Injuries of the central nervous system (CNS), such as acquired brain injury (ABI) and spinal cord injury (SCI), are one of the most common causes of long-term disability worldwide. Individuals with CNS-related disabilities often experience chronic pain, cognitive and neurological deficits, impaired mobility, and overall low quality of life as a result of their injuries. People living in community settings may face additional challenges as they and their loved ones manage the daily realities of long-term disabilities without support from inpatient care facilities.
Given the serious nature of CNS-related long-term disabilities, the World Health Organization developed the Disability Assessment Schedule 2.0 (WHODAS 2.0), an assessment tool that helps clinicians and researchers determine an individual’s disability severity, disability-associated outcomes, and quality of life. The WHODAS 2.0 enables health care professionals to understand patterns of disability among people with CNS injuries, improving their ability to care for these patients and to manage health resources for long-term disabilities.
Although both ABI and SCI are CNS-related injuries, symptoms differ by the location of injury (i.e., brain or spinal cord), so researchers are interested to understand how diverse experiences of CNS injuries inform disability health care. To this end, a recent study used the WHODAS 2.0 to compare disability outcomes between people with ABI and people with SCI who live in community settings. The research team enrolled 505 participants with severe disability as a result of CNS injury. Most participants (322) had ABI (from stroke, traumatic injury, or neurodegeneration), while 122 participants had SCI (from traumatic injury or degenerative disease). Each participant completed the WHODAS 2.0. The researchers used their responses to determine that:
- Participants with ABI experienced more cognitive disabilities and difficulties maintaining relationships.
- Participants with SCI were more likely to experience mobility-related disability.
- Participants who recently sustained ABI experienced higher degree of disability across all domains (including cognition, mobility, self-care, relationships, and life activities) than those who sustained ABI more than 10 years prior to the study.
- Most participants in the study were unemployed.
In general, people with ABI primarily struggled with cognition and social deficits, while people with SCI primarily struggled with mobility. Despite these differences, however, there were no significant differences in socioeconomic status or disability severity between ABI and SCI participants, suggesting that severe CNS injuries may be equally debilitating among people living in community settings. Although people with ABI and SCI may require different interventions target for injury-specific challenges, there remains an urgent need to allocate health care resources towards disability care for all community-dwelling people with CNS injuries.
Yoon SY, Leigh JH, Lee J, & Kim WH. Comparing activity and participation between acquired brain injury and spinal cord injury in community-dwelling people with severe disability using WHODAS 2.0. Environmental Research and Public Health. (April 2020).