The document summarizes the results of a rehabilitation needs assessment conducted on 18 individuals with spinal cord injuries following the 2010 Haiti earthquake. It describes the participants' demographics, injury characteristics, and level of functioning using the ICF framework. The assessment identified needs across various body functions, activities/participation, and environmental factors. Key areas that required rehabilitation support included emotional functioning, mobility, self-care, and community integration. The assessment provided insight into addressing rehabilitation priorities for improving quality of life in this vulnerable population after a natural disaster.

1. Rehabilitation Needs in Persons
with Spinal Cord Injury in Post-
earthquake Haiti
Alexandra Rauch,
M. Baumberger, E. v. Elm, F.G. Moise, J. Reinhardt

2. Background

3. The disaster

4. Disaster relief interventions
Disability Rehabilitation
Prevention
• Search and rescue
Lack of water and food • Medical services and supplies
• Clean water and sanitation
Decreased sanitary conditions
• Emergency shelter
Lack of Housing • Food
• Rubble removal and street cleaning
First • Logistics and telecommunications.
Dead response • Family reunification and other
Injuries protection concerns*
*United Nations: Haiti earthquake 2010 Flash appeal, Version 1.1. 16 January 2010

5. Objective
The International Classification of Functioning,
Disability and Health (ICF) provides a common
framework for the description of functioning.
To explore the feasibility of a rehabilitation
needs assessment using the ICF in persons
with spinal cord injury (SCI) following the
earthquake in Haiti

6. Methods
• Selecting ICF Core Sets
• Creating a documentation form
• Descriptive data analysis

7. 1. Selection of ICF categories
Body functions and Body structures Activities and Participation
b134 Sleep functions d230 Carrying out daily routine
b152 Emotional functions d240 Handling stress and other psychological demands
b280 Sensation of pain d410 Changing basic body positions
b420 Blood pressure functions d420 Transferring oneself
b440 Respiration functions d445 Hand and arm use
b525 Defecation functions d450 Walking
b620 Urination functions d455 Moving around
b640 Sexual functions d465 Moving around using equipment
b710 Mobility of joint functions d470 Using transportation
b730 Muscle power functions d510 Washing oneself
b735 Muscle tone functions d520 Caring for body parts
b810 Protective functions of the skin d530 Toileting
s1200 Structure of the spinal cord d540 Dressing
s430 Structure of respiratory system d550 Eating
s610 Structure of urinary system d560 Drinking
s810 Structure of areas of skin d760 Family relationships
d850 Remunerative employment

8. 1. Selection of ICF categories
Environmental factors
e110 Products or substances for personal consumption
e115 Products and technology for personal use in daily living
e120 Products and tecnology for personal indoor and outdoor mobility and transportation
e150 Desing, constructions and building products and technology of buildings for public use
e155 Design, construction and building products and technology for private use
e310 Immediate family
e340 Personal care providers and personal assistants
e355 Health professionals
e580 Health services, systems and policies

9. 2. Rating of the extent of a problem
ACTIVITIES AND PARTICIPATION
Some problem
Not applicable
Not specified
No problem
Complete
„How much difficulty has the patient in…“
problem
d230 Carrying out daily routine P 0 1 2 8 9
C 0 1 2 8 9
Description: Is able to organize and structure activities of daily living, sometimes calls
for assistance
Rehabilitation need: Yes No
d240 Handling stress and other psychological demands P 0 1 2 8 9
C 0 1 2 8 9
Description:
Is thinking a lot about his situation in the earthquake and the
consequences. The recollection causes stress. Listening to music helps him.
Rehabilitation need: Yes No
d410 Changing basic body position P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d420 Transferring oneself P 0 1 2 8 9
C 0 1 2 8 9
Description:
Has some movement restrictions due to the spinal surgery
which present little difficulty. Course of movement is not optimal
Rehabilitation need: Yes No
d445 Hand and arm use P 0 1 2 8 9
C 0 1 2 8 9

10. 2. Rating of the extent of a problem
Extent of the problem
no mild moderate severe complete
0 1 2 3 4
no some complete
0 1 2

11. 3. Determination of intervention need
ACTIVITIES AND PARTICIPATION
Some problem
Not applicable
Not specified
No problem
Complete
„How much difficulty has the patient in…“
problem
d230 Carrying out daily routine P 0 1 2 8 9
C 0 1 2 8 9
Description: Is able to organize and structure activities of daily living, sometimes calls
for assistance
Rehabilitation need: Yes No
d240 Handling stress and other psychological demands P 0 1 2 8 9
C 0 1 2 8 9
Description:
Is thinking a lot about his situation in the earthquake and the
consequences. The recollection causes stress. Listening to music helps him.
Rehabilitation need: Psychological support Yes No
d410 Changing basic body position P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d420 Transferring oneself P 0 1 2 8 9
C 0 1 2 8 9
Description:
Has some movement restrictions due to the spinal surgery
which present little difficulty. Course of movement is not optimal
Rehabilitation need: Physical therapy Yes No
d445 Hand and arm use P 0 1 2 8 9
C 0 1 2 8 9

12. Assessment Results

13. Sociodemograpic data (n=18)
Sex Women 11(61.1%)
Men 7 (38.9%)
Age (mean) 36.7 (26;55)
Cause for spinal cord injury Earthquake 17 (94.4%)
Traffic 1 (5.6%)
Level of lesion Cervical 1 (5.5%)
Thoracal 15 (83.3%)
Lumbal 2 (11.1%)
AIS (ASIA Impairment Scale) A 13 (72.2%)
B 1 (5.6%)
C 3 (16.6%)
D 1 (5.6%)
Spinal surgery 9 (50%)
Number of pressure ulcers since SCI 0 5 (27.8%)
1 7 (38.9%)
2 3 (16.7%)
3 2 (11.1%)
4 1 (5.6%)
Marital status (post earthquake) Never married 2 (11.1%)
Married 10 (55.6%)
widowed 5 (27.8%)
With partner 1 (5.6%)
Number of children (post earthquake) 0 5 (27.8%)
1 1 (5.6%)
2 3 (16.7%)
3 5 (27.8%)
4 2 (11.1%)
5 2 (11.1%)
Work situation (before earthquake) Employed 2 (11.1%)
Freelance 7 (38.9%)
Jobless 6 (33.3%)
Student 1 (5.6%)
Unknown 2 (11.1%)

14. Patient‘s perspective
Male, 43, AIS D, T12
Trapped while working on a roof,
Lost one of his five children (oldest sun),
Housing completely destroyed.
Acute care in Milot,
since March 12th in HHA
“I don’t know how my family is living, my
kids, my wife, It is such a big difference. I
don’t know when I will be able to go to
work and after I am here, I don’t know
how I will live.”
“I try not to think about what happened to
me. If I would, I don’t know what to do…”
Male, 43, AIS C, L1
Trapped in the ground floor of his own house,
Lost his wife and eight children,
Housing completely destroyed
Acute care in the Dom. Rep.,
since April 29th in HHA

15. Patient‘s perspective
Male, 27, AIS A, C6 „I am not the same person as
Trapped from collapsing before. It is such a big difference
buildings while on the street.
Acute care in the Dom. Rep.
how I live now in comparison to
Spinal surgery in Milot before. Thinking about it makes me
since March 12th in HHA. very sad. The only thing that I know
is that Jesus can help me to find
myself and my way again.“
Female, 39, AIS B, T12
„My biggest problem at the moment Trapped while at the third floor
are the finances. Before, I did not have of a building.
problems because I used to have a Housing completely destroyed.
Lost…
business – buying and selling things...“
Acute care at ‚Doctors without
borders‘, afterwards in Milot,
since March 13th in HHA.

16. Description of the problems
0% 20% 40% 60% 80% 100%
Sleep functions b134 7 10 1
Emotional functions b152 4 14
Sensaton of pain b280 1 17
Respiration functions b440 17 1
Defecation functions b525 1 17
Urination functions b620 1 17 0 No Problem
Sexual functions b640 16 2 1 Some problem
2 Complete problem
Mobility of joint functions b710 14 4
8 Not specified
Muscle power functions b730 5 13
Muscle tone functions b735 14 4
Protective functions of the skin b810 18
Structure of the spinal cord s1200 5 13
Structure of respiratory system s430 18
Structure of urinary sytem s610 18
Structure of areas of skin s810 8 10

17. Description of the problems 0% 20% 40% 60% 80% 100%
Carrying out daily routine d230P 12 5 1
Carrying out daily routine d230C 12 5 1
Handling stress and other psychological demands d240P 5 12 1
Handling stress and other psychological demands d240C 5 12 1
Changing basic body positions d410P 8 9 1
Changing basic body positions d410C 7 6 5
Transferring oneself d420P 7 10 1
Transferring oneself d420C 7 6 5
Hand and arm use d445P 17 1
Hand and arm use d445C 17 1
Walking d450P 2 16
Walking d450C 3 15
Moving around d455P 1 17
Moving around d455C 18
Moving around using equipment d465P 16 2 0 No Problem
Moving around using equipment d465C 1 15 2 1 Some problem
Using transportation d470P 2 16
Using transportation d470C 1 17 2 Complete problem
Washing oneself d510P 9 8 1 8 Not specified
Washing oneself d510C 1 16 1
Caring for body parts d520P 9 8 1
Caring for body parts d520C 1 16 1
Toileting d530P 1 12 4 1
Toileting d530C 1 1 15 1
Dressing d540P 8 10
Dressing d540C 1 16 1
Eating d550P 17 1
Eating d550C 17 1
Drinking d560P 18
Drinking d560C 17 1
Family relationships d760P 1 12 4 1
Family relationships d760C 1 13 3 1
Remunerative employment d850P 18
Remunerative employment d850C 18

18. Description of the problems
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Products or substances for personal consumption e110
Products and technology for personal use in daily living
e115
Products and technology for personal indoor and
outdoor mobility and transportation e120 Complete barrier
Design, construction and building products and Some barrier
technology of buildings for public use e150
No barrier/facilitator
Design, construction and building products and Some facilitator
technology of buildings for private use e155
Complete facilitator
Immediate family e310 Not applicable
Personal care providers and personal assistants e340
Health professionals e355
Health services, sytems and policies e580

19. Areas of Rehabilitation needs
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Sleep functions b134
Emotional functions b152
Sensation of pain b280
Respiratory functions b440
Defecation functions b525
Urination functions b620
Sexual functions b640
Mobility of joint functions b710
Muscle power functions b730
Muscle tone functions b735
Protective functions of the skin b810
Structur of spinal cord s1200
Structure of respiratory system s430
Structure of urinary systems s610
Structure of areas of skin s810

20. Areas of Rehabilitation needs
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Carrying out daily routine d230
Handling stress and other psychological demands d240
Changing basic body positions d410
Transferring oneself d420
Hand and arm use d445
Walking d450
Moving around d455
Moving around using equipment d465
Using transportation d470
Washing oneself d510
Carrying for body parts d520
Toileting d530
Dressing d540
Eating d550
Drinking d560
Family relationships d760
Remunerative employment d850

21. Areas of Rehabilitation needs
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Products or substances for personal consumption e110
Products and technology for personal use in daily living e115
Products and technology for personal indoor and outdoor mobility and
transportation e120
Design, construction and buiding prod. and techn. of buidlings for private
use e155
Immediate family e310
Personal care providers and personal assistants e340
Health professionals e355

22. Required health professionals

23. Implications and impact on
rehabilitation medicine
• Need for rehabilitation needs assessment
• ICF provides a useful framework for such an
assessment
However
• Tools needs to be tested
• Further developments required
• Data usage should be clarified
• Data collection presents challenges