Farooq Azam Rathore

Background: About 750 people were identified with sustained spinal cord injuries (SCI) in the October 05 earthquake. Their management was complicated by the inadequate rehabilitation services. Those returning homes did not have access to proper follow-up services.

The study: Cross-sectional in Northern Kashmir, Pakistan to follow up earthquake 2005
paraplegics and assess their rehabilitation needs. Number enrolled: 67, of which 42 had SCIs - 24 Male and 18 Females.

Brief… Show more

Background: About 750 people were identified with sustained spinal cord injuries (SCI) in the October 05 earthquake. Their management was complicated by the inadequate rehabilitation services. Those returning homes did not have access to proper follow-up services.

The study: Cross-sectional in Northern Kashmir, Pakistan to follow up earthquake 2005
paraplegics and assess their rehabilitation needs. Number enrolled: 67, of which 42 had SCIs - 24 Male and 18 Females.

Brief results: Predominantly patients (69%) were in their second and third decades, and had complete injury-ASIA A (50%). All were paraplegics with thoraco-lumbar injury. Pressure ulcers were present or had developed, most with grade 2–3 ulcers. Co-morbid conditions
were identified in 7%, while 33% had at least one complication.

Main recommendation: Need to improve community-based rehabilitation for spinal cord injured persons to ensure their transition into mainstream society. CBR recommended as a cost-effective solution in resource constrained settings. Show less

Abstract
Recent natural disasters have highlighted the lack of planning for rehabilitation and disability management in emergencies. A review of our experience with spinal cord injury (SCI) after the Pakistan earthquake of 2005, plus a review of other literature about SCI after natural disasters, shows that large numbers of people will incur SCIs in such disasters. The epidemiology of SCI after earthquakes has not been well studied and may vary with location, severity of the disaster… Show more

Abstract
Recent natural disasters have highlighted the lack of planning for rehabilitation and disability management in emergencies. A review of our experience with spinal cord injury (SCI) after the Pakistan earthquake of 2005, plus a review of other literature about SCI after natural disasters, shows that large numbers of people will incur SCIs in such disasters. The epidemiology of SCI after earthquakes has not been well studied and may vary with location, severity of the disaster, available resources, the expertise of the health care providers, and cultural issues. A lack of preparedness means that evacuation protocols, clinician training, dedicated acute management and rehabilitation facilities, specialist equipment, and supplies are not in place. The dearth of rehabilitation medicine specialists in developing regions further complicates the issue, as does the lack of national spinal cord registries. In our 3 makeshift SCI units, however, which are staffed by specialists and residents in rehabilitation medicine, there were no deaths, few complications, and a successful discharge for most patients. Technical concerns include air evacuation, early spinal fixation, aggressive management to optimize bowel and bladder care, and provision of appropriate skin care. Discharge planning requires substantial external support because SCI victims must often return to devastated communities and face changed vocational and social possibilities. Successful rehabilitation of victims of the Pakistan earthquake has important implications. The experience suggests that dedicated SCI centers are essential after a natural disaster. Furthermore, government and aid agency disaster planners are advised to consult with rehabilitation specialists experienced in SCI medicine in planning for the inevitable large number of people who will have disabilities after a natural disaster. Show less

Abstract
STUDY DESIGN:
A case report of spinal cord dysfunction following meningococcal meningitis.
OBJECTIVES:
To describe a rare complication of meningococcal meningitis.
SETTING:
Spinal Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan.
METHODS:
A young healthy male developed meningococcal meningitis followed by acute onset low thoracic flaccid paraplegia with complete motor and sensory loss and sphincter disturbance. He responded well to… Show more

Abstract
STUDY DESIGN:
A case report of spinal cord dysfunction following meningococcal meningitis.
OBJECTIVES:
To describe a rare complication of meningococcal meningitis.
SETTING:
Spinal Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan.
METHODS:
A young healthy male developed meningococcal meningitis followed by acute onset low thoracic flaccid paraplegia with complete motor and sensory loss and sphincter disturbance. He responded well to antibiotics but was not investigated for causes of paraplegia. While at home in a rural area, he developed pressure ulcers, anemia and depression. Magnetic resonance imaging of the whole spine and computed tomography scan of the brain performed after 4 and 10 weeks were normal.
RESULTS:
The patient had a comprehensive rehabilitation at our institute. Recovery was complicated by ossification in the right thigh, which responded well to radiotherapy. At 1-year follow-up, the motor deficit and neurogenic bladder and bowel persisted and the patient remained wheelchair dependent for mobility.
CONCLUSION:
Several mechanisms have been proposed to explain spinal cord damage after meningitis. These include spinal cord infarction; autoimmune-mediated inflammatory myelopathy and direct infection of the cord. Most probable cause of spinal cord dysfunction in this case was thoracic myelopathy. Show less

Study design: Prospective observational study.
Objectives: To assess the prevalence of symptomatic deep vein thrombosis (DVT) in earthquake
survivors with spinal cord injury (SCI).
Settings: Rawalpindi, Pakistan, in the months after the October 2005 earthquake.
Methods: Earthquake survivors (n¼187) with acute SCI were enrolled after verbal informed consent.
Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a
detailed clinical and… Show more

Study design: Prospective observational study.
Objectives: To assess the prevalence of symptomatic deep vein thrombosis (DVT) in earthquake
survivors with spinal cord injury (SCI).
Settings: Rawalpindi, Pakistan, in the months after the October 2005 earthquake.
Methods: Earthquake survivors (n¼187) with acute SCI were enrolled after verbal informed consent.
Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a
detailed clinical and radiological assessment was performed. They were followed for 10 weeks for
clinical signs and symptoms suggestive of DVT. Case with clinical suspicion of a DVT underwent a
duplex scan of both legs to confirm the diagnosis. The influence of age, gender, American Spinal Injury
Association (ASIA) grade and lower limb fractures on occurrence of DVT was determined.
Results: There were 80 men and 107 women with a mean age of 28.3±12.4 years. Seventeen
patients were clinically suspected to have a DVT and ultrasound was positive in nine (4.8%). There was
no influence of age (P¼0.4), gender (P¼0.4), ASIA grade (P¼0.1) or presence of a lower limb fracture
(P¼0.6) on the occurrence of a DVT.
Conclusion: This study adds further evidence to support the belief that the incidence of DVT in
Southeast Asian patients with an SCI is lower than the reported incidence in the West. It may not be
necessary to apply the recommendations for DVT prophylaxis in Caucasians with SCI to other groups,
including Southeast Asians.
Spinal Cord (2008) 46, 523–526; doi:10.1038/sj.sc.3102170; published online 29 January 2008 Show less

Objective: To identify the epidemiological pattern of traumatic spinal cord injuries (SCI) presenting at a
rehabilitation institute of a developing country
Methods: Eighty three patients of traumatic SCI admitted at Armed Forces Institute of Rehabilitation Medicine
in 2006 fulfilling the inclusion criteria were enrolled. Detailed clinical evaluation and radiological assessment was
done along with identification of mechanism of injury, mode of evacuation and presence of associated… Show more

Objective: To identify the epidemiological pattern of traumatic spinal cord injuries (SCI) presenting at a
rehabilitation institute of a developing country
Methods: Eighty three patients of traumatic SCI admitted at Armed Forces Institute of Rehabilitation Medicine
in 2006 fulfilling the inclusion criteria were enrolled. Detailed clinical evaluation and radiological assessment was
done along with identification of mechanism of injury, mode of evacuation and presence of associated injuries.
Data analysis was done in January 2007 and results were compiled and analyzed using SPSS 13.
Results: There were 68(81.9%) males and 15(18.1%) females. Mean age was 28.3 ± 12.4 years. Majority of the
patients were in their second decade 43 (51.8%) years. Ambulance evacuation was carried out in only 18
(22.2%) patients and none received any spinal trauma first aid and log roll at the injury site. Most of the patients
were paraplegics 49 (71.1%), 48 (57.8%) had complete injury and 43 (51.8%) spinal fixation. Fracture dislocation
was the predominant vertebral column injury in 25 patients. Associated injuries and problems were present in
49.4% patients.
Conclusion: Epidemiology of SCI in a developing country has unique epidemiological features and problems,
which is different from a developed country. This was to be considered while formulating a plan for SCI
management and rehabilitation. There is a dire need to establish a SCI registry in Pakistan, in order to improve
the spinal trauma evacuation protocols and develop spinal rehabilitation centers (JPMA 58:53;2008). Show less

Abstract
BACKGROUND:
Neurogenic Thoracic Outlet Syndrome (TOS) is a set of signs and symptoms existing due to compression of brachial plexus in the cervical area. We performed the study to highlight the role of therapeutic exercises on patients with neurogenic thoracic Outlet Syndrome.
METHODS:
This quasi-experimental study was carried out at Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi. Fifty consecutive patients of neurogenic TOS of both genders and all… Show more

Abstract
BACKGROUND:
Neurogenic Thoracic Outlet Syndrome (TOS) is a set of signs and symptoms existing due to compression of brachial plexus in the cervical area. We performed the study to highlight the role of therapeutic exercises on patients with neurogenic thoracic Outlet Syndrome.
METHODS:
This quasi-experimental study was carried out at Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi. Fifty consecutive patients of neurogenic TOS of both genders and all ages were selected. Patients were diagnosed clinically and the diagnosis was confirmed by electrodiagnosis. These patients were asked to follow a therapeutic exercises program for 6 months. Outcome measures included Visual Analogue Scale (VAS) and Ulnar Nerve Conduction Velocity across neck. Results were compared by applying relevant tests of significance on follow up visits at 3 and 6 months.
RESULTS:
Mean age was 39.1 +/- 7.79 years. Thirty seven (74%) cases were females and thirteen (26%) were males. On each visit, statistical analysis showed significant improvement with therapeutic exercises. After 6 months of conservative treatment, 17 (34%) of patients showed full recovery, 14 (28%) had marked improvement, 16 (32%) had partial improvement while 3 (6%) patients reported with persistent severe symptoms.
CONCLUSION:
Current study shows that a trial of therapeutic exercises provides relief of symptoms of Neurogenic Thoracic Outlet Syndrome in majority of patients Show less

Study design: Prospective observational study.
Objectives: To identify the epidemiological features specific to spinal injuries as a result of an
earthquake.
Settings: Rawalpindi, Pakistan in the months after the 8 October 2005 earthquake.
Methods: In the month after the earthquake, the one established rehabilitation center was
augmented with two makeshift spinal cord centers. Information on mechanism of injury, mode
of evacuation, associated injuries was gathered, and a… Show more

Study design: Prospective observational study.
Objectives: To identify the epidemiological features specific to spinal injuries as a result of an
earthquake.
Settings: Rawalpindi, Pakistan in the months after the 8 October 2005 earthquake.
Methods: In the month after the earthquake, the one established rehabilitation center was
augmented with two makeshift spinal cord centers. Information on mechanism of injury, mode
of evacuation, associated injuries was gathered, and a detailed clinical and radiological
assessment was performed. Neurological status and functional outcome was determined after
10 weeks.
Results: Of an estimated 650–750 spinal cord injuries, 187 were admitted to these centers,
including 80 men and 107 women with a mean age of 28.3712.4 years. Injuries occurred while
standing in 57.8% of patients. Most (83.4%) who reached the spinal cord center were airlifted.
A urinary catheter had been placed before admission in 91.5%. Most of the patients were
paraplegic 89.3, with 50.8% incomplete injuries. Fracture or fracture dislocation was present in
70, and 75% underwent spinal fixation. Although pressure ulcers (28.9%) and urinary tract
infections (39%) were common, deep venous thromboses (4.8%) and depression (5.8%) were
seldom detected. At 10 weeks, 75% were continent or performing intermittent catheterization.
There were no deaths and two births.
Conclusion: After a disaster, evacuation of persons with a spinal cord injury to a specialized
center results in low mortality. Response planning for disasters should include early aggressive
medical rehabilitation.
Sponsorship: None. Show less

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This is a list of my manuscript published and Indexed in Medline(Pubmed)