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Paraplegic Rehabilitation in South Africa

Late Rehabilitation without a Brace I

Orthopedic Surgeon

The brace came off twelve weeks after the operation. Flexion/extension X-rays were taken to ensure there is no instability at the fracture site.

Medical Treatment

The doctor continued to see Zamani regularly for any problems he might have.

Bladder tests done:

1. IVP (intravenous pyelogram): an X-ray study where opaque dye is injected in the veins (usually in the arms) and a series of films are taken. The dye is excreted by the kidneys and will outline the urinary tract to show the condition of the kidneys, urethras and the bladder, and any abnormalities e.g. bladder stones.
2. CUG (cystourethro gram): an X-ray done to visualize the bladder and urethra. Dye is placed into the bladder with a catheter to see the size of the bladder and it's condition. A CUG also shows whether the bladder neck, urethra, external sphincter areas are narrowed, or if a reflux (backup of urine into the urethras or kidneys) is present.
3. CMG (urodynamic studies): a diagnostic procedure to evaluate the bladder. Pressure in the bladder and urethra and the electrical activity of the external sphincter muscle is measured. During the test the bladder is filled with a certain quantity of water or gas. The test can also measure the bladder's ability to squeeze down. Measuring the urethral pressure shows areas and the degree of highest resistance in the urethra. Activities of the external sphincter can determine the amount of muscle activity and enables us to recognise any problems in the coordination of voiding.

The doctor needs to know:

• How much urine the bladder contains when it is full.
• Whether the bladder contracts itself, or if assistance is needed by pressing on the bladder or medication.
• If the patient feels anything while the bladder is filling.
• How the blood pressure is affected while the bladder is filling.

According to the above tests, Zamani had a lower motor neuron bladder and therefore a flaccid bladder.

Nursing

All activities of daily living were now done independently.

Bowel Control

Zamani took 4 Senokots® the night before bowel movements and a suppository early in the morning. He transferred to the toilet, put pressure on his abdomen and this way he had good bowel movements. He preferred to have his bowel actions early in the morning before he started his daily activities. Zamani had bowel movements every second day.

Bladder Control

After his bladder tests, Zamani could start intermittent catheterization. He preferred this to a permanent indwelling catheter, and the nurses provided training. After monitoring his intake and output, Zamani could empty his bladder every 3 hours with an intermittent catheterization.