الفهرس 
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Abstract
SUMMARY
SCI affects all aspects of a patient’s life, including the physical, behavioral, psychological and social functioning (North, 1999). As life expectancy is steadily improving through modern spinal unit care, the increased survival in SCI patients is associated with secondary complications, which continue to pose management challenges (Devivo, et al., 1992; Kreuter, et al., 2005). These all, secondary disabilities are usually not fatal and they impair independent living and are costly to treat. With rehabilitation and good follow up life expectancy of SCI patients can approach to normal (Kreuter, et al., 2005).
Spinal cord injury can be traumatic or non traumatic, and can be classified into three types based on cause: mechanical forces, toxic, and ischemic (from lack of blood flow) (Yu and He, 2015). The damage can also be divided into primary and secondary injury: the cell death that occurs immediately in the original injury, and biochemical cascades that are initiated by the original insult and cause further tissue damage. These secondary injury pathways include the ischemic cascade, inflammation, swelling, cell suicide, and neurotransmitter imbalances. They can take place for minutes or weeks following the injury (Sabapathy, et al., 2015).
Estimated global SCI incidence is 40 to 80 new cases per million population per year, based on quality country-level incidence studies of spinal cord injury from all causes. This means that every year, between 250 000 and 500 000 people become spinal cord injured. Studies that report incidence data for both traumatic and non-traumatic causes of SCI provide information about the overall constitution of SCI populations. This information is important to collect since the resource needs and characteristics of traumatic and non-traumatic populations are different. The proportion of TSCI varies within a wide range and appears to differ across regions (Garshick, et al., 2005).
In Egypt, The study was to determine the prevalence and cause of SCI in Al-Quseir City, using a door-to-door method. The affected population consists primarily of young male adults. The total of inhabitants was 33,285 in Al-Quseir City screened by 3 specialists of neurology. Suspected cases were subjected to full clinical assessment and MRI or CT of the spine. The prevalence rate of SCI was 63/100,000 for the total population. Traumatic spinal cord injury had a prevalence of 18/100,000, while non-traumatic SCI was found in 45/100,000. Degenerative cervical disc prolapse was the most common aetiology of SCI with a prevalence rate of 27/100,000 (El Tallawy, et al., 2013).
Primary prevention of SCI involves actions to avoid or remove the cause of SCI in an individual or a population before the problem arises, e.g. actions to reduce road traffic injuries. Secondary prevention comes into play once a SCI has occurred. The aim is to provide early diagnosis and treatment, and to limit disability. Early recognition of the possibility of SCI following an injury, including proper transportation to an appropriate facility, and access to acute rehabilitation is part of secondary prevention. Tertiary prevention focuses on rehabilitation post-SCI and environmental interventions to reduce complications and promote successful inclusion of the injured person in family and community life (Tharion, et al., 2009).
People with SCI are at risk of a range of secondary conditions, which can be a major cause of morbidity and mortality. While some of these complications occur primarily within the prehospital and acute care phase after injury, others may appear at any stage. There is evidence that, with appropriate management, many of these secondary conditions are preventable (Circulatory system, Respiratory system,
Genitourinary system, Neuromusculoskeletal system, Pain, Skin and Mental Health Conditions) (Shakespeare, 2012).
Accurate diagnosis of the SCI and any co-occurring conditions (e.g. traumatic brain injury, limb fractures, chest or abdominal injuries, wounds and penetrating injuries) is essential so that appropriate medical care and rehabilitation can be provided (Tharion et al., 2009).
Appropriate medical care and rehabilitation can prevent complications associated with SCI and can assist the person towards a fulfilling and productive life. Rehabilitation, defined as a “set of measures that assist individuals to achieve and obtain optimal functioning in interaction with their environments” (WHO, 2011).
In many cases, emotional distress may be difficult to evaluate without a complete history from the patient and a comprehensive assessment. Although the emotional reaction may be unique for each individual, psychosocial providers should be vigilant to some of the more common reactions to injury. These may include:
unnecessary dependency on others, social Isolation, negative body image or shame, feelings of worthlessness, low self esteem, anger and aggression, shame and embarrassment, feelings of helplessness and hopelessness, high levels of stress, self-blame, depression, post-traumatic stress disorder, suicidal thinking or lack of desire to live, apathy and not caring about life, inability to provide self-care and follow medical advice, marital and relationship conflict, lack of motivation for vocational or educational pursuits or feeling trapped in the family surroundings (Muldoon, 2015).
Psychologists, social workers, counsellors and other team members such as occupational therapists assist people with SCI by providing counselling, education, and problem solving. They also facilitate positive coping skills and teach methods to manage anxiety. In addition to improving mental health, a peer counsellor can serve as a role model by demonstrating mobility, involvement in sports, and a positive attitude (Sharma et al., 2006).
The “social or biopsychosocial approach” understands that disability does not only result from the physical limitation of a person but is determined by the interaction between a person’s functioning and their social and physical environment. In many cases, discrimination, fear and inaccessibility further intensify a disability. These negative views of disability tend to focus on issues of dependency and deficit, rather than on a more positive model in which disability is seen as an opportunity for growth and well-being (Sharma et al., 2006).
Rather than viewing disability in a negative light, a modern approach to disability views people with disability as autonomous individuals, with the right to make their own decisions and choose their own path in life. With this perspective, physical, sensory, cognitive, and psychological impairments only become disabling in an environment that fails to recognize individual differences (Beauregard et al., 2012).
The role of the various disciplines in rehabilitation tends to be fluid and somewhat overlapping at times. This is especially true among various psychosocial providers who are all providing similar services to people with SCI (Kennedy et al., 2010).
Responsibilities for assessment, education and intervention do not have precise boundaries and frequently are shared by various disciplines. Since psychiatrists, psychologists, social workers, occupational therapists and peer counsellors are qualified to perform some of the same functions in the provision of psychosocial care, it is important that they communicate among themselves and work collaboratively. In addition, they should work cooperatively with other disciplines in facilitating the personal and psychological growth of the person with SCI (Shin et al., 2012).
Psychiatrists, psychologists, social workers, peer counsellors and others who focus on mental health issues should receive an orientation to the philosophy and goals of the SCI programme, the administrative procedures governing the SCI programme, the roles and responsibilities of the different team members and any SCI-specific related issues. It is important that any mental health provider who will be providing services to the patient and family has both the knowledge of counselling as well as knowledge regarding SCI rehabilitation. They should understand both the psychological process as well as the physical implications of the injury (Priebe et al., 2007).
Since formal training programmes are not always available, education regarding SCI is often obtained on the job or by talking with other rehabilitation staff members. One excellent source of information and education about SCI is www.elearnSCI.org developed by the International Spinal Cord Society (ISCoS). Another resource available to those interested in learning about SCI is IPSCI by ISCoS in collaboration with WHO. Education regarding rehabilitation should provide ample opportunities for discussion, networking and exchange of ideas (Shin et al., 2012).