment of a regular pattern of evacuation.

This is achieved through multiple interventions including diet, fluid intake, stool softners, suppositaries and manual evacuation.

BOWEL CARE AND TRAINING

  • A bowel care is the term for assisted elimination of stool and is part of your bowel programme. It begins with starting a bowel movement, which is frequently done with digital stimulation and/or with using a rectal stimulant (suppository or mini-enema).
  • A bowel care includes all techniques, manoeuvers and medications applied to achieve efficient and satisfactory stool evacuation.

 

Why is the relation between my bladder and my bowel important?

Bowel care should be performed with an empty bladder. Great attention must be paid to hygiene. The greatest source of urinary tract infections is the bowel. Repeated urinary tract infection may be caused by a poor bowel programme and chronic constipation.

Remember…

  • A bowel diary should be maintained where timing and food intake should be specified
  • Diet plays a very important role in establishing a good bowel routine. Foods that have a lot of fibre can absorb and retain liquids and help make your stool more soft and easy to pass

Check your bowel programme:

Increasing the frequency of bowel care may reduce the amount of stool you store in your colon to produce gas

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Are there other ways to facilitate bowel care?

  • Abdominal massage Rubbing or running a hand firmly over your stomach may help to stimulate your bowel. Before a bowel care routine you could try massage of your abdomen starting from the lower right side across the top and down to the lower left side, in a clockwise motion.
  • Bending helps change the position of the colon and expel stool. For this, you need either a lap safety belt if you are using a commode chair or enough control of your upper body to be able to return to a sitting position after you bend forward.
  • Push-ups. If you have strong arms, you can raise your hips off the commode chair seat, as if doing a pressure release or do forward and sideways bending with Valsalva maneuvers.
  • Valsalva technique can help you increase pressure around the colon to push stool out. It works best with people who have control over their abdominal muscles. A tight elastic band around the abdomen may aid increasing the abdominal pressure. Breathe in and try to push air out, but block the air in your throat to increase the pressure in your abdomen. Try to contract your abdominal muscles as wellRepeat for 30 seconds at a time on and off until all the stool is expelled.

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Lastly,A bowel programme  plan must be followed as it  is designed to empty the bowels at a regular and predictable time through bowel care, to prevent or cut down on bowel accidents, and to keep bowel-related health and other problems to a minimum.

SCI support Group Booklet Click here for details of pressure, bowel bladder managment and home modification for spinal cord injury.

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