The Effects of Rehabilitation Programs on Spinal Cord Injury

Patients at Dr. Soetomo General Hospital

Agustina Mufidah, Martha Kurnia Kusumawardani

Department of Physical Medicine and Rehabilitation, Dr. Soetomo General Hospital, Faculty of Medicine, University of

Airlangga, Surabaya, Indonesia

Keywords: SCI, Rehabilitation, Barthel Index, Discharge Condition

Abstract: Acute medical management of people with SCI focuses on minimising further neurological damage to the

spinal cord and optimising recovery. Dr Soetomo Hospital Surabaya as a referral center in eastern

Indonesia often gets referral of patients with spinal cord injury severely cases. This research is a descriptive

study. Sample of study were all inpatients who were consulted at the medical rehabilitation, from January

2018 until Desember 2018. All patients received rehabilitation programs while in care (± 17,73 days). Level

of injury severity of SCI (AIS criteria),changes barthel index (BI) and discharge condition were investigated.

Therewere 1264 inpatients, 166 patients(13,13%) were SCI patients who were consulted at the department

of medical rehabilitation. The most cases are caused by tumor 31,32 %, AIS A 37,95%, location of injury

at thoracal region 51,20 %. Complications were bladder disturbance at 77 patients, bowel disturbance 74

patients, and ulcus decubitus there were 31 patients, home return rate 68,07% , death 19,28%, and discharge

against medical advice 12,6%. From Neurology ward that received rehabilation programs 68,57%

increased Barthel index. Management SCI patients with multidisciplinary teams between neurologi,

surgery and rehabilitation department at Dr. Soetomo Hospital can increased barthel index and home

return rate.

1 INTRODUCTION

The incidence of Spinal Cord Injury (SCI) in

various countries is quite high every year. With the

expansion of human activities, the incidence of SCI

also increased gradually. The incidence varied from

13.019 per million to 163.420 per million people.

Among them, the incidence rates of developed

countries ranged from 13.121 to 163.420 per million

people. The rates of non developed countries varied

from 13.019 to 220.022 per million people

. The

epidemiology in different regions is of significant

difference, which may be resulted from economic,

science and technology, medical, geographical and

even social conditions (Kang Y et al, 2018).

The most obvious consequence of spinal cord

injury (SCI) is paralysis. However, SCI also has

widespread consequences for many body functions,

including bladder, bowel, respiratory, cardiovascular

and sexual function. It also has social, financial and

psychological implications, and increases people’s

susceptibility to late-life renal complications as well

as musculoskeletal injuries, pain, osteoporosis and

other problems. Acute medical management of

people with SCI focuses on minimizing further

neurological damage to the spinal cord and

optimizing recovery. Stability of the spine is

clearly a priority

. Physiotherapy is predominantly

focused on treating respiratory complications and

preventing secondary musculoskeletal problems

related to prolonged bed rest (Lisa, 2016).

In Indonesia, several hospitals have SCI-related

treatments in intensive care, surgery, and

anesthesiology. Rehabilitation services for people

with SCI are provided by well-trained health

professionals such as physiatrists, nurses, and allied

health professionals (Angela et al,2017).

Dr Soetomo Hospital Surabaya as a referral

center in eastern Indonesia often gets referral of

patients with severe cases of spinal cord injury.

Team collaboration is needed in dealing with SCI

patients. The neurological and surgery department

often consults SCI patients to the rehabilitation

department to help improve quality of life and

Muﬁdah, A. and Kusumawardani, M.

The Effects of Rehabilitation Programs on Spinal Cord Injury Patients at Dr. Soetomo General Hospital.

DOI: 10.5220/0009088502270230

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 227-230

ISBN: 978-989-758-409-1

227

prevent SCI complications. The aim of this study to

know that effects of rehabilitation programs to

increase the barthel index (increase functional

outcome) and to know about discharge condition.

2 METHODS

This research is a descriptive study. Sample of study

were all inpatients who were consulted at the

medical rehabilitation. The data were obtained

through Chat Round reports (Weekly inpatient

reports from the surgical and neurological ward)

from January 2018 until December 2018.

2.1 Intervention

SCI patients were on average consulted in the

rehabilitation department in the acute period.

Patients get medication, surgery according to the

indication and rehabilitation programs according to

their severity. Rehabilitation programs pre and post

surgery include : proper positioning to prevent

complications from prolonged immobilization such

as decubitus and prevent the severity of the disease,

rehabilitation for respiratory functions, ROM

exercise, complication management such as bladder

and bowel management, and prescription orthosis

that adapted to the level of injury .

In this study will be noted about the level of

spinal cord injury, American Spinal Injury

Association Impairment Scale (AIS) classification,

causes of SCI, Barthel index before and after

getting a rehabilitation programs and discharge

condition were investigated.

Table 1: Baseline characteristics

Variable Frequency (n/%) Variable

Frequency (n/%)

Sex

Male 119 71,68%

Level of

injury

Cervical 63 37,95%

Female 47 28,31% Thoracal 85 51,20%

Age

0-10

lumbal 18 10,84%

11-20

Tumor 52 31,32%

21-30

Accident 33 19,88%

31-40

Trauma 50 30,12%

41-50

Spondylitis TB 26 15,66%

51-60

Canal stenosis 1 0,6%

61-70

Transverse myelitis 1 0,6%

71-80

unknown 3 1,8%

Compli-

cation

Bladder

disturbance

AIS

A 63 37,95%

Bowel

disturbance

74 B 42 25,30 %

Ulcus

decubitus

C 30 18,07 %

D 28 16,86%

E 3 1,8%

TB : tuberculosis, AIS : American Spinal Injury Association Impairment Scale

3 RESULTS

Based on the data, there were 1264 inpatients from

the department of neurology and surgery, of which

166 patients (13,13%) were SCI patients who were

consulted at the department of medical

rehabilitation. The numbers of males were always

more than the number of females among 3 : 1, the

age of the patients 2 - 77 years old, with the most

age in productive age 31-40 years old, most cases of

SCI are caused by tumor 31,32 %, most level of SCI

are AIS A 37,95% , and most location of injury at

thoracal region 51,20 %. Complications at SCI

patients were bladder disturbance at 77 patients,

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

228

bowel disturbance 74 patients, and ulcus decubitus

there were 31 patients (Table 1).

Barthel index before the rehabilitation program

tended to be low with an average of 22,07 and after

the rehabilitation program experienced a shift to

increase by an average 40.07 (figure 1). Discharge

condition from surgery and neurological ward are

home return rate 68,07% with wheelchair

ambulation status , death 19,28%, and discharge

against medical advice 12,6% (figure 2).

Patients SCI on everage undergo rehabilitation

program for 17,73 days. There were 53 patients from

the neurological ward that returned home 35

patients and 18 patients died. From the 35 patients

who returned home, 24 patients (68,57%)

underwent a complete rehabilitation program and

showed increase of barthel index. The other 11

patients (31,43%) who returned forcibly (not

medical advice) and did not attend the rehabilitation

program completely showed no increase of barthel

index (figure 3). In this study we didn’t analyze for

the significancy the barthel index increasing.

Figure 1: A. Barthel index. B. Discharge Condition.

Figure 2: A. Outcome 53 SCI patients from neurological ward. B. Functional status from SCI patients that return home. BI :

Barthel index

A

returnhome death

IncreaseBI

FixedBI

The Effects of Rehabilitation Programs on Spinal Cord Injury Patients at Dr. Soetomo General Hospital

229

4 DISCUSSIONS

Patients with SCI have many problems in the

society. They have problems with accessibility to

travel from home to the outpatient care in assigned

hospitals because of lack of facility, money,

functional status that depends on others or caregiver

(Angela et al, 2017).

Early rehabilitation is important to prevent

secondary complication, and to improve functional

outcome with independent activities in daily living.

Functional outcome can evaluate with barthel index

(Kemal et al, 2015 and Michael et al, 2017).

Dr Soetomo Hospital as a referral hospital in

eastern Indonesia has a multidisciplinary

management team which includes: neurological,

surgical, and rehabilitation. SCI patients receive

treatment, surgery as indicated and an early

rehabilitation program before and after surgery. The

patients who participated in the complete

rehabilitation program during the treatment, their

barthel index were increased compared with patients

who discharge against medical advice that did not

carry out a complete rehabilitation program, their

barthel index tends to stay. Most SCI patients treated

can return to their homes in wheelchair ambulation

status.

The limitation of this study is the incomplete

chatround report, there are not report barthel index

from surgical ward. There are no specific data for

the increased barthel index items. For the future the

chat round report must be make by same format

between surgical and neurological division, it can be

easy to make a report.

5 CONCLUSIONS

Management SCI patients is therefore complex,

involving many healthcare professional. Dr.

Soetomo hospital as a referral center have

multidicipliner team for threatening SCI patiens.

Dr.Soetomo Hospital often gets severe SCI

patients, patients with rehabilitation programs

completely can increased the barthel index

compared with patients who discharge against

medical advice that didn’t carry out a complete

rehabilitation programs.

 Most SCI patients treated

can return to their homes in wheelchair ambulation

status.

REFERENCES

Angela Bibiana Maria Tulaar, MD, PhD, Muhammad

Karyana, MD, MPH, Luh Karunia Wahyuni, MD,

Anitta Florence Stans Paulus,MD,Damayanti

Tinduh,MD, Fitri Anestherita,MD, and Grace

Wangge,MD,MSc, PhD, 2017. People with Spinal

Cord Injury in Indonesia, Physical Medicine and

Rehabilitation Association (PERDOSRI), Pulo

Gadung National Institute of Health, Research and

Development, Ministry of Health Indonesia, Johar

Baru (MK); and Department of Community Medicine,

University of Indonesia, Menteng (GW), Jakarta,

Indonesia.

Kang Y, Ding H, Zhou HX, Wei ZJ, Liu L, Pan DY, Feng

SQ, 2018. Epidemiology of worldwide spinal cord

injury: a literature review,

Kemal Nas, Levent Yazmalar, Volkan Şah, Abdulkadir

Aydın, Kadriye Önes, 2015. Rehabilitation of spinal

cord injuries, Department of Physical Medicine and

Rehabilitation, School of Medicine, Sakarya

University, Korucuk, Sakarya, Dicle University,

Erzincan University Mengucek Gazi Training and

Research Hospital, Turkey

Lisa A Harvey, 2016. Physiotherapy rehabilitation for

people with spinal cord injuries, John Walsh Centre

for Rehabilitation Research, Kolling Institute, Sydney

Medical School/Northern, University of Sydney,

Australia

Michael G. Fehlings,MD,PhD, FRCSC, FACS, Lindsay

A. Tetreault, PhD, Jefferson R. Wilson, MD, PhD,

Brian K. Kwon, MD, PhD5, Anthony S. Burns, MD,

PhD, Allan R. Martin, MD, Gregory Hawryluk, MD,

PhD, and James S. Harrop, MD, 2017. A Clinical

Practice Guideline for the Management of Acute

Spinal Cord Injury: Introduction, Rationale, and

Scope, Toronto Western Hospital, University Health

Network, Canada.

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Medicine and Rehabilitation Association

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