ISSICON 2017 puts spotlight on spinal trauma

New Delhi: Reintegrating spinal injury patients into mainstream workforce remains a major challenge in India and other low-income countries due to factors such as lack of quality rehabilitation facilities, delayed presentation of injury as well as absence of impactful assistive technology, leading experts attending a major international conference on spinal trauma agreed today.

The 17th edition of the International Spine and Spinal Injuries Conference (ISSICON) that opened in New Delhi witnessed participation of doctors, medical experts, and researchers from around the globe. Nearly 72 national and 34 distinguished international faculties became a part of the three-day conference which is organized every year by India Spinal Injuries Center (ISIC) in collaboration with the Spinal Cord Society in an effort to bridge the gap in professional development opportunities for health professionals involved in Spinal Cord Injury (SCI) management. Many international faculty members were felicitated in the inauguration ceremony of the event.

Highlighting the priorities of ISSICON 2017, Major H.P.S. Ahluwalia, Chairman, ISIC, said, “The theme of this year’s conference is Challenges and Opportunities, as the experts discussed the numerous challenges faced in the comprehensive management of spinal cord injury patients in India and other low and middle income countries.  Also, the strengths and opportunities of the society which help overcome many challenges were discussed. The strengths include strong support from family, spouse, and community, strong religious beliefs including the doctrine of karma, innovativeness and the relatively cheap as well as abundant manpower. ISIC and the spinal trauma community worldwide have been focusing on rehabilitating the spinal injury patients and integrating them back to active workforce to boost their confidence and make them economically stable. It also positively impacts the national economy. Growing incidence of the spinal injury cases due to human negligence has become a serious cause for concern and the need to ramp-up the healthcare facilities and staff to meet this growing challenge across the country needs to be recognized.”

Human negligence and ignored infrastructure are becoming key factors causing falls and slips which lead to severe injuries. Dr Fin Biering-Sørensen, former President, International Spinal Cord Society, expressed that in developed countries like Denmark, the aging population suffers most spinal injuries due to simple slips and falls. Also, as people have internalized road safety measures and even use seatbelts in rear seats while driving, spinal cord injuries are witnessed more in two-wheeler and bicycle riders. In comparison, Dr A K Mukherjee remarked India continues to witness high spinal injuries due to vehicular accidents. Also, Indians need to be alert about its aging population. By 2030, India is expected to have 15% of spinal cases in old people.

Vehicular accidents and specially those involving two-wheelers accounts for a majority of spinal injuries in India. Also, around 40% of spinal injuries happen to people in the age-group of 20 to 40. Unfortunately, shortage of quality rehabilitation services and lack of focus on reinstilling confidence among patients make reintegration of patients a major challenge in India.

Highlighting the role of negligence as main factor causing spinal injuries, Dr H S Chhabra, Secretary, Spinal Cord Society, Medical Director, India Spinal Injuries Center, said “A 26-year-old girl Karishma suffered severe spinal injuries that restricted her to wheelchair. She suffered these injuries due to a fall from a weak balcony railing of a Goa hotel room where she had checked-in during a holiday trip. Only after aggressive treatment and rehabilitative measures were we able to provide her the independence that she has now. She operates using her wheelchair and has been working for some time now. However, the important aspect of the case is that this was avoidable if there had been no negligence.

 In another case of aggressive rehabilitation reviving a severely injured patient, Dr Chhabra pointed out to the story of a poor laborer, Anil Kumar, who broke his spine when he received a shock from livewire and fell from the third floor. He lost power in his both legs and control of passing urine and stool. After surgery at ISIC and a course of dedicated rehabilitation, he is now wheelchair bound. However, he has not only returned to work and does all activities of daily living but also is a member of wheelchair basketball team. He recently became father for the first time and fulfils responsibilities there as well.

“Comprehensive rehabilitation remains the key to recovery of a spinal injury patient. This involves multiple therapies from physiotherapy, occupational therapy, psychosocial counseling, peer-counseling as well as creating appropriate assistive technology to help the patient lead independent and active lifestyles. We need to put greater thrust on these aspects to help patients get back to fruitful work lives,” said Dr H S Chhabra, Secretary, Spinal Cord Society, Medical Director, India Spinal Injuries Center.

‘Care for the caregivers’ — with this humble motto ISIC spinal trauma experts highlighted the need of building self-efficacy and emotional intelligence amongst the affected and their families. Dr Susan Charlifue from Craig Hospital, United States, elaborated further on how in some cases spinal cord injuries have resulted in strengthening of family bond, whereas in other cases  emotional stress have led to divorces. The importance of building resilience and the need for education and maintaining income for the victims was emphasized by Dr Shashi Bhushan, consultant physiotherapist at ISIC. Alongside technological innovations, ISIC also underlined the stringent need for treatment through “positive psychology”. Further measures to make India more disabled-friendly were discussed by expert faculties from over 14 countries at the conference.

Joining Dr. P. S. Ramani, Mumbai, and Dr. S. K. Srivastava, Delhi, and other leading Indian participants were Dr Stephen Muldoon, Ireland; Dr Fin Biering-Sørensen, Denmark, Dr Ronald K. Reeves, United States, Dr Sait Naderi, Turkey, Dr. Amiram Catz, United States, and other members of international faculty at ISSICON 2017.

The experts focused on the need for providing spinal cord injury (SCI) survivors with better rehabilitative care and treatments options. Various initiatives for penetration of best available technology and post-surgery rehabilitative and therapeutic care and easy accessibility of loans to try and make treatment reach a larger section of the country was stressed upon at the conference.

Making a case for the treatment options accessible for the masses, Dr Chhabra said, “Other than discussing various advancements in treatment and rehabilitative care, this conference also focused on means that can be employed on a national level in reaching out to maximum people with affordable treatment facilities, which will further contribute to the building of an inclusive India.”

While calling for proper awareness amongst people, professionals, and policy makers, doctors also cautioned against unethical and unregulated practices for treatment of spinal injuries. While other treatment options such as stem-cell therapies are in experimental stage, it is too early to undergo treatment using those therapies, which might have adverse effects. Doctors advised patients that only comprehensive rehabilitation is the only way for recovery and no present technology can guarantee complete recovery. However, studies have shown that 55% of paraplegic patients are known to have returned to active workforce, Dr Chhabra added.