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 A pilot project

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. 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

8. WHOQOL-Bref results 2010

9. Project background from the villages

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

11. Peer group training project A six month pilot project 3 men and 3 women Battambang province 3 meetings, each meeting lasted for 2 days, (27-28 November 2013, 5-6 January 2014, 5-6 Mars 2014). 3 topics

12. 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.

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

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

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

16. 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

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

18. Health Physical examination Example of referral made by the medical doctor: - severe headache and depression - 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.

19. Health 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. Results: increased awareness among the participants about pressure ulcers and bladder and bowel management.

22. Health 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.

23. 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

24. 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. One participant had severe spasticity and was not able to perform all tasks.

25. Social activities Transportation to a local market Cooking Games Not easy to measure the effect of those activities, but they were considered important, as previous studies showed an increased amount of depression and social isolation among this group of people.

26. Challenges Project management from Norway Teach the local team about the importance of accurate data collection Misunderstandings and cultural differences Going to the market

27. Challenges Only one intervention at a time would make it easier to evaluate results

28. Continuation of the project Phase 2. Evaluate the pilot project in detail, adjust and optimize. We will do it one more time in 2015. Need to assure that the activities are adapted to the individual capacity of the participants to avoid fear.

29. Questions?