Falling asleep while driving without a safey belt, Mr. Wun was involved in a serious motor vehicle accident that resulted in a fracture of his C6 vertebra. At the time he was 22 years old. Following an emergency surgery to stabilize his spine, the injury left him with an ASIA A, C6 tetraplegia. He remained in an intensive care unit (ICU) for four months, where interventions focused on healing his bodily structures and improving his bodily functions. To assist him with respiration after the surgery, a temporary tube was placed through his neck into his trachea (called a “tracheostomy tube”). Unfortunately, this caused difficulties in swallowing (“dysphagia”) and a second tube (known as a “percutaneuous endoscopic gastrostomy tube” or “PEG tube”) was placed for feeding directly to the stomach, minimizing his need to swallow.

Within the ICU, longer-term rehabilitation was not undertaken. In Thailand, families of SCI patients are regularly instructed to perform much of a patient’s care soon after he or she is stabilized.

Thus, Mr. Wun was discharged from the ICU and was brought to his mother’s home, where she – a trained nurse – took responsibility for his care and rehabilitation with the assistance of two household servants.

In the ensuing time, his mother and the housekeepers planned to adapt the house and surrounding area for wheelchair access. The costs for these adaptations were borne primarily by the family.

Additionally, a physiotherapist treated Mr Wun three times the week. Over the next eight months she oversaw the majority of his care.

During this period, Mr. Wun faced challenges that included greatly impaired mobility, poor upper and lower extremity functioning, incontinence and respiratory impairments. Additionally, the fistula 16 that remained once his tracheostomy tube had been removed led to further difficulties in both speaking and eating.

Mr. Wun quickly discovered that one of the greatest difficulties that impacted his quality of life was a lack of accessibility. While his family’s financial resources were sufficient to allow for greatly adapting both the indoor and outdoor areas within the perimeter of their property (e.g. installing ramps and making rooms and the bathroom facilities accessible), the world beyond the home remained out of reach. His wheelchair was heavy and cumbersome and maneuvering it outdoors or about town was next to impossible. High steps, unpaved sidewalks and roads, and inaccessible public transportation are environmental barriers that Mr. Wun has not been able to overcome. Even if transported directly to public areas, it did not take long to find new barriers: for example, wheelchair accessible public restrooms are a rarity.

One year following his SCI, Mr. Wun was admitted for the first time to a nearby hospital’s rehabilitation unit. Here he received a routine reevaluation, additional care and follow-up rehabilitation. He remained in the unit for one month of intensive therapy and rehabilitation focusing on his “complex limitations in functioning.” This included a number of interventions for the treatment and/or prevention of secondary conditions, dysphagia (swallowing training), respiratory functions (through another tracheostomy tube, regular suctioning of sputum and improving his “ineffective cough”), bladder management, self-care, and mobility (primarily changing body positions and balance).

He returned home, having made some minor improvements. Aside from trying to increase his mobility, little could be done for many other problems, not to speak about the problems related to the environment around him. In addition, four weeks later an unsuccessful attempt was made to close the wound left by the tracheostomy tube which was not healing on its own.

Sixteen months after his SCI, Mr. Wun was again readmitted to the Rehabilitation Unit to further address his tracheostomy incision, ongoing spasticity and bladder problems, and his continued dependence in both self-care and mobility.

Moving inside the house is no problem. But I am inside 24 hours a day. My biggest problem is not being able to get out...not being able to get around outside.

Mr. Wun