[Meaning, dimension and problems in home care of spinal cord injured persons]

Today, patients with paraplegia who have successfully passed a course of clinical treatment and rehabilitation in a specialized hospital, are no longer considered as 'sick' or as 'chronically sick'. Rather, they are considered as 'healthy', however, under conditions of being continuously, often severely, handicapped. Nevertheless, the lasting impairment determined the need for the patient to subject herself/himself for a lifetime to well-defined measures of regular checking of body functions, e.g. a monitoring of respiration, circulation, excretion and motor functions. This includes in particular the adherence to basic hygienic requirements. Depending on the degree of existing paralysis, i.e. complete or incomplete paraplegia or tetraplegia, but also on the age of the patient or the presence or absence of severe complications, spinal cord injury patients will remain dependent on care administered by other persons rendering such services or become largely or completely independent in that respect. Special attention has to be given to measures such as regular emptying of the paralysed bladder and the paralysed bowels, prevention of bed sores, skin conditions and of contractures. Depending on the patient's personality structure and the extent to which the handicap and the body functions including the severe disturbance of the body scheme are mastered psychosocially, deviant behaviour ranging from exaggerated and biased body care to almost suicidal negligence of this aspect can be observed. The necessity of education towards a behaviour that is in conformity with the requirements of hygiene during the stay at the special hospital and of checking of the resulting necessities by the attending practitioner is pointed out.