Secondary Conditions: Can We Be Proactive in Our Care?
Deborah Hall, M.D.
Secondary Conditions Committee
Disabilities Prevention Project
New Mexico Department of Health 

Secondary conditions are additional disabilities or adverse health consequences that develop as a result of someone with a disability.  Although a primary disability can be devastating, it is often the secondary conditions that cause the most problems in both physical and mental health.

In l993, the Disabilities Prevention Program conducted, through New Mexico's three Independent Living Centers, a survey of health status in 98 people with traumatic brain injuries or spinal cord injuries.  Results from this survey showed a clustering of problems.  As health care providers to people with disabilities, we are familiar with many of the problems identified; such as, depression, memory loss, emotionality, and headaches.  Equally important, routine health maintenance, such as an annual pap smear, was found to occur less frequently than recommended.

What can we as physicians and medical providers do to maximize the potential of our patients with disability?  We must think proactively and preventively.  Prevention of secondary disability begins at the time of injury and continues throughout the life of the individual.  Involving our patients actively in their own health care is critical to supporting them in developing a healthy lifestyle as a disabled person.

Some things to think about include: 

• Routinely identify individual and family support systems
• Watch for depression and attempt to treat early
• Start early with physical and occupational therapy, and home programs to maintain fitness and movement, and to prevent musculoskeletal and skin breakdown problems
  Discuss drug or alcohol use which might be prevented if appropriate support systems are encouraged and reinforced
• Think as early as possible about independence issues and job skills training
• Learn about organizations operated for and by people with disabilities, and connect your clients with these resources. Community resource lists are available through the New Mexico Centers for Independent Living
• Prevent further injury through good patient education and appropriate support technology (i.e., proper equipment)
• Remember women's health issues, including pap smears and mammograms
• Remember immunizations (tetanus, MMR, Hepatitis B) 
• Focus on the things people with disabilities can do, rather than what they cannot

Thinking proactively is critical when working with your patients with disabilities.  Involve them and their support system and encourage them to also think prevention, and we will be doing all a service.