Management of Spinal Cord Injury in Low Resource Settings

Introduction

Spinal cord injury (SCI) is a devastating condition which is associated with permanent disability and decreased life expectancy. Although more than 80% of the world's population live in more than 100 developing countries and as a consequence of poverty, many people with spinal cord injury (SCI) are likely to live with limited access to appropriate health care and rehabilitation services creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. People with spinal cord injury (SCI) in low income countries face serious challenges in their daily lives as a result of  lack of appropriate wheelchairs and services, limited knowledge about SCI among health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges.  Low and middle-income countries (LMICs) are often also described as "low resourced settings" or simply LMICs.

Epidermiology/Etiology

The incidence of SCI in developing countries is 25.5/million/year and ranges from 2.1 to 130.7/million/year. Males comprised 82.8% of all SCIs. The two leading causes of SCI were found to be motor vehicle crashes and falls. Complete SCIs were found to be more common than incomplete injuries. Similarly, paraplegia was found to be more common than tetraplegia. the life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries

1. Traumatic spinal cord injury-Traumatic SCI can result from several different mechanisms, e.g. road traffic crashes, falls, violence,w hile undertaking different activities, e.g. at work, during sport or while at home.
2. Non-traumatic spinal cord injury-non-traumatic causes of spinal cord dysfunction include:

• communicable
• diseases − tuberculosis (TB) and human immunodeficiency virus (HIV);

• noncommunicable conditions − cancer, degenerative diseases such as osteoarthritis leading to spinal stenosis, cardiovascular disease;

• nutritional deficiencies – neural tube defects, vitamin B12 deficiency;

• complications of medical care.

Management of spinal cord injury

spinal cord injury clinical guideline

community based rehabilitation

In low-income countries and particularly in rural areas, the range of rehabilitation services available and accessible is often limited. There may only be one rehabilitation centre in the major city of a country, for example, or therapists may be available only in hospitals or large clinics. Therefore community-based strategies such as CBR are essential to link and provide people with disabilities and their families with rehabilitation services.