American neurosurgeons stress on the need for neuro-rehabilitation at an international workshop organized by Indian Head Injury Foundation (IHIF) & Indraprastha Apollo Hospitals under aegis of Delhi Neurological Association
On an ill-fated day in February 2005, Yuvraj Shivraj Singh of Marwar (Jodhpur) was playing a game of polo when he fell off his pony & suffered Traumatic Brain Injury. It was then that his father HH Maharaja Gaj Singh II realized the severe dearth of TBI treatment & post-operative neuro-rehabilitation facilities in the country & established Indian Head Injury Foundation (IHIF) two years hence with a mission to build a comprehensive system for such patients. Thanks to the extensive neuro-rehabilitation that Yuvraj Shivraj Singh has received, his marriage to a princess from Uttarakhand recently is a pleasing denouement to a story that had the nation watching for over five years.
Neuro-rehabilitation includes physiotherapy, speech therapy, occupational therapy & neuro-physiological support that help patients return to normalcy or near-normalcy faster. According to Dr. Rajendra Prasad, Senior Consultant Neurosurgeon, Indraprastha Apollo Hospitals, New Delhi & Executive Director, Indian Head Injury Foundation said, “Half of those who die from TBI do so within 2 hours of injury. However, all neurological damage does not occur at the moment of the impact (primary injury) & evolves over ensuing minutes, hours & days (secondary brain injury) which results in increased mortality & disability. Precisely why, early & appropriate management of TBI is critical for the survival of such patients. Besides the metro cities, we do not have provision for it elsewhere in the country. Not to forget the acute shortage ambulances, trained paramedical staff & doctors that plague the scenario further.”
A visiting team of senior doctors from New York, USA (who have incidentally treated Yuvraj Shivraj Singh as well) which included Dr. Steven Flanagan, Chairman, Department of Rehabilitation Medicine & Dr. Mary Hibbard, Professor, Rehabilitative Medicine & Director, Neuro Rehabilitation Psychology Services from Rusk Institute, New York University Langone Medical Center as well as Dr. Andy Jagoda, Professor & Chairman, Department of Emergency Medicine & Dr. Silvana Riggio, Professor, Psychiatry & Neurology from Mount Sinai School of Medicine stressed upon the need for post-operative neuro-rehabilitation at an international workshop & symposium organized by IHIF & Indraprastha Apollo Hospitals at New Delhi today.
One of the major causes for head injuries & related Traumatic Brain Injuries (TBI) in India & across the world are road accidents. According to a WHO report, road deaths are assuming endemic proportions. It is estimated that by 2030, road fatalities shall emerge as fifth biggest killer – even deadlier than HIV/AIDS & Tuberculosis to claim 24 lakh lives. Around 90% of these road deaths occur in third world countries, more so in Asia-Pacific (44%) in the low to middle income group families - 66% of the deceased are in their most productive age group i.e. 16 to 44 years – throwing the families below the poverty line.
Unfortunately, India accounts to a whopping 10% of all road deaths across the world & has emerged as world’s road death capital. More people die in India because of road accidents than anywhere else including the more populous China despite the fact that majority of our population is agrarian, lives in villages & we have far less number of cars as compared to western countries. According to the National Crime Records Bureau (NCRB), 118,000 people lost their lives to road accidents in 2008 – around 14 deaths an hour or an average of more than 320 deaths per day – a significant increase of 40% as against the 2003 figures. In fact, road accidents claim more lives than terrorism. By 2050, it is estimated that India shall have maximum number of automobiles, even more than USA. The irony is that infrastructure growth in India is not keeping pace with the auto boom which has resulted in so many road deaths. “Over 1/3rd of lives can be saved if emergency medical facilities like timely TBI treatment & post-operative neuro-rehabilitation are provided to victims. We are far behind – 1 out of every 6 trauma victims die here as compared to 1 out of every 200 trauma victims in the USA. This is a serious issue which needs to be addressed nationally,” adds Dr. Prasad.
IHIF regularly conducts Primary Trauma Care (PTC) Course, a one-day course for first responders i.e. people who are the first to be present after the accident like bystanders, ambulance attendants, policemen, media personnel, etc. The first hour after the injury is referred to as the ‘Golden Hour’. Proper management in the golden hour saves lives & reduces disability owing to TBI. Creating a network of first responders provides the best chance that the victims will receive the best immediate aid possible. Besides this, IHIF also conducts PTCs for nurses / paramedics / doctors (two day course) which is a specialized training program to educate them on how to best diagnose & give immediate aid to patients with head injuries & poly-trauma. Disaster Management Exercises or drills are conducted from time to time by simulating disaster scenes & involving first responders, paramedical & medical professionals as well as public health & local administration on how to respond & cope with natural or man-made disasters, focusing on pre-hospital response & hospital preparedness, with the objective of providing appropriate & immediate medical aid to a large number of victims simultaneously.
