Topics

There will be 12 topics in total and 1 dialogue session. This part will be updated as we receive detailed information about the topics.

The Accreditation Committee of the General Physicians Organization of Curacao (CHV-CAN) has accredited the conference under No. A16.013 for a total of 9 points!

Aftercare - Speaker Dr Dirk van Kuppevelt

Since life expectancy in Spinal Cord Injury (SCI) is increasing spinal cord patients are aging with their SCI. Patients who have been living with SCI for 20 to 50 years are more common in the last years. The risks of Secondary health problems occurring are higher for patients with longstanding SCI. Prevention of those secondary health problems start already with the primary admission to the rehabilitation centre. So aftercare starts early after SCI and should go on lifelong. How should we optimize aftercare and better quality of life of SCI persons? The possibilities given in various countries are different and often dependent on the economic situation of the country.

The presentation will give an overview of the secondary health problems possible with aging in SCI. The design of a program of aftercare as this has started in the Netherlands will be presented. Also the results of this program from 2004 on will be discussed

Dealing with sexuality and intimacy following Spinal Cord Injury - Speaker Dr Woet Gianotten

Society and the media tend to remind us that sex is only for the young, the healthy and the beautiful.

However, even with high spinal cord injury (SCI), many patients and many partners continue to desire intimacy and sexual expression. Nonetheless, SCI can in various ways disturb sexual function, sexual identity and sexual relationship.

The sexual function is partly disturbed as a direct result of the trauma, partly indirectly because of incontinence, troublesome positioning and impaired erogenous zones. Malfunctioning fertility can be an additional factor decreasing relationship quality and sexual identity. Those can become extra factors adding to the damage, complicating the process of renegotiating intimacy.

It will be clear that attention should be paid to the various post-SCI sexual disturbances.

Because sexual expression is an important aspect of quality of life.

But also because sexual expression has various health benefits including elements of care and even elements of cure.

The presentation will address three different aspects:

•          How SCI can influence sexuality and intimacy

•          How to deal with direct and indirect sexual disturbances

•          The role of professionals in this area.

Attention will also be paid to sexual aspects of SCI in female patients.

How do we keep the spine safe after a trauma? - Speaker Dr Jeanne Koeyers

Directly after a trauma, at the scene, paramedics take care of the Airway, Breathing and the Circulation of the patient when they first approach a patient. They will immediately stabilize the spinal column treating the life-threatening injuries first. They will always take care to stabilize a patient’s complete spine before moving a patient. This will be done with a semi-rigid collar, head blocks and a backboard.

It is important for non-medical professionals to know that moving a trauma patient should not be done without the proper knowledge. If you need to move a trauma patient make shore that you do not bend or rotate their head or spine.

When the patient reaches the emergency department the patient will stay immobilized until other life threatening injuries are addressed and examinations reveals no trauma to the spinal column. If there is an injury the neurosurgeon and or the orthopedic surgeon are consulted for further treatment decisions. Depending on the level of injury patient will need monitoring or even support of their breathing and the circulation. We should protect the spine form hypoxia and hypotension next to immobilization.

Prognoses spinal cord injury - Speaker Dr Ayal Zahavi

Spinal cord injury is damage to the spinal cord resulting in a change, either temporary or permanent, in the cord’s normal motor, sensory, or autonomic function. Patients with spinal cord injury usually have permanent and often devastating neurologic deficits and disability.

It is important to establish if possible the prognosis of the resulting injury to the spinal cord. Knowing the prognosis is important to guide the patient as well as the rehabilitation team in establishing realistic goals. Providing education to the patient and his/her family is also essential.

Functional outcomes are strongly associated with the neurological level of the individual’s SCI. The ability to walk again is also related to the level of injury and the neurological exam at the time of injury.

Relevant literature pertaining to establishing the prognosis after a spinal cord injury related to both functional outcome and ability to walk will be reviewed which should be helpful in guiding patients as well as the rehabilitation team involved in the patient’s care.

Complicating conditions after Spinal Cord Injury - Speaker Dr Juan Martina

The consequences of a spinal cord injury (SCI) can have a tremendous impact on both the patient and his family. SCI does not only result in a loss of motor functions but often also in severe autonomic dysfunctions. Moreover, many individuals with SCI experience serious problems at a later stage, after having gone through hospital care followed by primary rehabilitation. Some of the complicating conditions can be prevented whereas other cannot.

Among the most frequent complications reported in literature are: pneumonia/atelectasis, deep venous thrombosis (DVT), pulmonary embolus, pressure ulcers, autonomic dysreflexia, renal calculi, and fractures. Other complicating entities are spasticity, autonomic dysreflexia and heterotopic ossification.   Complications are a frequent cause of morbidity and mortality and lead to increased rates of rehospitalization and cost of care along with loss of employability and decreased quality of life. Therefore, it is important to have a better understanding of the medical complications that can result from SCI, as well as their risk factors and current trends.

The literature provides much information about the incidence and risk factors related to secondary SCI medical complications.

In this congress the following three complicating conditions will be addressed: Spasticity, autonomic dysreflexia and heterotopic ossification.

New development in the management of spinal cord injury - Speaker Dr Ellen Maas
From ancient times until world war II spinal cord injury was “an ailment not to be treated”. Patients who suffered from spinal cord injury died in the acute phase or in the first year after onset of the lesion. They died as a result of urinary tract or other infection, decubitus or other complications, like kidney failure.
At the end of the 20th century partial weight bearing treadmill training with manual assistance was introduced.
In the second part of the 20th century electrical stimulation was introduced. The goal of functional electrostimulation was to achieve certain motor activities like standing, stepping, cycling and hand grasp and release function in normal life settings.
From the late 1960s reconstructive hand surgery has proven to be beneficial in improving hand function of patients with cervical spinal cord injury. Recent developments point to added value of the combination of nerve transplantation in the acute phase after onset of the lesion and then required reconstructive hand surgery in the chronic phase.
Beside these new developments in rehabilitation, recent research focuses on spinal cord repair: how to reduce the effect of the damage to the spinal cord in the acute phase, to enhance regeneration or axon growth, to replace lost nerve cells and how to inhibit scar or gliosis formation.
So, in the future spinal cord injury may become “an ailment to be cured”.

Spinal Cord Injury as public health issue - Speaker Dr Federico Montero

A review of the main components and current state of the principles of Primary Health Care (PHC), and its relevance with the health/rehabilitation services in general and Spinal Cord Injury (SCI) in particular, have as one of the main components of the strategy, is discussed. This discussion is based on some historical facts related to PHC, the published document by the Pan American Health Organization (PAHO) “Renewing Primary Health Care in the Americas” and the World Report of the World Health Organization: “Primary Health Care – now more than ever” (http://www.who.int/whr/2008/en/). The main recommendations of the PAHO Regional Plan of Action on Disability and Rehabilitation: 2014-2021, will be presented.

Current status and data about various aspects of Spinal Cord Injuries in the world and in the region will be presented, followed by a review of the impact and various implications (health, psycho-social, economical, etc.) that this type of condition produces in the people directly affected, and their families.

The implications of SCI and their effect on the person and how those can interfere for their social inclusion and participation, as well as the role of general environmental accessibility and access to assistive devices play, to facilitate the social inclusion.

The need to include disability in general and SCI in particular as part of the national health policies and services, will be discussed as well as the need to train health personal on the issue, in order to improve health and quality of life of people affected by SCI.

Information about some relevant and useful teaching and learning resources currently available will be provided.

Prevention of spinal cord injury in road traffic- Speaker Mr E. Baromeo
The leading causes of spinal cord injury are road traffic crashes all over the world and also in Curacao.  During my presentation I will elaborate on the possible causes that can lead to spinal cord injury. You will see different type of accidents that occur frequently. From the paramedic experience attention will be put on prevention after the accident to raise awareness for the ones that are no part of the paramedic team what is possible to do and what not.
The presentation will be accompanied by short footage which must be part of the awareness for road users.

Insurance and Policy - Speaker Mrs Maritza Becher LL.M.
Every citizen can find themselves in circumstances for himself or members of his family where they may need medical treatment due to long-term illness or disability. Almost no one is able to bear the consequent expenses associated with the high healthcare costs. Also, so far it has not been possible to find a solution through private channels. The reason being that these risks under civil law are normally not adequate insurable. Regardless of one’s social status or financial capacity one must therefore in practically all cases rely on help from the government.
Public healthcare is an area where the government plays a key role and has a significant responsibility. Since the financing by a national health insurance has its limitations, the government has created the broadest possible financial support.
Partly as a result, the government has expressed most clearly in a specific manner the solidarity basis of the provision and created the broadest possible financial support in order to continue to finance the facility.
The funds to cover benefit expenses and the implementation of the Ordinance of the General Insurance on Exceptional Medical Expenses (Algemene Verzekering Bijzondere Ziektekosten, known by the acronym AVBZ and in Papiamento as the “Lei di Labizjan”) and to create reserve funds are provided through the following sources, namely: premiums from the insured - contributions from the insured – and an annual contribution from the government.
During her presentation Maritza Becher will discuss how this National Ordinance came into being, how it is presently being implemented, and how the patient with a spinal cord injury is experiencing it


Dealing with Change - Speaker  Yoyceline Lover SCI patient
Dr Ludwig Guttmann, a neurologist and founder of the Paralympics described Spinal Cord injury as one of the greater calamities that can befall humans.
In the beginning, after a spinal cord injury, it is very hard to cope with it. It is a new system with all the secondary medical issues and……. you can’t walk. You have to adapt to it, depending on your own strength to move forward. Accepting the reality makes the process move easier. In my presentation I will focus on different areas of change we are facing: the physical, mental, family and social change

Neuroestimulation for Bladder management after spinal cord injury - Speaker Dr Juan Castaño Botero

“Neurostimulation of sacral anterior for the treatment of neurogenic bladder due to spinal cord injury, indications, technique and results in Latin America".
 
Neurogenic bladder predispose to patients with spinal cord injury to reflex incontinence, urinary tract infections, autonomic dysreflexia and renal failure, which is one of the key causes of mortality. Bladder catheterization is the key of the management in most neurogenic bladder patients with spinal cord injury usually associated with anticholinergic medications or botulinum toxin injections but when this therapies failed the more invasive treatment options can be related to important complications, morbidity and poor quality of life , neuroestimulation of the  sacral anterior roots is an option for the treatment of  bladder and bowel dysfunction with significant improvement in quality of life and good results in terms of complications reduction, effectiveness and costs.
 
The presentation will give an overview of what is Neurostimulation of sacral roots and its working”.

Recreation for people with SCI - Speaker Mr Juny Harms