Date Presented 04/04/19
Training patients with spinal-cord injury on the use of a bladder management method is essential for the independence in self-care. Intermittent self-catheterization (ISC) decreases the presence urinary tract lesions. There have been good results in patients with a C6 motor level, despite upper-limb impairment. The aim of this study is to explore the level of assistance in ISC that tetraplegic patients have received at discharge of the inpatient rehabilitation program in FLENI.
Primary Author and Speaker: Nicole Nagelkop
Contributing Authors: Mariana Bonetto
PURPOSE: Spinal cord injuries generate a disruption in motor, sensitive and autonomic functions that produce, amongst other alterations, neurogenic bladder syndrome. Consequences of these complications, such as urinary tract infections and lesions, are the main causes for morbidity and mortality in this population and its prevention constitutes one of the most important priorities reported by patients in relation with self-care. The selection of an adequate method for bladder management and the training on its use are essential components of the rehabilitation program. It has been demonstrated that clean intermittent self-catheterization significantly decreases the presence of infections and urinary tract lesions. At the same time, it gives more independence in self-care, less need of equipment and more freedom for the expression of sex life.
During the last years the use of clean intermittent self-catheterization has been extended to tetraplegics and there have been good results in patients with a C6 motor level (wrist extension) in countries like France, USA and Czech Republic. There is no evidence of experiences in Argentina.
The purpose of this study is to explore the level of assistance in clean intermittent self-catheterization that patients have received at discharge of the inpatient rehabilitation program in FLENI Rehabilitation Facility within years 2013 and 2016.
DESIGN: Quantitative, Descriptive.
METHOD: The motor level was compared with the results obtained in the Bladder Control section of the Functional Independence Measure (FIM) of 15 tetraplegic patients (C1-C8) who received inpatient treatment within the yeas 2013 and 2016 in FLENI. All participants were trained in clean intermittent self-catheterization: informative material and attention to patient inquiries and doubts, intake and evacuation record, pre-functional activities oriented to catheter handling to improve dexterity, training in dressing and undressing themselves, training in use of adaptative devices and lastly functional training supervised by nurses, for both patient relatives and those patients that are able to perform the process by themselves.
RESULTS: Of 15 tetraplegic patients that require clean intermittent self-catheterization for bladder control, 5 (33.3%) are able to self-catheterize with modified independence; 5 (33.3%) are able to participate of the activity with assistance; and 5 (3.33%) are dependent on the activity. The highest motor level in which patients can independently self-catheterize is C6 and C5 for patients that can participate of the activity with some degree of assistance.
CONCLUSION: Having received appropriate training and being equipped with assistive devices, patients with spinal cord injuries with motor levels C5 and below can achieve active participation in clean intermittent self-catheterization with assistance and patients with motor levels C6 and below can achieve modified independence.
References
D. Zlatev, K. Shem y CS. Elliott (2016) How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management. Spinal Cord, 1-5.
J. Kriz y Z Relichova (2014). Intermittent self-catheterization in tetraplegic patients: a 6-year experience gained in the spinal cord unit in Prague. Spinal Cord, 52, 163-166.
