Problems of adaptation to wheelchair in early stage rehabilitation after spinal cord trauma.
Spinal cord trauma (SCT) results local and generalized complications involving cardio-respiratory system, musculo-skeletal system, digestive and urogenital tracts. Early beginning of vertical position training improves functioning and reduces risk of these complications. Wheelchair position is an important achievement in early rehabilitation of (SCT) patients. Sitting allows locomotion, enhances upper limb function and contributes to obivate complications of chronic decubity and immobilisation.


OBJECTIVE
To determine main obstacles delaying adaptation to sitting during initial phase of rehabilitation after SCT.


METHODS
100 patients admitted with SCT (21 women, 79 men)aged between 15 and 74 years (mean age 33,5 years) observed during first hospital stay after SCT. There were 68 patients with a complete neural deficite and 32 persons with incomplete deficite. Lesion localization: C1-C7 - 63 cases; D1-D11 - 23 cases; D12-L1 - 11 cases; below L1 - 3 cases.


METHODS
Measurement of time relapsing between trauma and wheelchair adaptation. An analysis of reasons adaptation delay was performed.
Time of adaptation ranged from 7 to 187 (mean 40,6) days. There were no significant differences in adaption time between groups of cervical, thoracic and lumbar spine injury (Kruskall-Wallis test). Patients with incomplete neural deficite adapted to wheelchair earlier (mean time 26,9 days) than ones with plegia (mean time 45,8 days) (p<0,05) The most common reason for adaptation delay was orthostatic hypotension (68 cases). Statistically significant relation between length of intensive care related to cardio-pulmonary insufficiency and adaptation delay was observed (p=0). Among other factors responsible for adaptation delay we identified sepsis (41 cases, mean adaptation time: 52,02 days, p<0,001), lack of stabile spine fusionresulting in necessity of external trunk support , concomittant extremity injury (32 cases, mean adaptation time: 54,88 days, p<0,01), deep venous thrombosis (11 cases, mean adaptation time: 49,64 days, p<0,05), bed sores (8 cases, mean adaptation time: 49,64 days, p<0,05), psychiatic disorders (7 cases, mean adaptation time: 58,29 days, p<0,05) and heterogenic ossification (7 cases, mean adaptation time: 63,67 days, p<0,05).


CONCLUSIONS
1. Orthostatic hypotension is the most common reason for delay of adaptation to sitting position in patient after SCT. 2. Other factors resulting in wheelchair adaptation delay incude: concomittant limb inuries, sepsis, psychiatric disorders, heterotopic ossification and decubitus ulcers. 3. Level of injury sex and age do not affect time of wheelchair adaptation. 4. Patients with an incomplete neural have adapt faster to wheelchair than ones with a complete neural deficite.
Tederko
Piotr
P
Klinika Rehabilitacji Akademii Medycznej , Oddział II Rehabilitacji Schorzeń Narzadu Ruchu Centrum Rehabilitacji STOCER.
Limanowska
Halina
H
Krasuski
Marek
M
Kiwerski
Jerzy
J