Hanapi Nor Hanim Mohamad, Zainin Ehsan Syukri, Aziz Mohd Harith Abdul, Darus Daryani
Department of Rehabilitation Medicine, Hospital Raja Perempuan Zainab II, 15586 Kota Bharu, Kelantan Malaysia.
Spinal Cord Ser Cases. 2019 Jan 28;5:10. doi: 10.1038/s41394-019-0154-3. eCollection 2019.
Managing neglected spinal cord injury (SCI) patients in a rural setting can be challenging due to a lack of resources and the unique personal and environmental contextual factors that may hinder rehabilitation. This article aims to identify the contextual factors and their impact on successful rehabilitation.
A middle-aged man from a rural area had suffered a neglected traumatic SCI and was first seen by the rehabilitation team 17 years post injury. He had a T7 AIS A paraplegia and was bedridden with multiple secondary complications. He was admitted with goals of optimizing his health, initiating basic spinal rehabilitation and improving his functional status. By 1 month, the patient made gradual improvement of his mobility and ADL but requested discharge despite not having achieved his rehab goals. We identified the factors that contributed to his poor motivation to be more functionally independent. Personal factors include poor educational level, his background personality and erratic health-seeking behaviour. Environmental factors included poor family and financial support, physical barriers, lack of work opportunities and facilities for people with disability, poor community support and acceptance and poor healthcare facilities and expertise.
The patient's personal and environmental factors affected the delivery of SCI management, spinal rehabilitation and management of secondary comorbidities. Awareness of early spinal rehabilitation among the rural community and healthcare authorities is crucial to promote better implementation of policies, services or programs to support people with SCI.
由于资源匮乏以及可能阻碍康复的独特个人和环境背景因素，在农村地区管理被忽视的脊髓损伤（SCI）患者具有挑战性。本文旨在确定背景因素及其对成功康复的影响。
一名来自农村地区的中年男子遭受了被忽视的创伤性脊髓损伤，受伤17年后首次被康复团队接诊。他患有T7 AIS A级截瘫，卧床不起并伴有多种并发症。他入院的目标是优化健康状况、启动基本的脊髓康复并改善功能状态。到第1个月时，患者的活动能力和日常生活活动能力逐渐改善，但尽管尚未实现康复目标，他仍要求出院。我们确定了导致他缺乏提高功能独立性动力的因素。个人因素包括教育水平低、个人背景性格以及不稳定的求医行为。环境因素包括家庭和经济支持不足、身体障碍、缺乏残疾人工作机会和设施、社区支持和接纳度低以及医疗设施和专业知识匮乏。
患者的个人和环境因素影响了脊髓损伤的管理、脊髓康复以及并发症的管理。农村社区和卫生当局对早期脊髓康复的认识对于促进更好地实施支持脊髓损伤患者的政策、服务或项目至关重要。
