Objective:
For disabled person with spinal cord injury (SCI), return to society and adaption is most critical problem and object of fear. In the cases of overseas, it has been known that it usually takes 3 to 8 months to return to daily living after SCI. But in domestic circumstance, due to the lack of a transitional rehabilitation system(TRS), average period is over 31 months and there are many cases in which the patient lives a secluded life after discharge. In this project, we developed hospital based TRS model using daily living home for disabled person with SCI and verified effectiveness of it.
Subjects & Methods:
Through reviewing domestic researches, the return to daily living program of the Korea Spinal Cord Injury Association and cases of overseas institutions, 12 educational items (activity of daily living, wheelchair skill up, education for management of crisis, emotional support, sexual rehabilitation, driving, counseling for housing, sports or leisure for the disabled, return to school or work, counseling for linkage of economic and community resource, orthosis evaluation, education of spinal cord injury) were established and manuals of each item was developed.
The first subject of the project was a 47-year-old woman who had been hospitalized for 26 months, six hospitals after SCI, April 2017. Before admission to the program, in-depth interviews with subject was done, the patient 's needs were identified and user-centered program was planned through the goal setting meeting (table 1). Even if it was not in the patient's needs, the program was coordinated by supplementing the part of the educational items. Physicians, nurses, physiotherapists, occupational therapists, social workers, technician of orthosis, independent living coach(disabled person with SCI) were participated in the program operation. Neurological, occupational, social welfare, psychological, quality of life (QOL) evaluation was done before and after program and achievement of goals were measured.
Results:
Her neurological level of injury was C8, sensory incomplete injury. There was no significant change in neurological evaluation. But meaningful improvement was observed in occupational, social welfare, psychological and quality of life evaluation (table 2). Also goal attainment scaling(GAS) of six core goal showed much improvement 34.95 to 73.01 (table 3). The cost of implementing the program was 7,068,134 korean won. After this program, she can return to home from long term hospitalization.
Conclusion:
Comprehensive TRS offer improvement in ability of daily living and QOL to disabled person with SCI and reduce the fear of returning to society. And it can be expected that the shortening of length of stay and the reducing of medical expenses through application of hospital based TRS using daily living home at the appropriate time |
