Peer Counseling

Patient sustaining an injury to the spinal cord undergoes significant changes in host of behaviors for e.g. the ability to relieve pressure on the skin and ability to ambulate. The disability changes the patient's need as well as the way to fulfill these needs. But the new behaviors will not occur until the patient has learned them. Effective learning would be not only to acquire those skills but also to use them at appropriate time.

A Peer counselor can provide a lot of Psychological support to the patient and can help him/her in coming out of the depression phase and can advise the patients about the coping mechanism from his personal experiences and also of those who have been counseled in the past. 

 Psycho Social Counseling
 Sexuality and Spinal Cord Injury
 Vocational Counseling
 Special Employment Exchanges for the Physically Handicapped
 Vocational Rehabilitation Centre
 District Rehabilitation Centre
 Regional Rehabilitation Training Centre ( RRTCs)

Psycho Social Counseling

Spinal cord injury is a lesser known term. More over patients and their families do not believe that the patient may not walk again. If doctor makes such a statement, they feel doctor is not competent one and start looking for some one else. The role of a Peer Counsellor along with Psychologist becomes very crucial in deciding the time of breaking the news to the patient. 

Counseling in case of spinal cord injured is more about providing information rather then counseling in the real term. Any person who was walking and moving around day before would get a shock of one's life, when being told that he may not walk again. One will be depressed, feel completely helpless and even think of suicide. The problem of loss of control over bladder and bowel further adds to dejection from life. If the person happens to be the sole earning member of the family, depression becomes manifold. But then it is a temporary phase and the longitivity of the phase would depend on one's personality make up but more on the kind of counseling and advice one gets during hospitalisation.

There are different components of rehabilitation but two most important specially in the beginning are the medical rehabilitation and physical rehabilitation. During the process of medical rehabilitation, along with the stabilisation of the spine the patient has to be given ample knowledge about the morphology and physiology of the important systems like Urinary, Digestive, Excretory etc. That way one would understand the reason and thus the importance behind intermittent catheterisation or tapping in bladder management and changing of position to relieve pressure regularly for prevention of pressure sores. Sexual rehabilitation too have to be covered under medical rehabilitation itself. 

Physical rehabilitation at the physiotherapy and occupational therapy department helps in harnessing the residual muscle power in order to learn transfers and other activities of daily living such as feeding, dressing, grooming etc. Proper medical and physical rehab lays the right foundation for Psycho-Social rehabilitation.

Psyco-Social rehabilitation would depend on the personality, education, status in the family , age, background and various other factors. This would make the way for the economic rehabilitation through vocational rehab leading to integration of the individual into the society.
  

Sexuality and Spinal Cord Injury

People often ask ‘Can disabled people have sexual urges?’ Of course, aren’t they human beings? Even animals have them. On the one hand society talk extensively on the concept of integration and how the disabled people should lead a normal life. But when it comes to having intimate relationships they invariably get scared and pretend that such a problem does not exist and sex is hardly mentioned during various counseling sessions. In the case of spinal injured who have lead a normal life till a certain age, sex becomes more important because most of them have experienced it. 

Probably soon after the accidents the injured may not experience sexual desires but gradually and slowly they return and do not diminish as time goes on. It is assumed they would as there is no outlet. Also it is a myth that the sexual energy can be sublimated by channeling onto creative activity. Sex and sexuality are more psychological than physical issues and when a person has reached a stage of reasonable psychological equanimity with his/ her physical condition then the matter can be addressed. 

Sex is natural and we all need it and sometimes when this problem is not addressed it can lead to psychological trauma, frustration and may even heighten the already existing depression, thus lowering the self-esteem. But assertiveness on the part of the injured is important because nobody is going to think of you as a sexual being if you do not think of yourself as one. Your sexuality and your actions in the society are your responsibility. 

The injury may alter many things, the attitude and one’s life style but not the process your body goes through when it is sexually aroused. There is rise in the blood pressure, the increase in the heart rate, and the reflexes of the muscles. What changes is the ability to feel sensation in the genital area and other parts of the body? The exact degree of change depends on the level of the lesion. For persons, however, the essential sexual functions are unaltered, though there may be a decrease in lubrication of the vagina and they may have little or no sensation on the clitoris. Many people with disabilities find that sexual intercourse in the traditional position is often difficult and sometimes impossible. But using differing positions can help to overcome problems. 

It may take a little time, trial and error to find the position that is comfortable and satisfying. Getting an erection is one of the problems which men face. Men sometimes have a problem getting a full and stiff erection or the stiffness is lost before the intercourse begins. However if there is reasonable enlargement of the penis it should be possible to ease it into a woman’s vagina with the fingers of either partner. Also there are various aids to get an erection such as Penile injection of Papaverine, Vacuum erection aid, etc. Ejaculation is much more difficult than an erection. 

Even if one is able to ejaculate, the patient may experience a retrograde ejaculation i.e. instead of from the penis the semen backflows into the bladder. In persons with higher lesion, sexual activity especially ejaculation may bring on autonomic dysreflexia, a condition where the blood pressure rises very high and can even lead to a heart attack if medical intervention is not applied. Even if ejaculation does take place the spinal injury generally affects the ability to produce viable sperms. Whereas in case of women the fertility is not affected by spinal injury, the periods may cease for a while after the injury but they would resume as earlier. They are fertile and thus women should think about contraception if in a sexual relationship.

Vocational Counseling

Why should proper vocational counselling and training is required for people with spinal cord injury?

Statistics from India on occurrence of Spinal cord injury: 

• Age range for onset of injury: 20 - 40yrs
• Most productive population: 68%
  Male: 75%
• Injury from fall from height: 70%
• Rural population: 77%
• Senior citizens: 80%
• Illiterate: 80%

The chart above clearly shows that victims of spinal cord injuries fall in the most productive age group of 20-40 years and 75% of them are male. Nobody can dare neglect such a huge work force. More over it makes a good economic sense to make these people productive members of the society through proper vocational guidance rather then leave them as parasites on the economy of the country. One needs to get education, vocational counselling and training to be well economically rehabilitated.

There are various Government agencies working in the field of rehabilitation and looking into vocational guidance and training.

The contact person to avail the different concession/facilities would be Director, Social Welfare Department or the following officials of the respective State/Union Territory Govt.

A) For education / scholarship 

• District Inspector of Schools 
• District education officer 
• District Social Welfare Officers 
• Directorate of Education 
• Superintendent, Vocational Rehabilitation Centre for Handicapped 
• Principal of School 

B) For Training 

• Principal, Industrial Training Institute 
• Superintendent, Vocational Rehabilitation Centre for Handicapped 
• Directorate of Employment and Training 
• Director, Directorate of Technical Education and Training 
• Vocational Training Institutes for Persons with Disabilities 
• Industries Promotion Officer, Block Development Officer of Your Area 
• Project Officer, District Rural Development Agency of your District 
• Manager ( Cottage Industries), District Centre of your district 
• Head of Government Training Institute of your area 

C)For Employment 

• Superintendent, Vocational Rehabilitation Centre 
• Employment Officer of Special Employment Exchange for Physically Handicapped of your State 
• Employment Officer -in-charge, Placement Cell of Handicapped, District Employment Exchange of your District 
• Placement Officers of leading voluntary organization working for employment of people with disabilities. 
• Refer advertisements of Staff Selection commission, Union public Service Commission, Banking Service Recruitment Board, Post & Telegraph Dept., State Public Service Commission and Collectorate advertisements in which number of vacancies are being advertised as reserved for Persons with disabilities 

D)For Self Employment 

• Superintendent, Vocational Rehabilitation Centre 
• Director, Directorate of Social Welfare 
• District Social Welfare Officers 
• Project Officer, District Rural Development Agency of your District 
• Manager ( Cottage Industries), District Centre of your district 
• All the Nationalized Banks 
• Sub-Divisional Officer, Telephone Division of your Area for Telephone booth 
• Chairman of Municipal Corporation, Municipalities, NCA's for allotment of Kiosks, selling outlets, license for cart-puller etc 
• President Lion's club, Rotary club, Young Men club and other Social club / Societies 

Special Employment Exchanges for the Physically Handicapped

The Employment Officer Special Employment Exchange for Physically Handicapped Barrack No. 1/ E - 5, Block A Curzon Road,New Delhi - 110001	The Employment Officer Special Employment Exchange for Physically Handicapped Trans Yamuna,Delhi
The Regional Employment Officer, Special Employment Exchange for Physically Handicapped Azamabad, Hyderabad - 500020 Andhra Pradesh	The Employment Officer Special Employment Exchange for Physically Handicapped Visakhapatnam,Andhra Pradesh
The Assistant Director Special Employment Exchange for Physically Handicapped Naharlagun,Andhra Pradesh	The Employment Officer Special Employment Exchange for Physically Handicapped Jorhat,Assam
The Employment Officer Special Employment Exchange for Physically Handicapped Combined Building Labour Bailey Road Patna - 800001,Bihar	The Sub-Regional Employment Officer Special Employment Exchange for Physically Handicapped Kothi Building Baroda ( Gujarat )
The Employment Officer Special Employment Exchange for Physically Handicapped Mehsana, Gujarat	The Sub - Regional Employment Officer Special Employment Exchange for Physically Handicapped Multistory Building  Nanpura, Surat Gujrat
The Employment Officer Special Employment Exchange for Physically Handicapped 1282, Sector 13 - C Chandigarh - 160018	The Employment Officer Special Employment Exchange for Physically Handicapped Jammu, Jammu & Kashmir
The Employment Officer Special Employment Exchange for Physically Handicapped No. 5 Crescent Road High Ground, west Banglore -560020,Karnatka	The Employment Officer Special Employment Exchange for Physically Handicapped Mysore,Karnatka
The Employment Officer Special Employment Exchange for Physically Handicapped Kozikoda,Kerala	The Employment Officer Special Employment Exchange for Physically Handicapped Ernakulam,Kerala
The Employment Officer Special Employment Exchange for Physically Handicapped Kollam,Kerala	The Employment Officer Special Employment Exchange for Physically Handicapped Nandanvan Road Palayam, Trivandrum Kerala
The Employment Officer Special Employment Exchange for Physically Handicapped 965 Wright Town Jabalpur - 482001 Madhya Pradesh	The Employment Officer Special Employment Exchange for Physically Handicapped Mercantile Chambers 3rd Floor, Graham Road Ballard Estate, Mumbai - 400001 Maharashtra
The Employment Officer Special Employment Exchange for Physically Handicapped Nagpur, Maharashtra	The Employment Officer Special Employment Exchange for Physically Handicapped Pune, Maharashtra
The Employment Officer Special Employment Exchange for Physically Handicapped Thane,Maharashtra	The Employment Officer Special Employment Exchange for Physically Handicapped Imphal, Manipur
The Employment Officer Special Employment Exchange for Physically Handicapped Plot No. 357, Shaid Nagar Bhubaneswar,Orissa	The Employment Officer Special Employment Exchange for Physically Handicapped Block No. 2, Gill road Ludhiana,Punjab
The Employment Officer Special Employment Exchange for Physically Handicapped Ajmer,\Rajasthan	The Employment Officer Special Employment Exchange for Physically Handicapped Alwar,Rajasthan
The Employment Officer Special Employment Exchange for Physically Handicapped Jaipur,Rajasthan	The Assistant Director Special Employment Exchange for Physically Handicapped 33 Mount Road, Nandanam Tamilnadu
The Employment Officer Special Employment Exchange for Physically Handicapped Agartala,Tripura	The Regional Employment Officer Special Employment Exchange for Physically Handicapped Agra,Uttar Pradesh
The Regional Employment Officer Special Employment Exchange for Physically Handicapped Aligarh,Uttar Pradesh	The Regional Employment Officer Special Employment Exchange for Physically Handicapped Allahabad,Uttar Pradesh
The Regional Employment Officer Special Employment Exchange for Physically Handicapped Bareilly,Uttar Pradesh	The Regional Employment Officer Special Employment Exchange for Physically Handicapped Ghaziabad,Uttar Pradesh
The Regional Employment Officer Special Employment Exchange for Physically Handicapped Gorakhpur,Uttar Pradesh	The Employment Officer Special Employment Exchange for Physically Handicapped GT Road Kanpur,Uttar Pradesh
The Regional Employment Officer Special Employment Exchange for Physically Handicapped Lucknow,Uttar Pradesh	The Regional Employment Officer Special Employment Exchange for Physically Handicapped Mathura,Uttar Pradesh
The Regional Employment Officer Special Employment Exchange for Physically Handicapped Varanasi,Uttar Pradesh	The Employment Officer Special Employment Exchange for Physically Handicapped 67 Bentinct Street,3rd Floor,  Calcutta,West Bengal

Vocational Rehabilitation Centre

District Rehabilitation Centre

Regional Rehabilitation Training Centre ( RRTCs)

• Regional Rehabilitation Centre (RRTC)
  C/o All India Institute of Physical Medicine and Rehabilitation
  Haji Ali Park, Mahalaxmi, Mumbai - 400034
  Tel - 022 - 4435035
  
• Regional Rehabilitation Centre (RRTC)
  C/o National Institute of Rehabilitation Training and Research
  Oltapur, PO Bairoi, Cuttack - 754010
  Tel - 0674- 22
  
• Regional Rehabilitation Centre (RRTC)
  Limb Centre
  Opp. Hathi Park, Lucknow - 226018
  Tel - 0522 - 242047
  

• Regional Rehabilitation Centre (RRTC)
  Govt. Institute of Rehabilitation Medicine 
  KK Nagar, Chennai - 600083
  Tel - 044- 4821793 & 4821668

National Institutes

• National Institute for Orthopaedically Handicapped
  BT Road, Bon-Hooghl
  Calcutta - 700090
  Tel - 033 - 528379
  
• The Institute for the Physically Handicapped
  4, Vishnu Digambar Marg
  New Delhi -nm 110002
  Tel - 011 - 3314672, 3312403