Factors determining health awareness in persons after spinal injury with neurological complications. Pilot study.

BACKGROUND: Dedicated health education is a core intervention in comprehensive rehabilitation programmes. Health awareness of those disabled as a result of a spinal injury with neurological complications (SINC) has rarely been the subject of scientific analyses despite its importance for designing dedicated educational programs. PURPOSE: To evaluate factors determining the health awareness of persons after SINC. MATERIAL AND METHODS: 133 SINC patients (32 women) between 0.5 and 31 years after injury. An ad hoc questionnaire designed by the authors consisting of 150 detailed questions about the diagnosis, prophylaxis and management of typical health consequences of SINC. RESULTS: The mean test score (TS) was 56.6 points. TS correlated inversely with age in a statistically significant manner (correlation coefficient (CC) = -0.31). TS increased with the time elapsed since injury, with distinct increments at 1 year and 10 years after the event. Significantly higher TSs were noted in persons with university (64.6) and secondary education (65.7) compared with the rest of the group (37.9). Those unable to walk but able to use the wheelchair for independent locomotion had a higher TS (59.7) compared to wheelchair-bound persons unable to drive the wheelchair (47.5) and to persons with preserved walking ability (46.2). Significantly higher scores were achieved by inhabitants of towns above 100,000 population, those employed, members of an association for disabled persons, and respondents capable of independent self-care. There was an inverse correlation between TS and Beck's depression score (CC=-0.36). TS did not depend on gender. Interaction with other persons with SINC is perceived as the most important source of health related knowledge. CONCLUSIONS: Predictors of better health awareness in SINC persons include a young age, at least secondary education, more than 10 years since injury, participation in community rehabilitation organised by an association of persons with disability, being employed, being unable to walk, effective self-care, and absence of depression.

Problems of adaptation to wheelchair in early stage rehabilitation after spinal cord trauma.

Spinal cord trauma (SCT) results local and generalized complications involving cardio-respiratory system, musculo-skeletal system, digestive and urogenital tracts. Early beginning of vertical position training improves functioning and reduces risk of these complications. Wheelchair position is an important achievement in early rehabilitation of (SCT) patients. Sitting allows locomotion, enhances upper limb function and contributes to obivate complications of chronic decubity and immobilisation. OBJECTIVE: To determine main obstacles delaying adaptation to sitting during initial phase of rehabilitation after SCT. SUBJECTS: 100 patients admitted with SCT (21 women, 79 men)aged between 15 and 74 years (mean age 33,5 years) observed during first hospital stay after SCT. There were 68 patients with a complete neural deficite and 32 persons with incomplete deficite. Lesion localization: C1-C7 - 63 cases; D1-D11 - 23 cases; D12-L1 - 11 cases; below L1 - 3 cases. METHODS: Measurement of time relapsing between trauma and wheelchair adaptation. An analysis of reasons adaptation delay was performed. RESULTS AND DICUSSION: Time of adaptation ranged from 7 to 187 (mean 40,6) days. There were no significant differences in adaption time between groups of cervical, thoracic and lumbar spine injury (Kruskall-Wallis test). Patients with incomplete neural deficite adapted to wheelchair earlier (mean time 26,9 days) than ones with plegia (mean time 45,8 days) (p<0,05) The most common reason for adaptation delay was orthostatic hypotension (68 cases). Statistically significant relation between length of intensive care related to cardio-pulmonary insufficiency and adaptation delay was observed (p=0). Among other factors responsible for adaptation delay we identified sepsis (41 cases, mean adaptation time: 52,02 days, p<0,001), lack of stabile spine fusionresulting in necessity of external trunk support , concomittant extremity injury (32 cases, mean adaptation time: 54,88 days, p<0,01), deep venous thrombosis (11 cases, mean adaptation time: 49,64 days, p<0,05), bed sores (8 cases, mean adaptation time: 49,64 days, p<0,05), psychiatic disorders (7 cases, mean adaptation time: 58,29 days, p<0,05) and heterogenic ossification (7 cases, mean adaptation time: 63,67 days, p<0,05). CONCLUSIONS: 1. Orthostatic hypotension is the most common reason for delay of adaptation to sitting position in patient after SCT. 2. Other factors resulting in wheelchair adaptation delay incude: concomittant limb inuries, sepsis, psychiatric disorders, heterotopic ossification and decubitus ulcers. 3. Level of injury sex and age do not affect time of wheelchair adaptation. 4. Patients with an incomplete neural have adapt faster to wheelchair than ones with a complete neural deficite.