In this study, half of the participants with SCI had thoracic injury. Most of them lived in Tehran and were unemployed. Participants' profiles are presented in the table 2.
In general, 110 initial codes emerged in this section of the study and eventually data analysis revealed three sub-themes: 1) physical rehabilitation by various methods, 2) tendency towards the use of alternative medical methods, and 3) making effort for self-reliance and one main theme (towards overcoming physical disability).
Towards overcoming physical disability
All participants with SCI had been trying to overcome physical disability. Also, their family caregivers had been trying to help them return to normal life; as well as, their physicians and paramedics had tried to help them in this issue with ordering physical rehabilitation activities and activities daily living education. Therefore, most of our participants with SCI had undertaken physical rehabilitation with the help of their families. Other efforts such as “using alternative medical methods” often had been tested by the affected person and their families. However, most of them had been spending time and money ineffectively. Another effort was self-reliance, which was made by the participants through the long process. Lack of necessary training at home to achieve self-reliance had made the process longer.
- Physical rehabilitation by various methods
Most of the participants had been referred to an occupational therapy and had been given simple mechanical tools such as hand and foot pedals for exercises at home. This sub-theme was extracted by four other sub-themes: 1) maintaining organs function with physical exercises, 2) establishing an appropriate living environment as much as possible, 3) using special rehabilitation services, and 4) using physical aids and equipment. Each of these sub-themes is described below:
1.1. Maintaining organ function with physical exercises
The efforts made by the physical therapists, occupational therapists, family caregivers and individuals with SCI in this subtheme include: A) increasing the motion range and preventing articular deformities with active exercises (by the individuals with SCI) and inactive exercises (by occupational therapist), B) prescribing appropriate means of fixing (such as splints), and C) putting the injured person in correct situation that would increase muscle strength. The primary data categories that created this sub-theme were:
1.1.1. Increasing the disabled organs’ strength above the lesion level
Most participants considered exercises as essential factor in increasing organs’ function above the lesion level.
“Since then, I do the upper body exercises. Now, I (the disabled) need strong hands and arms to move easily as I am a little overweight.” (Paraplegic man, 32-year-old)
1.1.2. Maintaining of organs’ function below the lesion level
Almost all participants did the below lesion level exercises to increase articular movement range and this was mostly noted in those who had been injured for a long time.
“At the beginning, there were some signs days before the injury when I was healthy. But they
began to fade away as the time passed by. The more you improve those remaining abilities; there is more possibility to keep them. For example, I saw a patient with the same injuries, but he did not do anything except for sitting on the wheelchair; so his foot became the size of my hands; but I did a lot of exercises with the help of the therapist and my mother.”
(Tetraplegia man, 32-year-old)
1.2. Establishing an appropriate living environment as much as possible
Most participants only carried out part of what is needed to adjust the home for a person with SCI. However, others were not able to change the home because of being a tenant. So, after living in difficult circumstances for some time, they had to move to a townhouse which is more comfortable for transferring.
“We used to live in a duplex home, so I made a stair rail for her to come downstairs with; but since I have to put her on and off the chair each time we decided to rent a townhouse for convenience.” (Husband of a paraplegia woman, 62-year-old)
1.3. Using special rehabilitation services
Almost all participants had experienced physiotherapy and occupational therapies, even for a short term. They had noted that, these approaches are effective and essential.
“I come here for occupational therapy three times a week, and I also went to a rehabilitation institute; which was offering balance exercises". (Paraplegic woman, 39-year-old)
Some individual with SCI prepared some available tools in the occupational therapy to use them whenever required.
“I bought foot pedals and I thought it would help him to exercise his feet, now we are going to buy hand pedals for home exercises.” (Daughter of a tetraplegia man, 25-year-old)
1.4. Using physical aids’ equipment
Equipment such as canes, walkers, wheelchairs, braces, and Ankle Foot Orthotic (AFO) would reduce the dependency of individuals with SCI and improve their functional independence. Almost all of our participants used some sort of aids and equipment depending on their economic status.
“AFO is a plastic tool for the legs to take a few steps, however, I should hold on to something else. But I am glad that I can still stand on my own foot.” (Paraplegic man, 28-year-old)
Some of the studied participants with SCI had bought the typical physical auxiliary equipment, but others had managed to make their own electric hoists or wheelchairs at home.
"Since it is too difficult for him to move, I bought these electric lifting hoists; so I put him at
the electric lift to wear his pants or sit on his wheelchair". (Mother of a tetraplegia man, 52-year-old)
- Tendency towards the use of alternative medical methods
Some of studied individuals with SCI used alternative or complementary medicine based on the advice of relatives or friends to improve excretion or reduce physical pain. They were looking for recovery. Furthermore, some of them did not do anything else and did not even have job. They had experienced homeopathy, acupuncture, traditional Persian medicine, energy therapy, water therapy and stem cell therapy.
2.1. Testing the homeopathy
Participants used plants and minerals instead of chemical drug witch they called homeopathy. They believe these nature materials stimulate the healing process. In this regard, one of the participants with SCI stated:
“A friend who was suffering from headache was satisfied with homeopathy; I asked her about the technique and she said: “this method helps the body to begin repairing itself, so people can reduce drug consumption. I went there for pain and incontinence and now after a few months, I feel a little better.” (Paraplegia woman, 47-year-old)
2.2. Testing the acupuncture
Most of the individuals with SCI were dissatisfy of acupuncture and called it "ineffective" or "waste of time and money".
“I went to Zanjan city for acupuncture and it was not useful. I wasted my time and money. I'm not doing anything else and looking for recovery” (Tetraplegia man, 31-year-old)
2.3. Testing the traditional Persian medicine
In Iranian traditional medicine everybody has a definite temperament which is determinant to construct all physical or mental characteristics. Some individuals with SCI had used traditional Persian medicine to improve their digestive and motion status.
“Sure! The traditional medicine was quite effective; I was crawling like little kids, but now I can standup. The traditional bloodletting also makes me feel better every time.” (Paraplegia man, 52-year-old)
2.4. Testing the energy therapy
Few participants with SCI were undergoing energy therapy to relieve pain and severe spasms. Participants cited that energy therapy means the touch by energy therapist for health and peace.
They stated that, it had good short-term effects.
“I have a friend who introduced me for energy therapy. I went there and energy therapist touch me, during the energy therapy, my pain stopped for few minutes.” (Paraplegia man, 37-year-old)
2.5. Testing the hydrotherapy
Most of participants with SCI had used water therapy to increase their physical strength according to physicians’ suggestion or advice of friends.
"My doctor told me to go to the pool, and now I think it is so effective as it is softening my joints.” (Paraplegia man, 40-year-old)
2.6. Testing the stem cell therapy
Most participants wanted to try the stem cell therapy (special cells infusion) to restore the sense and movement of the disabled limbs. Some of them satisfied with doing that and few of them were dissatisfied and rest of them didn’t know about the result and they didn’t have comment.
"I have heard, this place offers cell therapy here, so I came to talk to the doctor about my son. This is his second injection and it is relatively expensive and I am waiting for the results.” (Mother of a paraplegia man, 51-year-old)
- Making effort for self-reliance
Most participants tried to change from physical dependence to independence as much as possible. This sub-theme had two sub- sub- themes which were “innovation of family in manufacturing a rehabilitation tool” and “Trying to become independent in personal activities.”
3.1. Innovation of family in manufacturing a rehabilitation tool
Few individual with SCI had done innovations with help of their families to improve their physical conditions. They claimed that there was no equipment available that they needed for physical rehabilitation.
“ I saw something like a baby walker and since I was not able to stand up, I decided to make a large baby walker in big size for myself. I told my family about it and they helped me so it was made by a friend blacksmith. Now, I use the big-sized baby walker and I am satisfied with it.” (Paraplegia man, 28-year-old)
3.2. Trying to become independent in personal activities
Both the injured people and their families tried to make the disabled person independent in doing his/her personal activities. Sometimes the person decided to become independent and at other times the family did not help the person in personal tasks on purpose to make the disabled person to become independent. All participants stated that they had no training on this issue.
“My brother helped me a lot to become independent. He prevented others to feed me so I had to learn how to eat by myself." (Tetraplegia man, 36-year-old)