1. Knowledge Profile About the Care of Spinal Cord Injury
Patients Among Their Caretakers at BPKIHS
Mehta RS*1, Shrestha B*2 , Khanal GP*3, Rijal D*4
B.P. Koirala Institute of Health Sciences, Dharan, Nepal
Abstract: According to the National Spinal Cord Injury Association, as many
as 450,000 people in the United States are living with a spinal cord injury (SCI).
Other organizations conservatively estimate this figure to be about 250,000.
Every year, an estimated 11,000 SCIs occur in the United States. Most of these
are caused by trauma to the vertebral column, thereby affecting the spinal
cord's ability to send and receive messages from the brain to the body's systems
that control sensory, motor and autonomic function below the level of injury.
It is chronic disease condition which requires a lot of care during
hospitalization as well as in the home. Special training to care the activities of
daily living is vital. Keeping these issues in mind the investigator has planned
to assess the training need of the SCI caretakers so that educational package
can be planned and implemented in ward for better patient care.
It was a hospital based descriptive analytical study conducted among the SCI
patients and their caretakers admitted in orthopedic ward. Using purposive
sampling technique 30 subjects were selected from 1st July 2006 to 31st
December 2006. Using prepared semi-structured questionnaire data was
collected.
It was found that the most of the subjects were between age 20-60 years, male,
married, middle economic group and from villages. Majority of cases admitted
in first time (83%) having cervical and thoracic spine injury. The main reasons
are fall injury. Most of the subjects have the ability to care manage the
problems of bed sore, Paralysis, Nutrition where as very less no of care takers
have knowledge about management of UTI, constipation, Pneumonia, and
traction.
This study concluded that the continuous in-service education programme on
care of SCI patient to their caretakers is very essential for quality patient care.
Key Words: Knowledge Profile, Spinal Cord Injury, Caretakers
Note:
*1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department,
*2 Dr. Bikram Shrestha, Associate Professor, Department of Orthopedics,
*2 Dr. Guru Prasad Knanal, Asst. Professor, Department of Orthopedics,
*3 Mrs. Dewa Rijal, Nursing Officer, orthopedic Ward
Corresponding Author: RS Mehta, Email: ramsharanmehta@yahoo.com

2. Introduction: Mobility is the most prized human capability. It denotes
independence. Impaired mobility due to trauma not only leaves the
person dependent on others for the activities of daily living but also
hinders body’s normal physiological functions apart from draining the
person psychologically.
The human spine is more frequently exposed to the traumatic influences
than one would expect. Traumatic injuries are becoming major public
health problems, with ever increasing prevalence, imposing a great
burden on society than other disease.1
Spinal Injuries are known to occur since time immemorial. Population
growth and rapid industrialization leading to increased vehicular traffic,
growing social tension leading to increase violence and modern day
stress of daily living have greatly increased the number and rate of spinal
injuries and the associated mortality and morbidity.2
Spinal injuries occur when excessive forces are exerted on the spinal
column. These forces are the result of acceleration deceleration events
which result in hyperflexon, hyperextension, deformation, axial loading
and excessive rotation of spine.3,4,5
Injuries remain the leading cause of death each year, under 45 years of
age, claiming more than 1,42,000 lives and causing 62 million people to
seek medical help in America. Of course, spinal cord injuries are one of
the leading causes of young deaths.6
The Incidence of spinal injuries in industrialized countries is
approximately 3 per 1 lac population. Approximately 10,000-12,000
cases of SCI occur every year in U.S.A.6,7
The treatment of such injury begins at the outset and ideally these
patients should be transferred to specialized centers geared up to
manage spinal trauma. Morbidity (further injury to the spinal cord,
pressure sores, pneumonia and urinary tract infections) will be reduced
and so will the mortality and thus in the long term there will be money
saved which would normally be used to treat complications related to
inadequate initial care. 8
The incidence of SCI is highest among persons age 16-30, in whom 53.1
percent of injuries occur; more injuries occur in this age group than in
all other age groups combined. Males represent 81.2 percent of all
reported SCIs and 89.8 percent of all sports-related SCIs. Among both
genders, auto accidents, falls and gunshots are the three leading causes
of SCI, in that order. Among males, diving accidents ranked fourth,
followed by motorcycle accidents. Among females, medical/surgical

3. complications ranked fourth, followed by diving accidents. Auto
accidents are the leading cause of SCI in the United States for people age
65 and younger, while falls are the leading cause of SCI for people 65
and older. Sports and recreation-related SCI injuries primarily affect
people under age 29.
Persons with neurologically complete tetraplegia are at high risk for
secondary medical complications. The percentages of complications for
individuals with neurologically complete tetraplegia have been reported
as follows: 60.3 percent developed pneumonia , 52.8 percent developed
pressure ulcers , 16.4 percent developed deep vein thrombosis , 5.2
percent developed a pulmonary embolism and 2.2 percent developed a
postoperative wound infection
Young males of age group 15-34 years form the majority of spinal injury
patients. Therefore these injuries place a great burden on society by
claiming the young lives and increasing permanent disabilities among
the youth. 8
Most common areas of spinal injury are mid to low cervical and thoracic-
lumbar junction, as they are the areas of maximum mobility. Thoracic,
lumbar and sacral points are other commonly involved areas of spine.
Cervical injuries are the most devastating kind of spinal injuries
constituting maximum morbidity and mortality among these injuries. 3
B.P. Koirala Institute of health sciences is a center of excellence in the
eastern region of Nepal for orthopedic services. Under the orthopedic
department spinal cord injury patients are admitted and treated. The
incidence of admitted SCI patients in orthopedic ward is very high. About
10-15 patients every day out of 34 patents of orthopedic are SCI patients.
SCI patients need special attention, treatment and care. As problem is
very life threatening and chronic in nature patient admitted in orthopedic
wards for more than 4-6 weeks. The prognosis of SCI patients depends
upon the services and nursing care provided to them. Usually SCI
patients treated with bed rest traction, surgery, and conservative
management, which require a lot of knowledge and skill to take proper,
care, especially caretakers, as the number of nurses are limited.
Title of the study: Knowledge Profile about the Care of Spinal Cord
Injury Patients among their Caretakers at BPKIHS
Objectives: The Objectives of this study is to find out the socio-
demographic profile of the SCI patients, examine the various facts about
SCI patients and explore the knowledge regarding care of SCI patients
among their care takers.

4. Methodology: It is hospital based descriptive analytical study,
conducted among the SCI patients admitted in Orthopedic unit of
BPKIHS and their main caretaker during the period of 1st July 2006
to31st December 2006 i.e. 6 Months. Using purposive sampling technique
all the diagnosed SCI clients admitted in orthopedic ward during the
study period was included in the study. Using self-prepared pre-tested
interview scheduled the data was collected from the SCI patients and
their caretaker, who most of the time involved in the care after three days
of admission in ward by a trained nurses working in orthopedic unit after
obtaining informed verbal consent. The collected data was entered in
SPSS-10 software package and analyzed.
Results:
Socio-demographic Profile of the SCI patients: Majority of the SCI
patients (76.7%) were of age group 20-60 years. The mean age was 41.5
yrs, SD 14.926 and range 16-68 years. Majority of the subjects were
Male (73.3%), Hindu (90%), Villagers (76.7%), married (83.3%), Non-
vegetarian (73.3%), middle class family (60%), and heavy physical
workers.
The details about demographic profiles are depicted in table – I.
Details about injury and admission: Majority of the patients are
admitted in first time (83.3%), most of the injury occur between 6am to
12MD, i.e. 54.4%, most of the Patients (69.7%) were admitted within 12
hours after injury. Fall Injury (73.3%) is the main cause of SCI among
the admitted clients.
The details about the injury are mentioned in table – II.
Opinion Regarding Knowledge profile about the care of SCI among
the caretakers:
Most of the caretakers reported that they have knowledge about the basic
structure so spinal cord ( 62.1%), functions of spinal cored (57.1%),
reasons for paralysis (53.6%), common complications of SCI
(59.31%),and None of the caretakers mentioned proper method of turning
the spinal cord injury patients.
The details are described in table- III.
Opinion Regarding the Ability of caretakers to care/manage the
problems of SCI patients: It was found that the care takers are capable
to manage the problems like: Bed sore (83.3%), care of paralysis parts
(79.3%), Nutrition/diet (86.7%), but not at all able to manage the
problems like: urinary tract infection(43.3%), constipation(43.3%),
incontinence bowel (43.3%), pneumonia(40%) and care of traction (40%).
The details are mentioned in table IV.

5. Discussion: It was found that most of the patients are of age group 20-60 years
i.e. of productive age group and most of the time they are involved in work. Male
(73.3%) subjects have more chance of SCI as they are involved in heavy and
risky physical works. Most of the subjects are villagers (76.7%), illiterate (40%),
or literate/primary education (36.7%) , from middle class (60%) family and
heavy physical workers(56.7%). This picture clearly explains that the spinal
cord injury is common among the heavy physical workers of middle class family
may be due to nature of work.
Most of the subjects are admitted for first time (83.3%). The most of the injury
(54.4%), occurs between 6am-12MD, because this is peak working hours for
villagers. Most of the subjects (67.9%), admitted in hospital within 12 hours as
BPKIHS is a only center of orthopedic patients of SCI in eastern Nepal and high
awareness among the public.
About half of the caretakers have basic knowledge abut structure, functions,
causes of paralysis and complications of SCI, which may be due to learning in
hospital as the interview is collected only after 3 day. The mean duration of stay
was 23.366 days, SD14.4114, and range 3 to 48 Days.
Regarding the care of their patients most of the caretakers reported that they
are capable to care of bed sore, paralyzed parts, and Nutrition as relatives are
involved in these care inward by the sisters, where inadequate knowledge on
management of urinary tract infection, constipation, incontinence, pneumonia
and traction, as these complications require advanced knowledge and nurses
themselves mostly provide the care during hospitalization.
Conclusions: Skin Breakdown, pneumonia , Osteoporosis and Fractures,
Heterotopic Ossification, Spasticity, Urinary Tract Infections, Autonomic
Dysreflexia, Deep Vein Thrombosis, Pulmonary Embolism, Orthostatic
Hypotension, Cardiovascular Disease, Syringomyelia, Neuropathic / Spinal
Cord Pain, Medication Problems, Hyperthermia and Hypothermia are the areas
of care for SCI patients. Continuous in-service education programme for
nurses involved in the care of SCI patients and all caretakers of SCI is very
essential.
References.
1. Junghanns HS. The human spine in health and disease. New York: Grune and Stratton,
1971.
2. Glass CA, Krishman KR, Bingley JD. Spinal Injury Rehabilitation: Do staff and patients
agree on what they are talking about. Paraplegia.1999; 29(5): 343-9.
3. Black JM, Jacobs EM. Medical surgical Nursing – Clinical Management for continuity of
care. Philadelphia: Saunders, 1997.
4. Errico TJ, Bauer RD, Waugh T. spinal Trauma. Philadelphia. JB Lipppincott comp. 1991.
5. Post MW, Bloemn J, Wittee LP. Burden for Partners of Person’s with spinal cord injuries.
Spinal cord. 2005; 43(5): 311-9.
6. Eyester EF, Kelker DB, Porter Rw, The national had and SCI prevention program
Neurosurgry. New York: Mc. Graw Hill Pub, 1996.
7. Devivo MJ. Causes and costs of spinal cord injury in US. In Gibbbs SR. Bradly WG ed.
Yearbook of Neurology and Neurosurgery. St. Louis: Mosby Inc, 1999.
8. Yashon D. spinal Injury. Norwalk: Appleton Century Crofts, 1986.

6. Table – I
Socio-demographic Profile of the Spinal Cord Injury Patients
N= 30
SN Item/Particular Percentage
1 Age ( In years)
< 20 10.0
20-40 33.3
40-60 43.4
>60 13.3
Mean 41.5
SD 14.9268
Range 16-68
2 Sex
Male 73.3
Female 26.7
3 Religion
Hindu 90
Buddhist 6.7
Kirat 3.3
4 Ethnic Group
Brahmin/Chhetri 33.3
Mangolian 40
Newar 3.3
Tetai Origin 20
Others 3.4
5 Occupation
Agriculture 46.7
Business 10
Service/Job 10
Others 33.3
6 Education Level
Illiterate 40
Literate/Primary 36.7
Secondary 20
Higher secondary and above 3.3
7 District ( Permanent address):
Basantpu 6.7
Bhojpur 6.7
Dhankuta 16.7
Janakpur 3.3
Jhapa 3.3
Kathmand 3.3
Mahendra 3.3
Morang 6.7
Sankhuwa 3.3
Sirha 10.0
Sunsari 20.0
Tanhu 3.3
Terathum 6.7
Udayapur 6.7

7. Table – I ( Continue)
Socio-demographic Profile of the Spinal Cord Injury Patients
N= 30
SN Item/Particular Percentage
8 Residence
Village(VDC) 76.7
Municipality ( NP) 23.3
9 Marital Status
Married 83.3
Unmarried 16.7
10 Dietary Habit
Vegetarian 20
Non-Vegetarian 73.3
Egg-Vegetarian 6.7
11 Yearly Saving
Deficit Budget/Loan 10
No Saving/balanced 60
< 5000 10
5000-25000 20
> 25000 00
12 Economic Status
Poor 40
Medium 60
High 00
13 Life style
Heavy physical worker( farmer/labor) 56.7
Office worker 10
Sedentary life style 20
Others 13.3
14 Obesity
Present 00
Not Present 100
Table – II
Details about Nature Spinal Cord Injury
N=30
SN Item/Particular Percentage
1 Frequency of Admission
st
1 time 83.3
nd
2 time 13.3
> 2 times 3.3
2 Duration of Diseases: till the day of admission
3 days 21.7
3-7 days 47.9
7-14 days 13
> 14 days 17.4
3 Time of Injury
6 AM-12 MD 54.4
12 MD-6 PM 35.6
6 PM-12 MN 6.7
12 MN-6 AM 3.3

8. Table – II (continue)
Details about Nature Spinal Cord Injury
N=30
SN Item/Particular Percentage
4 Interval between injury and admission
< 6 hrs 39.3
6-12 hrs 28.6
12-24 hrs 7.1
24-48 hrs 2.6
>48 hrs 21.4
5 Level of Injury
Cranio-Vertebral Junction 0
Cervical 44
Cervico-thoracic 4
Thoracic 36
Thoraco-Lumber 4
Lumber 12
Lumbo-Sacral 0
Sacral 0
6 Causes of Injury
Road Traffic Accident 13.3
Fall Injury 73.3
Gun Shot/Stab Injury 0
Work related Injuries 13.3
Sport Injuries 0
7 Mode of Immobilization applied
Skeleton / Skull traction 42.9
Cervical color 9.5
Others: Skin traction, Conservative management etc. 47.6
Table – III
Knowledge Profile about Care of Spinal Cord Injury among the Caretakers
` N=30
SN Item/Particular Percentage
1 Have Knowledge about Structure of Spinal Cord 62.1
2 Have Knowledge about functions of Spinal Cord 57.1
3 Have Knowledge about Occurrence of Paralysis 53.6
4 Have Knowledge about Complications of SCI 59.3
5 Have Knowledge about Turning of the SCI Patients 0
Table – IV
Ability to Care/Manage the Problems of Spinal Cord Injury Patients
N=30
Capability/ Ability to manage Problems
SN Problems
Fully Some Extent Not at all
1 Bedsore 40 43.3 16.7
2 UTI 13.3 43.3 43.3
3 Paralysis 17.2 62.1 20.7
4 Nutrition 53.3 33.3 13.3
5 Pain 30 46.7 23.3
6 Constipation 26.7 30 43.3
7 Incontinent of bowel 20 36.7 43.3
8 Pneumonia 13.3 46.7 40
9 Care of traction 30 30 40