Rehabilitation Needs in Persons    with Spinal Cord Injury in Post-           earthquake Haiti              Alexandra Rauc...
Background
The disaster
Disaster relief interventionsDisability                                                   Rehabilitation                  ...
ObjectiveThe International Classification of Functioning,  Disability and Health (ICF) provides a common  framework for th...
Methods• Selecting ICF Core Sets• Creating a documentation form• Descriptive data analysis
1. Selection of ICF categories       Body functions and Body structures             Activities and Participationb134     S...
1. Selection of ICF categories                              Environmental factorse110   Products or substances for persona...
2. Rating of the extent of a problemACTIVITIES AND PARTICIPATION                                                          ...
2. Rating of the extent of a problem             Extent of the problemno        mild   moderate   severe   complete0      ...
3. Determination of intervention need  ACTIVITIES AND PARTICIPATION                                                       ...
Assessment Results
Sociodemograpic data (n=18)Sex                                    Women             11(61.1%)                             ...
Patient‘s perspective                 Male, 43, AIS D, T12                 Trapped while working on a roof,               ...
Patient‘s perspective                            Male, 27, AIS A, C6              „I am not the same person as            ...
Description of the problems                                        0%           20%     40%             60%             80...
Description of the problems        0%               20%              40%             60%             80%          100%    ...
Description of the problems                                                           0% 10% 20% 30% 40% 50% 60% 70% 80% 9...
Areas of Rehabilitation needs                                         0   1   2   3   4   5   6   7   8   9 10 11 12 13 14...
Areas of Rehabilitation needs                                                        0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15...
Areas of Rehabilitation needs                                                                             0   1   2   3   ...
Required health professionals
Implications and impact on          rehabilitation medicine• Need for rehabilitation needs assessment• ICF provides a usef...
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Rauch reha needs in persons with sci in post eq haiti-crdr.disaster.symp.isprm11

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Rauch reha needs in persons with sci in post eq haiti-crdr.disaster.symp.isprm11

  1. 1. Rehabilitation Needs in Persons with Spinal Cord Injury in Post- earthquake Haiti Alexandra Rauch,M. Baumberger, E. v. Elm, F.G. Moise, J. Reinhardt
  2. 2. Background
  3. 3. The disaster
  4. 4. Disaster relief interventionsDisability Rehabilitation Prevention • Search and rescueLack of water and food • Medical services and supplies • Clean water and sanitationDecreased sanitary conditions • Emergency shelterLack of Housing • Food • Rubble removal and street cleaning First • Logistics and telecommunications.Dead response • Family reunification and otherInjuries protection concerns**United Nations: Haiti earthquake 2010 Flash appeal, Version 1.1. 16 January 2010
  5. 5. ObjectiveThe International Classification of Functioning, Disability and Health (ICF) provides a common framework for the description of functioning.To explore the feasibility of a rehabilitation needs assessment using the ICF in persons with spinal cord injury (SCI) following the earthquake in Haiti
  6. 6. Methods• Selecting ICF Core Sets• Creating a documentation form• Descriptive data analysis
  7. 7. 1. Selection of ICF categories Body functions and Body structures Activities and Participationb134 Sleep functions d230 Carrying out daily routineb152 Emotional functions d240 Handling stress and other psychological demandsb280 Sensation of pain d410 Changing basic body positionsb420 Blood pressure functions d420 Transferring oneselfb440 Respiration functions d445 Hand and arm useb525 Defecation functions d450 Walkingb620 Urination functions d455 Moving aroundb640 Sexual functions d465 Moving around using equipmentb710 Mobility of joint functions d470 Using transportationb730 Muscle power functions d510 Washing oneselfb735 Muscle tone functions d520 Caring for body partsb810 Protective functions of the skin d530 Toiletings1200 Structure of the spinal cord d540 Dressings430 Structure of respiratory system d550 Eatings610 Structure of urinary system d560 Drinkings810 Structure of areas of skin d760 Family relationships d850 Remunerative employment
  8. 8. 1. Selection of ICF categories Environmental factorse110 Products or substances for personal consumptione115 Products and technology for personal use in daily livinge120 Products and tecnology for personal indoor and outdoor mobility and transportatione150 Desing, constructions and building products and technology of buildings for public usee155 Design, construction and building products and technology for private usee310 Immediate familye340 Personal care providers and personal assistantse355 Health professionalse580 Health services, systems and policies
  9. 9. 2. Rating of the extent of a problemACTIVITIES AND PARTICIPATION Some problem Not applicable Not specified No problem Complete „How much difficulty has the patient in…“ problemd230 Carrying out daily routine P 0 1 2 8 9 C 0 1 2 8 9 Description: Is able to organize and structure activities of daily living, sometimes calls for assistance Rehabilitation need: Yes Nod240 Handling stress and other psychological demands P 0 1 2 8 9 C 0 1 2 8 9 Description: Is thinking a lot about his situation in the earthquake and the consequences. The recollection causes stress. Listening to music helps him. Rehabilitation need: Yes Nod410 Changing basic body position P 0 1 2 8 9 C 0 1 2 8 9 Description: Rehabilitation need: Yes Nod420 Transferring oneself P 0 1 2 8 9 C 0 1 2 8 9 Description: Has some movement restrictions due to the spinal surgery which present little difficulty. Course of movement is not optimal Rehabilitation need: Yes Nod445 Hand and arm use P 0 1 2 8 9 C 0 1 2 8 9
  10. 10. 2. Rating of the extent of a problem Extent of the problemno mild moderate severe complete0 1 2 3 4 no some complete 0 1 2
  11. 11. 3. Determination of intervention need ACTIVITIES AND PARTICIPATION Some problem Not applicable Not specified No problem Complete „How much difficulty has the patient in…“ problem d230 Carrying out daily routine P 0 1 2 8 9 C 0 1 2 8 9 Description: Is able to organize and structure activities of daily living, sometimes calls for assistance Rehabilitation need: Yes No d240 Handling stress and other psychological demands P 0 1 2 8 9 C 0 1 2 8 9 Description: Is thinking a lot about his situation in the earthquake and the consequences. The recollection causes stress. Listening to music helps him. Rehabilitation need: Psychological support Yes No d410 Changing basic body position P 0 1 2 8 9 C 0 1 2 8 9 Description: Rehabilitation need: Yes No d420 Transferring oneself P 0 1 2 8 9 C 0 1 2 8 9 Description: Has some movement restrictions due to the spinal surgery which present little difficulty. Course of movement is not optimal Rehabilitation need: Physical therapy Yes No d445 Hand and arm use P 0 1 2 8 9 C 0 1 2 8 9
  12. 12. Assessment Results
  13. 13. Sociodemograpic data (n=18)Sex Women 11(61.1%) Men 7 (38.9%)Age (mean) 36.7 (26;55)Cause for spinal cord injury Earthquake 17 (94.4%) Traffic 1 (5.6%)Level of lesion Cervical 1 (5.5%) Thoracal 15 (83.3%) Lumbal 2 (11.1%)AIS (ASIA Impairment Scale) A 13 (72.2%) B 1 (5.6%) C 3 (16.6%) D 1 (5.6%)Spinal surgery 9 (50%)Number of pressure ulcers since SCI 0 5 (27.8%) 1 7 (38.9%) 2 3 (16.7%) 3 2 (11.1%) 4 1 (5.6%)Marital status (post earthquake) Never married 2 (11.1%) Married 10 (55.6%) widowed 5 (27.8%) With partner 1 (5.6%)Number of children (post earthquake) 0 5 (27.8%) 1 1 (5.6%) 2 3 (16.7%) 3 5 (27.8%) 4 2 (11.1%) 5 2 (11.1%)Work situation (before earthquake) Employed 2 (11.1%) Freelance 7 (38.9%) Jobless 6 (33.3%) Student 1 (5.6%) Unknown 2 (11.1%)
  14. 14. Patient‘s perspective Male, 43, AIS D, T12 Trapped while working on a roof, Lost one of his five children (oldest sun), Housing completely destroyed. Acute care in Milot, since March 12th in HHA “I don’t know how my family is living, my kids, my wife, It is such a big difference. I don’t know when I will be able to go to work and after I am here, I don’t know how I will live.”“I try not to think about what happened to me. If I would, I don’t know what to do…” Male, 43, AIS C, L1 Trapped in the ground floor of his own house, Lost his wife and eight children, Housing completely destroyed Acute care in the Dom. Rep., since April 29th in HHA
  15. 15. Patient‘s perspective Male, 27, AIS A, C6 „I am not the same person as Trapped from collapsing before. It is such a big difference buildings while on the street. Acute care in the Dom. Rep. how I live now in comparison to Spinal surgery in Milot before. Thinking about it makes me since March 12th in HHA. very sad. The only thing that I know is that Jesus can help me to find myself and my way again.“ Female, 39, AIS B, T12„My biggest problem at the moment Trapped while at the third floorare the finances. Before, I did not have of a building.problems because I used to have a Housing completely destroyed. Lost…business – buying and selling things...“ Acute care at ‚Doctors without borders‘, afterwards in Milot, since March 13th in HHA.
  16. 16. Description of the problems 0% 20% 40% 60% 80% 100% Sleep functions b134 7 10 1 Emotional functions b152 4 14 Sensaton of pain b280 1 17 Respiration functions b440 17 1 Defecation functions b525 1 17 Urination functions b620 1 17 0 No Problem Sexual functions b640 16 2 1 Some problem 2 Complete problem Mobility of joint functions b710 14 4 8 Not specified Muscle power functions b730 5 13 Muscle tone functions b735 14 4Protective functions of the skin b810 18 Structure of the spinal cord s1200 5 13Structure of respiratory system s430 18 Structure of urinary sytem s610 18 Structure of areas of skin s810 8 10
  17. 17. Description of the problems 0% 20% 40% 60% 80% 100% Carrying out daily routine d230P 12 5 1 Carrying out daily routine d230C 12 5 1Handling stress and other psychological demands d240P 5 12 1Handling stress and other psychological demands d240C 5 12 1 Changing basic body positions d410P 8 9 1 Changing basic body positions d410C 7 6 5 Transferring oneself d420P 7 10 1 Transferring oneself d420C 7 6 5 Hand and arm use d445P 17 1 Hand and arm use d445C 17 1 Walking d450P 2 16 Walking d450C 3 15 Moving around d455P 1 17 Moving around d455C 18 Moving around using equipment d465P 16 2 0 No Problem Moving around using equipment d465C 1 15 2 1 Some problem Using transportation d470P 2 16 Using transportation d470C 1 17 2 Complete problem Washing oneself d510P 9 8 1 8 Not specified Washing oneself d510C 1 16 1 Caring for body parts d520P 9 8 1 Caring for body parts d520C 1 16 1 Toileting d530P 1 12 4 1 Toileting d530C 1 1 15 1 Dressing d540P 8 10 Dressing d540C 1 16 1 Eating d550P 17 1 Eating d550C 17 1 Drinking d560P 18 Drinking d560C 17 1 Family relationships d760P 1 12 4 1 Family relationships d760C 1 13 3 1 Remunerative employment d850P 18 Remunerative employment d850C 18
  18. 18. Description of the problems 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Products or substances for personal consumption e110Products and technology for personal use in daily living e115 Products and technology for personal indoor and outdoor mobility and transportation e120 Complete barrier Design, construction and building products and Some barrier technology of buildings for public use e150 No barrier/facilitator Design, construction and building products and Some facilitator technology of buildings for private use e155 Complete facilitator Immediate family e310 Not applicable Personal care providers and personal assistants e340 Health professionals e355 Health services, sytems and policies e580
  19. 19. Areas of Rehabilitation needs 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Sleep functions b134 Emotional functions b152 Sensation of pain b280 Respiratory functions b440 Defecation functions b525 Urination functions b620 Sexual functions b640 Mobility of joint functions b710 Muscle power functions b730 Muscle tone functions b735Protective functions of the skin b810 Structur of spinal cord s1200Structure of respiratory system s430 Structure of urinary systems s610 Structure of areas of skin s810
  20. 20. Areas of Rehabilitation needs 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Carrying out daily routine d230Handling stress and other psychological demands d240 Changing basic body positions d410 Transferring oneself d420 Hand and arm use d445 Walking d450 Moving around d455 Moving around using equipment d465 Using transportation d470 Washing oneself d510 Carrying for body parts d520 Toileting d530 Dressing d540 Eating d550 Drinking d560 Family relationships d760 Remunerative employment d850
  21. 21. Areas of Rehabilitation needs 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Products or substances for personal consumption e110 Products and technology for personal use in daily living e115 Products and technology for personal indoor and outdoor mobility and transportation e120Design, construction and buiding prod. and techn. of buidlings for private use e155 Immediate family e310 Personal care providers and personal assistants e340 Health professionals e355
  22. 22. Required health professionals
  23. 23. Implications and impact on rehabilitation medicine• Need for rehabilitation needs assessment• ICF provides a useful framework for such an assessmentHowever• Tools needs to be tested• Further developments required• Data usage should be clarified• Data collection presents challenges
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