Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study.

OBJECTIVE: To determine the effectiveness of Occupational therapy (OT) in improving activities of daily living performance in complete cervical tetraplegic patients. METHODS: A quasi experimental study was conducted at Paraplegic Center Peshawar from May 2018 to March 2019. Seventy two spinal cord injury patients with complete cervical tetraplegia having age 18-60 years were included in the study using non probability convenience sampling technique. A trained Occupational therapist conducted two occupational therapy sessions per day, three times a week on alternative days for a period of six weeks. Self-care portion of Spinal cord injury independence measure (SCIM) was used to collect pre and post data. Data was analyzed using SPSS version 20. RESULTS: Mean age of the participants was 30.21±13.52.Majority of the participants were (n= 61, 84.7%) male while remaining 11 (15.3%) participants were female. Pre self-care total score was 0.39±0.987 and post self-care total score was 7.17±5.536. There was significant differences (P value <0.05) between pre and post scores of feeding, upper & lower body bathing, upper & lower body dressing, grooming and total self-care scores. CONCLUSION: Occupational therapy significantly improves activities of daily living performance in complete cervical tetraplegic spinal cord injury patients.

Employment status of person with disability in Government Departments in Khyber Pakhtunkhwa Pakistan.

OBJECTIVE: The objective of the study was to determine whether anticipated number of person with disabilities was employed in different government departments of Khyber Pakhtunkhwa (KPK), Pakistan. METHODS: Using across sectional survey, data from 16 different departments of provincial government of KPK was collected by volunteers of 'Friends of Paraplegics. RESULTS: Out of total 1, 71,137 Govt. employees, only 1151 (0.67%) were person with disabilities. None of the included departments fulfilled 2% allocated job quota for person with disabilities. Majority of the employees included in study were from Elementary & Secondary Education Department (n=140345) and Agriculture, Livestock & Cooperation Department (n=14315). The number of person with disabilities in these departments were 960 (0.68%) and 68 (0.48%) respectively. The highest percentage of person with disabilities were working in Higher Education Archives & Libraries Department (1.65%)followed by Law, Parliamentary Affairs & Human Rights Department (1.42%), Planning & Development Department (1.39%) and Administration & Establishment Department (1.16%). CONCLUSION: It is concluded that a small number of person with disabilities are employed in different Govt. Departments. Moreover, these departments has not ensured providing 2% job quota for person with disabilities.

Spinal cord injury due to fall from electricity poles after electrocution.

OBJECTIVE: The objective of this study was to report epidemiology, complications and rehabilitation outcomes of patients who sustained spinal cord injury (SCI) due to fall from electricity poles after electrocution. METHODS: A prospective observational study was conducted in which patients admitted to Paraplegic Centre Peshawar from July 2016 to July 2018 who sustained SCI due to fall from electricity poles after electrocution were included. Of total 852 patients, 39 (4.58%) sustained SCI due to fall from electricity poles after electrocution. Two patients were excluded and data of 37 patients was analyzed. RESULTS: The mean age of the participants was 35.03±13.47 years. Twenty-two (59.4%) patients had associated burns on different parts of body. Twenty-seven (72.9%) had pressure ulcers, 31 (83.8%) had spasticity, 18 (48.6%) had neuropathic pain and 2 (5.4%) had limb amputations due to injury. Mean Spinal cord injury independence measure score at the time of discharge was 53.4±5.7. CONCLUSION: SCI due to fall from electricity poles after electrocution is rare however combined effect of injury by electricity along with fall from electricity poles are associated with severe complications. Rehabilitation outcomes in these patients are also minimal.

Effectiveness of transcutaneous electrical nerve stimulation in management of neuropathic pain in patients with post traumatic incomplete spinal cord injuries.

OBJECTIVE: To determine the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) in management of neuropathic pain in post-traumatic incomplete spinal cord injury patients. METHODS: A quasi-experimental study was conducted at from January 2017 to June 2017 at Paraplegic Center Hayatabad, Peshawar. Total 60 incomplete spinal cord injured patients with diagnosis of neuropathic pain were subjected to high frequency TENS of 80 HZ. One session was of 45 minutes while there were two sessions per day. TENS was applied for four days in a week and all patients were followed for eight week duration. Pain intensity was measured by using VAS (Visual analogue scale). RESULTS: Mean pain intensity on VAS at baseline was 6.45 which was decreased to 4.77 post intervention at day-1 while it was decreased to 3.48 at day-4 of week one. After application of TENS for 8 weeks, mean pain intensity was decreased to 2.80 ± 1.74. During the consecutive sessions of the TENS application, the pain intensity decreases in a linear fashion and there were significant difference (p<0.05) between pre and post treatment sessions. CONCLUSION: TENS is useful and safe adjuvant in spinal cord injury patients for the management of neuropathic pain.

Epidemiology, Clinical Features and Consequences of Spinal Cord Injury in Children.

OBJECTIVE: To describe epidemiology, clinical features and clinical consequences of Spinal Cord Injury (SCI) in children. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Paraplegic Centre, Hayatabad, Peshawar, from July 2011 to March 2017. METHODOLOGY: SCI patients having age up to 15 years, admitted to Paraplegic Centre, were inducted in 2017. Exclusion criteria was foreign-national SCI patients, and/or SCI patients re-admitted to paraplegic centre. List of all SCI patients admitted to the centre was retrieved and 102 patients were identified. Data of these patients was evaluated for demographic information, physiological intactness (complete SCI/incomplete SCI), neurological level and complications. RESULTS: A total of 102 patients (66 males and 36 females) with mean age 10.9 ±3.7 years were included in this study. Firearm injury was the most common cause (n=39, 38.2%) of SCI in these patients, followed by fall from height (n=23, 22.5%), road traffic accidents (n=14, 13.7%), and weight fallen over (n=14, 13.7%). Bomb blast injury (n=7, 6.9%), diving accident (n=3, 2.9%), and sports related injuries (n=2, 2.0%). Majority of the patients (n=82, 80.4%) had complete SCI (ASIA A); the commonest SCI level was thoracic region (n=59, 57.8%) and the least reported region was (n=14, 13.7%) cervical. Out of the total, 50 (49.0%) patients had pressure ulcer in which 15 (30.0%) patients were having grade IV pressure ulcer, 9 (18.0%), 15 (30.0%) and 11 (22.0%) patients were had grade I, grade II and grade III pressure ulcer, respectively. CONCLUSION: Majority of causes of SCI in children are similar to those reported in adult population. However, the commonest causes of SCI in children in Pakistan were firearm injury and bomb blast, which are rarely reported in other countries. Like adult population, these children with SCI are prone to developing pressure ulcer.

Consequences of traumatic spinal cord injury during pregnancy in Pakistan.

INTRODUCTION: Traumatic spinal cord injury (SCI) is one of the major causes for poor outcomes of pregnancy. Injury during pregnancy is uncommon; therefore, outcome data are scarce. This case series presents outcomes of pregnancy in five women who sustained SCI during their pregnancies. CASE PRESENTATION: Five women who sustained SCIs during pregnancy (age range: 24-38 years) were identified and included in this case series. The causes of SCI in this population were fall from heights (cases 1 and 2), road traffic accidents (cases 3 and 4) and firearm injury (case 5). Two of the females were managed conservatively (cases 1 and 5) and the rest underwent surgical procedures for fixing their spine. Out of these patients, four patients delivered normal healthy babies, while the baby of one patient died within 1 hour after delivery. DISCUSSION: Limited data about the outcomes of pregnancy in women who sustained SCIs during pregnancy are available in the literature. The outcomes of pregnancy in women who sustained SCIs during the first trimester are not satisfactory, and special attention may be needed to improve the expected outcomes. Data from our study show similar findings to developed countries.