Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research.

STUDY DESIGN: Narrative literature review. OBJECTIVES: To (1) summarize epidemiological and scientific research on spinal cord injury (SCI) populations from three severe earthquakes (EQs) in rehabilitation resource-scarce settings; (2) summarize SCI rehabilitation services by local and foreign providers in response to these EQs and (3) provide implications including research gaps for a supporting global scientific research agenda. SETTING: International. METHODS: A literature review was conducted using PubMed to identify epidemiological studies reporting data on SCI survivors of the 2005 Kashmir EQ in Pakistan, the Sichuan EQ of 2008 in China and the 2010 Haiti EQ. A follow-up review on the SCI rehabilitation services provided by local and foreign providers in response to these EQs was also performed. RESULTS: Review of the scientific literature revealed the qualitative trends in focused EQ victim epidemiological data, including SCI classification and types of medical complications. Selected EQ country narratives showed that post-disaster SCI rehabilitation services were expanded by adapting local resources with international assistance to manage the significant numbers of SCI survivors. The resulting SCI research was limited. CONCLUSION: A global disaster research agenda for SCI in EQs in rehabilitation resource-scarce settings is needed to strengthen the evidence base for improvement of clinical management and outcomes for SCI EQ survivors. Expansion of this limited narrative review into a systematic review to identify additional research gaps is a proposed next step. Effective disaster setting data management and research collaborations of foreign and local SCI disability and rehabilitation stakeholders will be required for agenda implementation.

Suicide bombing as an unusual cause of spinal cord injury: a case series from Pakistan.

STUDY DESIGN: Descriptive case series. OBJECTIVES: Describe the unusual etiology and pattern of spinal cord injury due to terrorist suicide bombings in Pakistan. SETTINGS: Spinal Rehabilitation Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. METHODS: Hundreds of suicide attacks on civil and military forces have occurred over the last 6 years in Pakistan. These have resulted in thousands of death and many more injured. Six victims of terrorist suicide bombings were admitted over the years 2006 to 2009, who had a spinal cord injury (SCI). This is the first case series of SCI, secondary to terrorist suicide blast. RESULTS: All patients were males. The mean age was 30±11 years. Most (five) were injured directly due to splinters from the blast. On admission to rehabilitation, all patients had thoracic complete paraplegia and their SCI was managed conservatively for their spinal injuries. Associated injuries included intestinal perforations, fracture metatarsals, humerus and brachial plexus injury. Pressure ulcer was the commonest complication (3 patients). Two patients had neurological improvement at 1-year follow-up. CONCLUSION: Suicide bombing is an effective weapon of terrorists in the modern world of today. The resulting injuries can be diverse and devastating. Spinal cord injury is an uncommon sequel of suicide bombing, which should be kept in mind while dealing with victims of suicide bombing.

How do patients with chronic spinal injury in Pakistan manage their bowels? A cross-sectional survey of 50 patients.

STUDY DESIGN: A cross-sectional survey. OBJECTIVES: To document bowel care practices of chronic spinal cord injury (SCI) patients in Pakistan. SETTINGS: Outpatient Department, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. METHODS: A total of 50 adult patients (18-65 years) with SCI of duration >12 months were sampled by convenience sampling. Medical record was reviewed, detailed neurological examination was performed and face-to-face semistructured interviews were conducted. Data were collected and analysed using SPSS v10. Frequencies and descriptive statistics were calculated for the various variables. RESULTS: Most of the patients (29) were males. The mean age was 33±11 years. Majority of the patients (76%) had thoracic-level injury. In all, 43 patients gave a history of occasional or regular faecal incontinence. In addition, 17 patients reported the regular use of laxatives whereas 22 used bulk-forming agents on a regular basis. Majority of the patients (56%) had at least one bowel evacuation daily. In addition, 31 patients required 16-30 min to complete the bowel evacuation. Approximately half (54%) required assistance in bowel evacuation. CONCLUSION: A large number of patients with chronic SCI in Pakistan had faecal incontinence. A majority of patients used methods such as suppositories, laxatives and bulk-forming agents to control the frequency and duration of the bowel programme. Adherence to standard bowel care programme and practices are influenced by sociocultural factors and lack of education on the part of the patients.