01 anghelescu icf-dh conceptual approach

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ICF-DH CONCEPTUAL APPROACH OF THE COMPLEX MEDICAL AND PSYCHO-SOCIAL PROBLEMS ENCOUNTERED AT HOME AND IN THE COMMUNITY; THE Q of L OF PERSONS WITH SCI SEQUELS ANGHELESCU A. GELU ONOSE MARINESCU F.L. CARMEN CHIPĂRUŞ LAPADA T MAGDA MIHĂILES CU CEZARA ANCA S. MIHĂESCU DOINA GEORGESCU VIRGINIA ROTĂRESCU ABSTRACT In our project we reviewed 660 patients with chronic spinal cord injury by the questionnaire technique. Most of the patients in- terviewed have a good accessibility to the medical services, but one third of them had a tiny medical supervision. Main medical complications at home were pressure sores, recurrent urinary infections and incontinence.After discharge, half of the patients had continued the therapy program but only 18% managed to walk independently. Only 13% of the patients managed to make minor adaptations at home and ambient. Scholar (14%) and professional reintegration (12,6%) scored low. Key-words: SCI, tetraplegia, paraplegia, comprehensive rehabilitation, medical complications, B-ADL, I-ADL,ICF-DH, ISCoS, ROSCoS INTRODUCTION Spinal cord injury (SCI) represents one of the most severe medical situations, occurring most frequently in young adults. SCI refers to the impairment or loss of motor, sensory and/or bladder, bowel functions in the cervical, thoracic, lumbar or sacral segments of the spinal cord, secondary to the traumatic damage of the neural elements within the spinal canal. Survivors of initial injury can now expect to live longer because of the improvements in medical care (g. 1) [1]. Lifelong disability places an important burden on these individuals, their families and society. Long-term functional outcome after SCI depend on neurological recovery, medical interventions, rehabilitation and community reintegration. The attitude towards the person with special needs (with handicap) had known historical, political, lawful, ethical – in a progressive or regressive contextual evolution. The SCI sequel patients represent a vulnerable social group, predis- posed to: poverty, stigmatization, lack of affectivity from the family, relatives, friends, despondency, toxicophily, insti- tutional discrimination, personal and professional prejudice, loneliness, isolation and exclusion from community (fre- quently). Often the ex-patients have limited access to the basal social services, education, professional improvement, (protected) work place [2] – [6]. The major problems (still present in our country) confronting SCI persons, are: the architectonic barriers in personal house (apartment in block of ats/ country house); the lack of access facilities in public buildings and transport; the difculties in accessing information; the lack of assistive appliances and services; the reactive depression, low level of self-perception and hyper-protective families; the imperfection of the legislative frame; the indolence / unconcernment of the political class. The standardized assessment measures of the International Classication of Functioning, Disability and Health (ICF- DH) developed by the World Health Assembly, offers for clinical practice a comprehensive and universally accepted framework to describe functioning, disability and health in persons with all kinds of diseases or conditions. The medico-psycho-social problems encountered at home and in the community by persons with SCI sequel, were retrospectively evaluated using ICF-DH conceptual approach. PART EXPERIMENTAL Materials used The target population of this retroactive study, covering a period of 7 years (1999-2006), consisted of 660 subjects with chronic spinal cord injury (SCI), admitted during the last 7 years in our rehabilitation department, reviewed by the ques- tionnaire technique. There were 16 questions, with self-asses items, focused on the medical and social items (educa - tion, work, intellectual and leisure activities,), which gave the subjects the possibility to evaluate their major problems and quality of life QoL. Work methodology The questionnaire items focused upon:  Health after discharge [7] addressability at medical services; systemic complications/ control of infections; • pressure sores; bladder, bowel management;

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