Case Study - Spinal Cord Injury in Disasters and Conflicts

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Rucha Gadgil and Olajumoke Ogunleye      

Title

T12 - L1 Spinal Cord Injury following 2015 Nepalese Earthquake

Thanks to Humanity and Inclusion for Case Study taken from Early Rehabilitation in Conflicts and Disasters.

Abstract

A 27-year-old male admitted to a Spinal Injury Rehabilitation Centre 3-weeks after sustaining a T12-L1 Spinal Cord Injury managed surgically following Nepal Earthquake.

Key Words 

Spinal Cord Injury, Earthquake, T12-L1 Fracture, Rehabilitation

Patient Characteristics

Past Medical History

A 27-year-old male sustained a spinal cord injury caused during the 2015 Nepal Earthquake. He was admitted to the Spinal Injury Rehabilitation Centre three weeks later, after being referred from another hospital with a diagnosis of T12 – L1 fracture that had been surgically managed. He was discharged five months post-injury.

Examination Findings

Observation

On Admission: Bedridden, Foleys Catheter, Irregular bowel habit and totally dependent with activities of daily living. All vital signs were stable.

Medical Management

• Pain Management
• Wound Management (Multiple Soft-tissue Injury).

Nursing Management

• Bladder and Bowel Management
• Education on Intermittent Catheterisation, Personal Care, Bowel Routine, Prevention of Complications, Pressure Injury and Urinary Tract Infection.

Physiotherapy Management

Range of Movement: Passive ROM exercises of bilateral lower limbs, active ROM exercises of bilateral upper limbs.

Strength: Strengthening of upper back and upper limbs.

Mobility (Room and Toilet): Independent in bed mobility and pressure relief techniques, transfers from bed to wheelchair independently.

Wheelchair Skills: Basic and advanced, balance training ongoing in static and dynamic settings.

Education: DVT and its prevention, education to caregiver and patient on ROM exercises and bedside positioning.

Occupational Therapy Management

• Independent in most activities of daily living, including feeding, upper and lower body dressing (in chair), upper and lower body bathing and grooming, toilet transfer and use of toilet, all level transfer, basic and advanced wheelchair skills.
• Educated about and accomplished home modification, initiated a return to work and leisure activities (artist) and has regained his previously role in his family and community.
• Psychological: Realisation counselling on expected functional outcomes, deep relaxation therapy, individual/group session on safe reintegration to community, group education on sexuality and fertility after a spinal cord injury, education on disability rights, encouraged to participate actively all rehabilitation activities, including music therapy and yoga.
• Wheelchair Service Department provided a Motivation three-wheeler wheelchair.

Functional Outcome Measure:

AIS

• On Admission: T12 AIS- A;
• On Discharge: T12 AIS –A

SCIM

• On Admission: 10
• On Discharge: 69

Community Reintegration

• Has been working as a Peer Counsellor at SIRC since 2016.
• Active role model to newly injured people with a Spinal Cord Injury
• An excellent artist.

Resources

Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion