Day 1 , Saturday , 14th July 2018; 08.15-08.

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SPINAL CORD INJURY REHABILITATION:

OPTIMIZING QUALITY OF LIFE

Apichana Kovindha, MD, FRCPhysiatrT

Department of Rehab Med
Faculty of Medicine, Chiang Mai University, Thailand
Rehabilitation optimizes QoL of
patients with SCI

DO YOU BELIEVE THAT

Rehabilitation physicians
Physiatrists are …
doctors who bring quality to life.
 Aspirations: Accomplishments:
wishes, desires, possessions, statuses,
goals, plans, etc. roles, etc.

is defined as the congruence between

QOL
(WELL-BEING)
What are your aims/wishes?

People in general Patients with SCI

 Having a good education  Being treated properly by
 Becoming a professional skilled medical
professional team
 Getting good job/career
 Alive
 Having freedom to do
 Back to normal health
 Being rich and famous
 Back to work/school
 Having a happy family
 Back to family
 Happiness
 Resuming normal life,
 Good health
normal role
 Sufficient life
Aims/needs and expectations

 Being treated properly

by skilled medical
professional team
 Alive  How could we (rehab
physicians/physiatrist)
 Back to normal
do to MAKE THEM
 Back to work/school achieve these?
 Back to family
 Resuming normal life,
normal role
 As early as possible
 The sooner, the better
 Start from the acute phase
 Multi-/inter-/trans-disciplinary team approach

REHABILITATION PROCESS
 Not only surgeons and nurses but also a medical
rehab team who take care them and ready to help.
 Make them know that they are in good hand.
 Not hopeless, not helpless
 First, to survive and pass the critical period together

ACUTE PHASE
 Provisional diagnosis
 Goals: short-term
 Plan of management e.g. surgery, medical
treatment, rehab therapy etc.

 Prognosis?

ADEQUATE MEDICAL INFORMATION

 Correct the cause e.g. stabilizing the spine
 Promote neural recovery and prevent secondary
cord ischemia with adequate oxygenation
 Actively exercise all necessary and functional
muscles

PHYSICAL HEALTH
IMPROVING BODY FUNCTIONS
Mind controls body.

Do not destroy hope.

Accept the truth.
Choose an appropriate coping strategy
Reduce worries of both patients and families
Probe social impact and find out how to help them

PSYCHOLOGICAL HEALTH
“Reflecting an individual’s overall perception of and
satisfaction with how things are in their life.”
Wood-Dauphinée et al 2002

“An individual’s perception of his/her position in life in

the context of the culture and value systems in which
he/she lives, and in relation to his/her goals,
expectations, standards and concerns.
WHO 1995

QUALITY OF LIFE
If we provide our best management to them,
although neurological recovery is less than
expected, one perceives that one has had best
management.
Loss of body functions

Loss of ability to do
 self-care activities
 general tasks in daily life
 walk
 work
 do enjoy life as before
 Loss independency
 Loss of freedom
 Loss of career
 No future?

IMPACT OF SCI ON LIFE IS HUGE.

Medical conditions are stable.
 More expectation: mid-term, long-term goals

 Rehabilitation process improves functions, reduces

impairments and disability, makes one be able again.
 Principles of rehab therapy: exercises, compensatory
techniques, and adaptation of environment

POST-ACUTE PHASE
 Improvement do happen.
 But not normal.
 How to make one accept imperfect outcomes?

YOU DO NOT NEED TO HAVE 100%

BUT USE 100% OF WHAT YOU HAVE
Tomorrow is better than today.

 Keep training
 Training can be at any place
 With adapted environment, one can improve
functions and capability.
 Assistive technology makes life easy. Use it.

CHRONIC PHASE
 Poor physical health – paralysis, complications
 Limitations in mobility, self-care, social activity
 Feeling of difficulty
 Negative affect: anger, despair, impaired
cognition

POOR QOL
AMONG INDIVIDUALS WITH SCI
 Locus of control – internal not external
 Sense of coherence
 Self-worth
 Self-efficacy
 Hope
 Purpose of life
 Positive affect: joy, excitement, vigour

GOOD/HIGH QOL RELATES WITH…

Changing from
‘not know’ to ‘know’
‘cannot’ to ‘can’

Patient education and training

Restoring functions to life.

REHABILITATION IS LIKE SCHOOLING

At school Rehabilitation program
Teach Train
 Knowledge  Knowledge: disease/injury,
 Skills consequences, complication
 Skills: how to management;
how to look after one’s health
 Attitude – good
person for family,
community, country,  Attitude – POSITIVE
world TOWARDS DISABILITY AND
ABILITY
YES, I DO.

DO YOU BELIEVE THAT

“REHABILITATION” CAN BRING
“QOL” TO SCI PERSONS?