INTRODUCTION

Paraplegia

Paraplegia , sometimes called partial paralysis, is a form of paralysis in which function is substantially
impeded from the waist down. Most people with paraplegia have perfectly healthy legs. Instead the
problem resides in brain or spinal cord, which cannot receive signals to the lower body due to injury or
disease.

Like other form of paralysis, paraplegia substantially varies from one person to another. while the
stereotype of a paraplegic is of someone on a wheel chair who cannot move his or her legs, cannot feel
anything below the waist, and cannot walk, paraplegic actually have a range capabilities that may
change over time, both as their health evolves and their physical therapy helps them learn to work
around their injuries.

RATIONALE FOR THE CASE SELECTION

a) Criteria of inclusion of a case of disability.

b) The majority of spinal cord injuries are due to preventable causes such as road traffic crashes,
fall or violence.

CLINICAL PROFILE;

Particulars of patient-

Name: Dal bir

Age: 48 years

Sex: Male

Marital status: Married

Education:Literate

Occupation: Entrepreneur

Address: Mulpani

Religion: Hinduism

Language: Nepali

Residence: Permanent

CLINICAL HISTORY

Chief complain: unable to move his bilateral lower limb since 31 years.

History of presenting illness Mr. Dal bir was apparently well 31 years back when he fell down of a tree
while cutting the branches. He became unconscious following the incident and was taken to koshi anchal
hospital by his family members and from there he was referred to teaching hospital. After coming to
hospital he got bed sores for which he received treatment and got cured.

Past history

He has diabetes from 6 years and hypertension from 7 years for which he is currently under
medication .He also had some respiratory disease which got cured after taking some ayurvedic
medicine.

Family history

There is no significant family history.

Personal history

He is non vegetarian .he does not smoke or consume alcohol.

Diagnosis:

Paraplegia

Family tree
First visit

date

Objectives

a) To locate the residence

b) Introduction and rapport building.

C) To get a detailed review regarding the disease/condition and its awareness in the family and
patient.

d) to evaluate the socio economic status

Activities

a) meeting arrangement

b) introduction and rapport building

c) various open and closed question regarding;

I. Socio-economic status
II. Culture and belief system
III. Just an overview of housing and environment
IV. KAP of the patient and family
V. Difficulties they faced during the period of illness and also which they are facing
now.

Outcomes:

Family profile

He has a nuclear family consisting of four members. The patient is the household head living with his
wife and daughter .His elder son lives in town for his education purpose. His daughter studies in third
standard.

Socioeconomic status

The family lives in their permanent residence. The patient belong to a middle class family. He works as
an entrepreneur and his wife is a clerk in a private company. Ther is no economic burden in his family.

Housing and environment

The family lives in their own house . It has one room, kitchen, hall and an attached toilet. The room was
well ventilated and have a direct access to sunlight. There is a kitchen garden in their house and a sty.
There were four pet dogs in his house.
Lpg is the main source of cooking fuel

They use boiled water for drinking.

The sanitation in and around the house is good.

Effect of disease on the patient:

ECONOMIC IMACT:

The treatment expanses was beared by his parents and elder sisters and there was
an economic crisis but within a month the patient started earning and the issue got
resolved.

FAMILY AND SOCIAL IMPACT:

The wife takes good care of the patient and his brothers regularly visit him and
help him in his work.

PSYCHOLOGICAL IMPACT:

The patient became emotionally labile at the time of illness but did not lose his
hope and decided to work for his family as early as possible.

SECOND VISIT:
DATE:

OBJECTIVES:
a) To trace the progression of condition/disease
b) To find out about the impact of disease and disability on the patient, family and
the community
c) To evaluate the consequent change in their KAP.
d) To evaluate their housing and environmental condition.
e) To evaluate the gender role through the gender analysis tool

ACTIVITIES:
 a) The progression of the condition was assessed.
b) Discussion with the family members regarding the impact of disease on them was
conducted.
c) The KAP of members regarding the condition of patient was assessed.
d) Gender status was analysed.

Progression of the condition:

The patient parents and sister were supportive throughout his stay in the hospital but his
brother were not concerned. After discharge from the hospital the patient started working
in a small scale industry.

ROLE OF FAMILY IN DISEASE

Effect of Disease on the Family:

Economy:
This particular event considerably increased their expenditure as he had to
stay for quite a longer duration in hospital.

Psychology:
All members were emotionally disturbed after the incident. As there was
no proper cure of the disease and he cannot stand on his own and has to
depend on others even for his daily needs. But the patient did not lose his
hope and accepted his condition and thought to fight back.
Gender analysis:

Activity profile:
The patient plays a major role in decision making in the family. His wife looks after the domestic
chores with the help of his daughter like washing clothes, cooking and washing utensils. The
decision regarding health seeking is made principally by him and his wife. The active earning
members are both patients and his wife.

Access and control profile:

All the members of family have equal access to all the resources. They make various household
decisions on the basis of mutual understanding. His son and daughter are currently studying. His
wife works in private company, this shows that there is no bias on the gender

Third visit

Date:

Activities:

a) The information that was gathered was reviewed.

b) Counselling on lifestyle and behavioural modification was conducted.
c) Thanked the family for their cooperation and support.
Counseling

Our third visit was mainly focused on the counseling part.we suggested him to go for regular
physiotherapy.we asked him to check his blood sugar and blood lipid level .

SUMMARY MATRIX

Factors affecting disease process (health related issues):

Role of family and individual to

cause the diseases/problem
Family factor
Economic resources (Source of income and
sufficiency of income)
Caste ethnic group
Cultural factor to access health care
Household environmental factor ( water,
toilet, waste management, room space and
ventilation etc)
Decision making system for health care and
domestic expenses by gender ( men or
women)
Their income has been sufficient to maintain
his good health, the health expenses are
bearable by family.
No direct association was noted.
No direct association as such was noted.
The environmental and housing conditions are
above average with proper ventilation adequate
no of rooms, clean water access and proper
waste disposal.
As decision is made thorough mutual
understanding, there is not much relation to
this.

Individual factor
Education Patient and his wife are not well educated but they
 are able to understand the severity of the disease.
Occupation Patient works as an entrepreneur.
Gender role (being men or women specific Household chores are done together. But cooking
workload not shared by other gender) and washing clothes is mainly done by patient’s
wife.
Knowledge and attitude towards the disease The knowledge of family regarding the
condition of patient was adequate. They took
proper care of patient with regular medications
and follow ups.
Personal risky habit or behaviour (e.g. No smoking and consumes alcohol. Patient
Smoking ,alcohol, risky personal hygiene consumes mixed diet.
etc)
Health service factor
Availability of health services (as per health no proper access to health care services as he lives
system: traditional, modern other far from the city.
alternative)
Accessibility to health care ( distance, cost, No issues faced regarding health care cost, but
time) distance was a major concern.
Role family for recovery of the disease
Health care practices of patient / family The family is very supportive and coordinated
decision (what, why, when, where by when it comes to taking care of the patient.
whom)
Family support to look after the patient Good care and constant support has helped him
to maintain positive attitude towards bearing
illness.
Interpersonal relations among the family The interpersonal relation was good but
members and the community worsened after the disease occured.
Effects of disease on the family
Economic resources of the family The patient economic condition worsened after
the disease.
Economic productivity of patient and care The patient being economically active there
taker of the patient was huge effect on family.
Changes in life style and burden in the He made his room well furnished so that he could
family easy move his wheelchair and he sleeps on air
mattress to prevent bed sores.
Changes in health related knowledge, he understood the challanges a disable people face
attitude and practice in their day to day life.
Impact in patients physical, emotional and He become emotionally labile. He is mentally
psychosocial stress and coping mechanisms sounded.
Effect on general wellbeing of the family The family members seemed to have mild
members level of distress after the illness but they seem
 to have coped up nicely with the illness.
Relationship within the family members and They have cordial relation with their
community neighbours. Patient is also visited by his
relatives and friends.

(This tool will help us to see into the different factors affecting disease causation, progression
and treatment and rehabilitation, and thus help us to formulate a natural course of healing of
physical disability and disease.

EXAMINATION AT THE TIME OF ADMISSION

Vitals: Pallor :absent

Pulse:74 beats/min Icterus :absent
Blood pressure:110/80 mm of Hg Lymphadenopathy: absent
Temperature: 98.6F (afebrile) Cyanosis: absent
Spo2: 98% in right arm Clubbing: absent
Edema: absent
Dehydration: absent

Respiratory system Breath sound normal, no added sound

Cardiovascular system S1 S2 normal, murmur absent

CNS examination Higher mental functions: intact
GCS is 15/15 (E4 V5 M6)
Power of:
Right upper limb was 5/5
Left upper limb was 5/5
Right lower limb was 1/5
Left lower limb was 1/5

Abdominal examination No organomegaly

 Musculoskeletal system No joint pain, rashes and swelling.
Range of movement normal in all joints

Treatment

ANNEXURE

OBSERVATION CHECKLIST

Housing Assets Sanitation

 Type of House: own  Motorbike  Toilet: Water seal; Condition:
house  Television Soap
 House not given on rent  Refrigerator  Dust: minimal
 No. of rooms: 3  Cooking appliance-  Unpleasant odor: No
 Adequate lighting: Gas Stove  Garbage disposal site:
present collected by municipality,
 No. of members per compost
room: 2  Source of Water: boring
 Cross ventilation: water
present  Processing before use: yes
 Kitchen: ventilation present
 Source of Fuel: LPG

Activity profile:

(Activity profile shows the pattern of distribution of labour, and the burden of work each sex has
to bear)

MEN/BOY BO
ACTIVITIES WOMEN/GIRLS S TH
Source of Income
Agriculture √
Business √
 Employment √
Domestic chores

Water related
Collection √
Washing clothes √
Cleaning dishes √
Fuel related
Obtaining gas/kerosene √
Cooking √
Health related chores
Child immunization
Care during ill-health √
Taking sick to medical institute √
Buying medicine √
Child care
Cleaning and maintenance tasks √
Budget allocation and
Marketing √

The values are either positive or negative, and the skewing of positive values towards a particular
sex shall imply that the respective gender bears a greater burden of work than the other.)

Table 2.3.3-Access and control profile:

ACCESS CONTROL
WOMEN/ MEN/ WOMEN/ MEN/
GIRLS BOYS GIRLS BOYS
+ ++ + ++
Land/Housing
+ + + ++
Equipment
Labour and division
++ + ++ ++
of labour
Cash/Economic
++ ++ ++ ++
resources
++ ++ ++ ++
Education/Training
+ ++ + ++
Ownership of assets
Basic needs
 Food/Clothing/
++ ++ ++ ++
Shelter

(Difference in number of + sign of less than 5 signifies good gender situation.

Difference in number of + sign of 5 to 9 signifies satisfactory gender situation.

Difference in number of + sign of 10 and more signifies poor gender situation. )