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Working with SCI/D

Reprinted from PN/Paraplegia News November 2015

For many individuals with spinal-cord injury or disease (SCI/D), employment is a vital part of their lives, not only for financial reasons, but also to maintain their independence

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For many individuals with spinal-cord injury or disease (SCI/D), employment is a vital part of their lives, not only for financial reasons, but also to maintain their independence and sovereignty.
Research has consistently shown that people who are employed after SCI/D live longer, have higher satisfaction with life and better health outcomes than individuals who aren’t working.
Although many with SCI/D have successful careers, they have to overcome a great number of barriers not faced by able-bodied individuals.
Knowing how to properly manage SCI/D-related issues in the workplace is imperative in overcoming some of these barriers.

Know Your Rights

The Americans with Disabilities Act (ADA) requires all employers to make “reasonable accommodations” for a person with a disability, unless the accommodation causes an undue hardship on the employer.

Typical examples of reasonable accommodations are:

  • Flexible work schedules that allow an employee with SCI/D who has a lengthy morning personal care routine, to start his or her workday later.
  • Installing special software and hardware so a person with minimal or no hand function can work on a computer.
  • Raising an office desk and 
making supplies, materials and office machines easily reachable and accessible.
  • Providing a private changing area for individuals who may have occasional bladder accidents. Allowing more frequent work breaks to accommodate medical care needs.

These reasonable accommodations eliminate barriers that may prevent an individual with SCI/D from being able to perform the necessary functions of the job. In addition to obtaining reasonable accommodations, it’s critical to clinically manage the health conditions associated with SCI/D.

Manage Your Bladder

The main goal of bladder management is to protect and preserve 
kidney function.
Emptying your bladder on a regular basis throughout the workday is an essential component in maintaining kidney function. There are two general guidelines for bladder management. The first is to have a regimented bowel program. Constipation can impair bladder function and increase the risk of a urinary tract infection. Secondly, keep the genital area as dry as possible. As mentioned earlier, a reasonable accommodation by the employer is to provide a private changing area. This can be used for intermittent catheterization and other bladder management needs. In addition, it’s essential to maintain adequate fluid intake throughout the day. This decreases the risk of infection and limits kidney stones.

Regulate Your Bowel

After sustaining SCI/D, your bowel may not work the same as before. Therefore, establishing a regular bowel program ensures predictable bowel movements and helps avoid accidents.
While addressing this topic with your employer may be uncomfortable, it’s extremely important for them to be aware of your care needs throughout the workday. Many individuals with SCI/D prefer to schedule bowel care early in the morning prior to their daily activities. Therefore, it’s essential to allow enough time in the morning to perform bowel care and to work out a schedule with your employer that meets this need. In addition, it’s important to eat a well-balanced meal with high-fiber foods and to drink an adequate amount of fluids.

Monitor Your Skin

Several skin concerns caused by the loss of sensation can also happen to people with SCI/D. Performing routine skin checks throughout the workday is essential in preventing pressure ulcers and maintaining proper skin integrity. It’s recommended that skin checks be performed at least twice a day, preferably in the morning and at night. During the workday, perform pressure releases every 15 minutes to take the weight off the tailbone and other bony prominences. Various types of pressure releases include:

  • Pushing up out of the seat of 
the wheelchair and holding for 30–60 seconds
  • Moving side to side, lean to each side for 30–60 seconds per tilt
  • Bending the chest forward onto your knees and holding the position for 30–60 seconds

Shift positions as much as possible throughout the workday. A good way to ensure these pressure releases are done routinely is to set a reminder on your watch or phone. It’s also imperative to use a well-maintained seat cushion that gives good pressure relief. The key to a successful work career is setting up a specific routine and communicating your medical care needs to your employer to create a positive and comfortable workplace environment.

Farnaz Firoz, RN, BSN, serves as an Associate Director of Paralyzed Veterans of America’s Medical Services Department in Washington, D.C.

 

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