1. 2013-2014 Conducted by: Rune Nilsen (CPO), Pia Nolstedt (CPO, MSc), Thomas Glott (MD) Rehabilitation Science Organisation (ReSciO) Peer group training among people with a spinal cord injury in Cambodia

2. Peer group training

3. Disability in the world More than one billion people 80% in low income countries Poor The largest humanitarian crisis in the world No coordinated aid

4. Cambodia Population 15 million Old culture 40 years of conflict Khmer Rouge 1975-79 Killed all educated people 2 generations without proper education Breakdown of society, education, health, politics trade. Many very poor people People with disabilities experience social discrimination and stigma

5. Spinal cord injury rehabilitation center in Battambang Built 1993 by HI Handed over to government in 2008 Center about to be closed 2009 - We established Rehabilitation Science Organisation (ReSciO) in 2009. (Brønnøysund Register).

6. ReSciO is a non- governmental organization with the aim to promote, organize and support cross-cultural international projects in the area of rehabilitation science.

7. Spinal cord injury In a poor country without proper rehabilitation a person with a spinal cord injury will live on an average 6 months With proper rehabilitation the same person will have almost normal life expectancy

8. Project background - Quality of life study in Cambodia and Norway 2010 (WHOQOL-Bref) - Nutritional study in 2011 Battambang - Report on pressure ulcers in Battambang 2011 - Qualitative study of the life situation among people with spinal cord injuries in Cambodia 2012 -Continued QOL study -2014

9. WHOQOL-Bref results 2010

10. Project background from the villages

11. Project background Results from previous studies suggested a peer group training project could address important issues. Previous studies also decided topics in the training

12. Peer group training Study performed by Cambodian Spinal Cord Injury Association Leader and project manager Sokha Cheati 3 meetings over 6 months

13. Peer group training project topics 1. Health: prevention and treatment of pressure ulcers, bladder and bowel management. 2. Mobility: transfer techniques in wheelchair; using ramps and stairs; physical activities. 3. Social activities: going to a local market, buy food, cooking and games.

14. Peer group training project First meeting Medical examination Mobility practice and tests Health related information and discussion WHOQOL-Bref questionnaire Social activities

15. Second meeting Mobility practice and test Health related information and discussion Social activities

16. Third meeting Mobility tests Medical examination WHOQOL-Bref questionnaire Social activities

17. Topic: Health 1. Physical examination by a medical doctor at 1 st and 3 rd meeting 2. Discussion and information about pressure ulcers and bladder management. 3. WHOQOL-Bref questionnaire

18. Health 1 Physical examination Common finding: Pressure ulcers Contractures Pain Spasticity Bladder and bowel problems Depression

19. Health 1 Physical examination Example of referral made by the medical doctor: - surgery of the pressure ulcer is needed - ultrasonography exam to check urine residue and infections Results: Comparison between the 1 st and 2 nd medical examination: - The conditions was the same, no improvements at all. Suggested treatment and referral was not completed. - Reason: poor financial and transport possibilities among the participants and treatment not available if they could reach hospital. Need for appropriate technology in rehabilitation of SCI?

20. Health 2 Discussion and information All three meeting included session with discussion and information about prevention and treatment of pressure ulcers, bladder and bowel management. Learned about: Causes, consequences, treatment, and prevention. And the important of adequate bladder and bowel management, how to do it, hygiene, Intermittent catheter.

21. Health 2 information

24. Health 3 WHOQOL-Bref WHOQOL-Bref, 4 domains: Physical health Psychological Social relationships Environment The four domain scores perception of quality of life in each particular domain. Establishing a baseline score, and then after interventions, Looking at changes in quality of life over the course of interventions.

25. Quality of life– WHO QOL N.S.P=0.02 P=0.01 P=0.03 N.S. = Ikke signifikant

26. Mobility Eight mobility tasks: Three wheels on smooth floor(100 m) Two wheels on smooth floor ( 30 m ) Two wheels descending the ramp (5 m) Three wheels on rough ground (10 m) Descending one step Transfer from wheelchair to chair Transfer from wheelchair to toilet Transfer from wheelchair to floor

27. Mobility results Almost everyone improved their performance in all eight tasks between the first and third meeting. Main reason for not completing a task was fear.

28. Transfer from wheelchair to toilet (n=12) P=0,04 51

29. Wheelchair 100 meter race (n=12) P<0,001 137

30. Social activities Go to a local market and buy food Cooking Games Karaoke

31. Social gathering with karaoke

32. PSGT cost in three sessions NoNoItemsUnit# of unitUnit costDayAmount 1Perdiem allowancePerson6102120 2Travelling allowanceTrip67284 3AccommodationNight66272 4Total 3 items 276 1Total 3 itemsMeeting3276 828 2CookTime140 3KaraokeTime140 4Medical examinationTime255 110 5Grand total 1018 USD Peer group training costs

33. Participant feeback "I have a good feeling when meeting other people with spinal cord injury. Before I did not know anyone, now we could share experiences". "I think we should meet regularly, like go for shopping, cooking or have a meal together at the market.

34. Challenges Funding Possible participants too weak to travel

35. Continuation of the project

36. Questions?