33 Living after disability

This episode is called autonomic dysreflexia. A systematic review searched Medline, CINAHL, EMBASE, and PsycINFO, included 31 studies, and of those 6 were randomized controlled trials. The review states that non-drug management during an episode is three steps: put the patient in an upright position, loosen tight clothing, and remove the triggering stimulus. Those three steps rest on clinical consensus and physiology data and are Level 5 evidence. The review body text states that episodes are most common with injury at thoracic level 6 or above, and the most common triggers are bladder or bowel irritation. Stimuli below the injury level set off a large sympathetic discharge, blood pressure rises sharply, and sensation below the injury is partly or wholly gone. Symptoms include severe headache and heavy sweating above the injury level; there may also be no symptoms at all. Untreated, it can lead to intracranial hemorrhage, seizures, or death. No study specifically measured the effect of sitting up during an episode, but when people with spinal cord injury go from lying flat to sitting or tilting, resting blood pressure falls clearly. Antihypertensive drugs are used only when blood pressure stays high; among them prazosin has Level 1 evidence, and nifedipine and prostaglandin E2 have Level 2 evidence. The review also states that prevention mainly targets two common types of trigger, urogenital and surgical, and most of that evidence is only Level 4 or Level 5

This study tracked 2,304 patients with traumatic spinal cord injuries who were newly admitted between 1991 and 2010, survived the first year after injury, and had residual neurological impairments at discharge, with follow-up lasting until the end of 2014. Among them, 63 patients (2.7%) had suffered their injury as a direct result of a prior suicide attempt. By the end of the follow-up period, 533 patients had died, of which 4.2% died by suicide; 91% of all suicides occurred within the first ten years after injury. The age-standardized suicide mortality rate was 62.5 cases per 100,000 people per year (95% CI 36.4–88.6), which is five times the average suicide rate of 12.2 cases per 100,000 people in England and Wales in 2014. Compared to patients with other causes of injury, those whose injury was triggered by a prior suicide attempt had an odds ratio of 4.32 for death (P<0.001) and an odds ratio of 9.46 for suicide (P<0.001).

Article 30 of the Mental Health Law (精神卫生法) states that “hospitalization for mental disorders follows the voluntary principle.” Inpatient treatment shall be given only when diagnosis and assessment show a serious mental disorder and one of the following applies. The first is “harm to self has already occurred, or there is a risk of harm to self.” The second is “harm to others’ safety has already occurred, or there is a risk of harm to others’ safety.” Article 31: for the first situation, the facility carries out inpatient treatment only with guardian consent; without it, it must not. Article 32: for the second situation, if the person or guardian objects, a second diagnosis may be demanded within three days of receiving the diagnostic conclusion, by two psychiatrists other than those who made the first diagnosis; if there is still objection to the second diagnosis, the person may independently commission a licensed appraisal body for a medical appraisal of mental disorder. Article 35: if the second diagnosis or appraisal report cannot confirm a serious mental disorder, or shows the patient does not need inpatient treatment, the facility must not hospitalize them. Article 78: intentionally sending a person who does not have a mental disorder into a medical facility as a mental-disorder patient incurs liability for damages (nationwide, in force from 1 May 2013, amended 2018)

This was a prospective population cohort, 1993 to 1998, mean follow-up 4.5 years, in four U.S. communities. 392 caregivers and 427 non-caregivers, ages 66 to 96, all living with a spouse. In four years 103 people (12.6%) died. After adjusting for sociodemographic factors, existing disease, and subclinical cardiovascular disease, people who both provided care and reported mental or emotional strain had a 63% higher death risk than non-caregiver controls (RR 1.63, 95% CI 1.00–2.65, credible range). Caregivers who did not report strain (RR 1.08, 95% CI 0.61–1.90) and people whose spouse was disabled but who did not provide care (RR 1.37, 95% CI 0.73–2.58) showed no rise in adjusted mortality

This randomized clinical trial ran in 12 nursing homes, enrolling in 2004 to 2008 232 residents aged 65 or older who sat in a wheelchair 6 or more hours a day with a Braden score of 18 or lower. Everyone first received a fitted wheelchair, then was randomized into two groups. One used skin-protection cushions (air, viscous fluid plus foam, or gel plus foam); the other used segmented foam cushions 7.6 cm thick. Follow-up was 6 months or until a pressure ulcer occurred. Ischial tuberosity pressure ulcers: segmented foam 8 cases (6.7%), skin-protection 1 case (0.9%), P=0.04. Combining ischial and sacrococcygeal ulcers: segmented foam 21 cases (17.6%), skin-protection 12 cases (10.6%), P=0.14 — no difference shown

Article 16 of the Advertising Law (广告法) states that ads for medical care, drugs, or medical devices must not contain: “(1) assertions or guarantees of efficacy or safety; (2) statements of cure rate or effectiveness rate; (3) comparisons of efficacy or safety with other drugs, medical devices, or other medical institutions; (4) use of an advertising endorser for recommendation or proof.” Article 17 states that except for ads for medical care, drugs, or medical devices, “any other ad is forbidden from involving disease-treatment functions, and must not use medical wording or wording that easily confuses the promoted goods with drugs or medical devices.” Article 4 states that ads must not contain false or misleading content, must not deceive or mislead consumers, and the advertiser is responsible for the truth of the ad content (nationwide, amended 2021)

Benefits tied to the certificate include at least six, each with its own source. Living subsidy for disabled people in need and care subsidy for severe disability — see Section 7, item 8 (the two subsidies). Rehabilitation aid for disabled children — see item 8 of this section (rehabilitation aid). Subsidy for configuring basic assistive devices, under Article 26 of the Regulations on Disability Prevention and Rehabilitation of Persons with Disabilities (残疾预防和残疾人康复条例). Home barrier-free modification subsidy — see item 9 of this section (ramps, handrails, and bathroom modifications). Quota employment and employment services — see item 10 of this section (state that you hold a certificate). Personal income tax reduction — see item 11 of this section (individual tax reduction). Article 26 of those Regulations also states that the state provides basic rehabilitation services to urban and rural poor and severely disabled people through key rehabilitation projects, and “provides subsidies for configuring basic assistive devices under relevant national provisions.” Article 20 states that relevant departments of people’s governments at county level and above and Disabled Persons’ Federations (残联) shall use community resources to set up rehabilitation places or buy services for community rehabilitation: guidance, daily living training, rehab nursing, assistive-device configuration, information, and referral (nationwide, in force from 1 July 2017). Article 21 of the same Regulations states that rehabilitation services start with a needs assessment, then an individualized plan from the assessment. A 2016 State Council document says “where conditions allow, localities may subsidize basic rehabilitation assistive devices for urban and rural poor and severely disabled people.” A 2026 three-year action plan from the Ministry of Civil Affairs and other departments states the need to “standardize and strengthen the subsidy system for fitting basic assistive devices for persons with disabilities.” Disability from a work injury follows another path. The Measures for Configuring Assistive Devices under Work-Injury Insurance (工伤保险辅助器具配置管理办法) cover prostheses, orthoses, artificial eyes, artificial teeth, wheelchairs, and the like. Confirmation by the work-capacity assessment committee comes first; then configuration. Costs of fitting, repair, and training are paid by the work-injury insurance fund under the rules. Configuration without confirmation, or at a non-contracted facility, is not paid by the handling agency

The State Council Opinions on Establishing a Rehabilitation Aid System for Children with Disabilities state that eligible recipients are children aged 0–6 with vision, hearing, speech, physical, or intellectual disability, and children with autism, who meet the conditions. That includes children with disabilities in urban and rural dibao households, registered poverty households, children with disabilities raised in child-welfare institutions, orphans with disabilities, children with disabilities covered by extreme-poverty support, and children with disabilities from other economically difficult households. How “other economically difficult households” are defined is set by people’s governments at county level and above. The document also states that “where conditions allow, localities may widen the age range for rehabilitation aid for children with disabilities, and may relax limits on household economic conditions.” Funding standards are set by people’s governments at county level and above by local finances, numbers of recipients, and disability categories, with a dynamic adjustment mechanism. Applications go to the county Disabled Persons’ Federation (残联) where the child’s hukou is (or where the residence permit was issued). After approval, the guardian chooses a designated rehab facility. Designated facilities are selected by the Disabled Persons’ Federation (残联) at county level and above together with health, education, and civil-affairs departments “on open, competitive principles.” Costs at designated facilities are settled directly between finance and the facility. “Costs of rehab services at a non-designated facility that the county Disabled Persons’ Federation (残联) has approved go by settlement rules set by that federation with same-level finance.” Provincial governments were to issue local systems and supporting policies by the end of September 2018. The higher basis is Article 26 of the Regulations on Disability Prevention and Rehabilitation of Persons with Disabilities (残疾预防和残疾人康复条例): the state establishes a rehabilitation-aid system for children with disabilities and shall “gradually make surgery, assistive-device configuration, and rehab training free for children aged 0–6 with vision, hearing, speech, physical, or intellectual disability and for children with autism” (nationwide, from 2018)

Article 19 of the Law on the Construction of a Barrier-Free Environment (无障碍环境建设法): “People’s governments at county level and above shall support and guide home barrier-free facility modifications. Eligible households of persons with disabilities and older adults shall receive an appropriate subsidy.” Article 18 states that for existing residential buildings, residential areas, public buildings, public places, transport facilities, and urban and rural roads that do not meet barrier-free construction standards, people’s governments at county level and above shall, by the actual situation, make targeted barrier-free modification plans and organize implementation. Article 22: “The state supports adding elevators or other barrier-free facilities to existing multi-storey housing in older urban neighbourhoods, to make things easier for persons with disabilities and older adults.” The same article says people’s governments at county level and above and their departments shall “use the role of community grassroots organizations” to push elevator installation in existing multi-storey housing. Article 62 states that any organization or individual may submit opinions and suggestions on strengthening barrier-free environment construction to the competent government department, and may complain or report acts that violate this law; the department that receives a complaint or report “shall handle it promptly and reply.” Article 63 states that for acts that violate this law and harm the public interest, the people’s procuratorate may issue a procuratorial suggestion or bring a public-interest lawsuit (nationwide, in force from 1 September 2023)

Article 8 of the Regulations on Employment of Persons with Disabilities (残疾人就业条例): “The share of persons with disabilities an employing unit arranges for employment shall be no lower than 1.5% of its on-payroll headcount. The exact share is set by the people’s government of the province, autonomous region, or municipality in light of local conditions.” Article 9: units that fall short of the provincial share shall pay the disabled-persons employment-security levy. Article 8 of the Measures for Collection and Use of the Disabled-Persons Employment-Security Levy (残疾人就业保障金征收使用管理办法) gives the formula: “Annual levy = (prior-year on-payroll headcount × provincial mandated employment share − prior-year actual number of persons with disabilities employed) × prior-year average annual wage of the unit’s on-payroll staff.” Article 16: for three years from industrial and commercial registration, small and micro enterprises with 20 or fewer on-payroll staff (including 20) that have not reached the mandated share are exempt from the levy. Article 7: a person with a disability counts toward the unit’s arranged employment number only if hired as staff on the establishment, or given a labour contract of 1 year or more while of working age, paid no less than the local minimum wage, and with social insurance paid in full. Arranging employment of 1 person holding a level-1 or level-2 disability certificate counts as arranging 2. Ministry of Finance Announcement No. 8 of 2023 further provides that from 1 January 2023 to 31 December 2027, units that reach 1% but not the provincial share pay 50% of the amount due; units under 1% pay 90%; and “enterprises with 30 or fewer on-payroll staff (inclusive) continue to be exempt from the disabled-persons employment-security levy.” Article 36 of the Law on the Protection of Persons with Disabilities (残疾人保障法) states that the state grants tax preferences by law to employing units that meet or exceed the mandated share or that concentrate employment of persons with disabilities (nationwide; Regulations on Employment of Persons with Disabilities in force from 1 May 2007)

Article 5 of the Individual Income Tax Law (个人所得税法): “In any of the following cases, individual income tax may be reduced; the specific range and term are prescribed by the people’s government of the province, autonomous region, or municipality and reported for the record to the standing committee of the people’s congress at the same level: (1) income of persons with disabilities, older persons living alone, and dependents of martyrs; (2) major losses from natural disasters.” Article 36 of the Law on the Protection of Persons with Disabilities (残疾人保障法) separately provides that the state grants tax preferences by law to persons with disabilities in individual business, and waives administrative and institutional fees (nationwide; Individual Income Tax Law in force from 1 January 2019)

Article 46 of the Law on the Construction of a Barrier-Free Environment (无障碍环境建设法): “Operators of public places and of transport facilities and public transport vehicles shall make it convenient for persons with disabilities to bring guide dogs, hearing dogs, assistance dogs, and other service dogs.” Paragraph 2 of the same article states that when bringing a service dog into public places or onto public transport, persons with disabilities “shall follow relevant national rules, put clear identification gear on the service dog, and take necessary protective measures.” Article 68 states that departments and units with public-service duties that fail to provide barrier-free social services as required by law shall be ordered by the people’s government at the same level or a higher competent department to correct within a time limit; if they do not, the directly responsible managers and other directly responsible persons shall be disciplined by law. Article 35 states that government convenience hotlines and emergency call systems for police, fire, traffic accidents, and medical emergency shall gradually gain barrier-free features such as voice, large print, Braille, and one-touch call. Article 62 states that any organization or individual may complain or report acts that violate this law, and the competent department shall handle promptly and reply. Article 50 of the Law on the Protection of Persons with Disabilities (残疾人保障法): “Blind people with valid credentials ride city buses, trolleybuses, metro, ferries, and similar public transport free. Reading matter for blind people is mailed free.” The same article states that people’s governments at county level and above shall give convenience and preference when persons with disabilities take public transport, and that persons with disabilities may bring essential assistive devices free (nationwide; Law on the Construction of a Barrier-Free Environment in force from 1 September 2023)

Article 5 of the Provisions on Administration of Participation by Persons with Disabilities in the National Unified Examination for Admission to Regular Institutions of Higher Education (残疾人参加普通高等学校招生全国统一考试管理规定) lists twelve reasonable accommodations. These include providing current Braille papers, large-print papers, or ordinary papers for candidates with vision disability; exempting candidates with hearing disability from the foreign-language listening test; allowing candidates with vision disability to bring Braille pens, Braille writing boards, non-storage Braille typewriters, non-storage electronic low-vision aids, white canes, optical magnifiers, and similar aids; allowing candidates with hearing disability to bring hearing aids or cochlear implants; allowing candidates with limited mobility to use wheelchairs or walking aids, and those with special needs to bring special desks and chairs. The time extension is in Article 5, item 6: “For candidates with vision disability using Braille papers, exam time is extended by 50% of the subject’s set total duration; for candidates with vision disability using large-print or ordinary papers, and for candidates for whom writing is especially difficult, such as those whose upper limbs cannot write normally because of cerebral palsy or other disease or who have no upper limbs, exam time is extended by 30% of the subject’s set total duration.” There are also priority entry to the site and rooms, separate standardized rooms, and guides and sign-language interpreters. Article 7 sets the application process: candidates file a formal written application by the time, place, and method set by the provincial education examination body, with a second-generation or later disability certificate; an expert group confirms on site and assesses comprehensively; the provincial education examination body issues a Notice. Article 8: if the candidate objects to the Notice, a written review may be filed with the provincial education administration. Article 9: if foreign-language listening is exempted, the foreign-language score is “written score × total foreign-language points / total written-part points.” Article 18: persons with disabilities who need reasonable accommodations for other national education exams may follow these Provisions (nationwide, issued and in force 7 April 2017)

Article 7 of the Regulations on Education of Persons with Disabilities (残疾人教育条例): “Preschool institutions, schools at all levels, and other educational institutions shall implement education for persons with disabilities under these Regulations and relevant national laws and regulations; they must not refuse to enroll persons with disabilities who apply and who meet conditions set by laws and regulations.” Article 29: “Ordinary vocational schools must not refuse to enroll persons with disabilities who meet national admission standards; ordinary vocational training institutions shall actively enroll persons with disabilities.” The Regulations also state that for school-age children and adolescents with disabilities who need dedicated nursing and cannot attend school, the education administration of the county people’s government shall arrange overall, providing compulsory education through teaching at home or distance education, and include them in student-status management. Article 20: the county education administration shall, with health, civil affairs, and the Disabled Persons’ Federation (残联), set up an expert committee on disability education of specialists in education, psychology, rehabilitation, and social work to assess physical condition, capacity to receive education, and capacity to adapt to school life, and to advise on admission and transfer; assessment results are the child’s privacy, and relevant units and staff have a duty of confidentiality. Article 23: disabled students in ordinary schools in regular classes may use ordinary compulsory-education curriculum schemes, standards, and textbooks, but learning requirements may have moderate flexibility. Article 52: persons with disabilities who need necessary support and reasonable accommodations for national education exams may apply (nationwide, in force from 1 May 2017)

Annex 1 of the Provisions on the Application for and Use of Motor Vehicle Driving Licences (机动车驾驶证申领和使用规定) sets physical conditions in detail. Item 8: “If the right lower limb or both lower limbs are missing or have lost motor function but the person can sit independently, and the upper limbs meet item 5 of this section, the person may apply for a driving licence for the disability-dedicated small automatic passenger-car class. If one palm is missing, the other hand has an intact thumb and two other intact fingers, upper-limb and finger motor function is normal, and the lower limbs meet item 6 of this section, the person may apply for a driving licence for the disability-dedicated small automatic passenger-car class.” Item 6: if only the left lower limb is missing or has lost motor function but the right lower limb is normal, the person may apply for the small automatic-car class. Vision: “single-eye vision impairment, with the better eye’s uncorrected or corrected vision at 5.0 or above on the logarithmic chart and horizontal visual field of 150 degrees,” may apply for small car, small automatic, low-speed goods, three-wheel, and disability-dedicated small automatic passenger-car classes. Hearing: with hearing impairment but able to tell sound-source direction while wearing a hearing aid, may apply for small car and small automatic classes, and must wear the hearing aid when driving. Article 85: the physical-condition certificate submitted when handling disability-dedicated small automatic passenger-car licence business shall be issued by a specialized medical institution recognized by the provincial health administration. Holders of this class shall have a physical check every three years and submit the physical-condition certificate within thirty days after the end of a demerit cycle. Article 78: when driving, the disability motor-vehicle special mark shall be placed on the vehicle as required. Article 79, paragraph 1, item 9: for holders of the disability-dedicated small automatic passenger-car class, “if the physical-condition certificate is not submitted within one year after the end of three demerit cycles,” the vehicle administration shall cancel the driving licence (nationwide, as amended by Ministry of Public Security Order No. 172, in force from 1 January 2025). Article 23, paragraph 1, item 5 of the Provisions on Motor Vehicle Registration (机动车登记规定) states that after adding, removing, or replacing limb-disability operating aids on small or micro automatic passenger cars, the owner shall apply for change filing with the registration vehicle administration within thirty days. Article 24: for that filing, submit identity proof, driving permit, motor-vehicle safety technical inspection certificate, and operating-aid installation certificate, and present the vehicle (Ministry of Public Security Order No. 164)

A Cochrane systematic review included 29 trials and 5902 participants, comparing organized inpatient stroke-unit care with other care. The review describes a stroke unit as a team using standard approaches to common post-stroke problems and providing coordinated multidisciplinary care. At final follow-up (median 1 year), the odds ratio for a poor outcome (death, disability, or need for institutional care) was 0.77 (95% CI 0.69–0.87, credible range), for death 0.76 (95% CI 0.66–0.88), and for death or dependence 0.75 (95% CI 0.66–0.85); evidence quality moderate. In absolute terms, per 100 people in stroke-unit care, 2 more survive, 6 more live at home, and 6 more live independently. Separately, the AVERT trial randomized 2104 patients across 56 acute stroke units in 5 countries to “usual care” or “usual care plus very early high-intensity activity.” At three months, a good outcome (modified Rankin Scale 0–2) was 480 people (46%) in the very-early group versus 525 (50%) in usual care; adjusted odds ratio 0.73 (95% CI 0.59–0.90, P=0.004). Deaths were 88 versus 72, with no difference shown (odds ratio 1.34, 95% CI 0.93–1.93, P=0.113)

The ACHIEVE trial ran in 4 U.S. communities and enrolled 977 people aged 70 to 84 with untreated hearing loss and no clear cognitive impairment. They were randomized to hearing intervention (hearing counseling and hearing aids) or health-education control, with follow-up every 6 months. The primary endpoint was 3-year change in global cognitive score. In the main analysis pooling both source populations, the two groups did not differ significantly: hearing intervention −0.200 (95% CI −0.256 to −0.144), control −0.202 (95% CI −0.258 to −0.145), difference 0.002 (95% CI −0.077 to 0.081), P=0.96. A pre-specified sensitivity analysis showed the intervention effect differed between the two source populations (interaction P=0.010). Participants from that long-term cardiovascular-health observational study were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores. In that subgroup of 238 people, hearing intervention reduced 3-year cognitive decline by 48% (difference 0.191, 95% CI 0.022–0.360, P=0.027). In the other 739 newly recruited healthy volunteers, the groups did not differ significantly (difference −0.061, 95% CI −0.151 to 0.028, P=0.18). The investigators concluded that hearing intervention may reduce 3-year cognitive change in people at higher risk of cognitive decline, and not in those at lower risk. The trial reported no serious adverse events attributed to the study

Article 21 of the Civil Code (民法典): “An adult who cannot recognize their own conduct is a person with no civil capacity; civil juristic acts are performed by their legal representative.” Article 22: “An adult who cannot fully recognize their own conduct is a person with limited civil capacity; civil juristic acts are performed by their legal representative or with that representative’s consent or ratification; but they may independently perform civil juristic acts that purely obtain benefits, or that match their intellect and mental health.” Article 24: “For an adult who cannot recognize or cannot fully recognize their own conduct, an interested person or a relevant organization may apply to a people’s court to determine that the adult has no civil capacity or limited civil capacity.” The same article provides that after such a determination, on application by the person, an interested person, or a relevant organization, the court may, by recovery of intellect or mental health, determine restoration to limited or full civil capacity. Relevant organizations include residents’ committees, villagers’ committees, schools, medical institutions, women’s federations, Disabled Persons’ Federations (残联), legally established older-persons’ organizations, civil-affairs departments, and others. Article 23: the guardian of a person with no civil capacity or limited civil capacity is their legal representative (nationwide, in force from 1 January 2021). Procedure is in the special-procedure chapter of the Civil Procedure Law (民事诉讼法). Article 198: the application goes to the basic people’s court at the citizen’s domicile; “the application shall state the facts and grounds for no civil capacity or limited civil capacity.” Article 199: “After accepting the application, the people’s court shall, when necessary, arrange an appraisal of the citizen requested to be found to have no civil capacity or limited civil capacity.” Article 187: special-procedure cases “shall be concluded within thirty days of case filing or within thirty days after the public notice period ends”; extension for special circumstances needs approval by the court’s president. Article 8 of the Measures for Payment of Litigation Costs (诉讼费用交纳办法): cases tried under the Civil Procedure Law’s special procedures do not pay a case-acceptance fee. Article 12: costs arising in litigation from appraisal and the like are paid by the parties directly to the relevant body under the court’s “who asserts, who bears” principle

Article 28 of the Civil Code (民法典): for an adult with no civil capacity or limited civil capacity, the following persons with guardianship capacity serve as guardian in order: “(1) spouse; (2) parents, children; (3) other close relatives; (4) other individuals or organizations willing to serve as guardian, but subject to consent of the residents’ committee, villagers’ committee, or civil-affairs department at the ward’s domicile.” Article 31: if there is a dispute over who the guardian is, the residents’ committee, villagers’ committee, or civil-affairs department at the ward’s domicile designates; anyone who disagrees with the designation may apply to a people’s court for designation, or apply directly to a people’s court. Designation “shall respect the ward’s true wishes and follow the principle most favourable to the ward.” Before designation, if rights and interests are unprotected, the residents’ committee, villagers’ committee, a relevant organization provided by law, or civil affairs serves as temporary guardian. Article 33: “An adult with full civil capacity may, in advance and in writing, agree with close relatives or other individuals or organizations willing to serve as guardian on who their guardian will be.” Article 1188: “If a person with no civil capacity or limited civil capacity causes harm to another, the guardian bears tort liability. If the guardian has fulfilled guardianship duties, tort liability may be reduced.” If the person has property, compensation is paid from that property; the shortfall is paid by the guardian. Article 1189: if the guardian entrusts guardianship duties to another, the guardian still bears tort liability; the trustee who is at fault bears corresponding liability (nationwide, in force from 1 January 2021)

Article 3 of the Law on the Protection of Persons with Disabilities (残疾人保障法): “Discrimination based on disability is prohibited. Insulting or infringing persons with disabilities is prohibited.” Article 38: “In hiring, conversion to regular status, promotion, professional-title evaluation, labour remuneration, living welfare, rest and leave, social insurance, and similar matters, persons with disabilities must not be discriminated against.” The same article states that the workplace of a disabled employee shall, by the employee’s characteristics, provide suitable labour conditions and labour protection, and modify workplaces, equipment, and living facilities as actually needed. Article 64: “Anyone who, in violation of this Law, discriminates against persons with disabilities in hiring and similar matters shall be ordered by the competent department to correct; disabled workers may bring a lawsuit in a people’s court by law.” Article 4 of the Regulations on Employment of Persons with Disabilities (残疾人就业条例): “Discrimination against persons with disabilities in employment is prohibited.” Article 13: employing units must not discriminate against disabled employees in promotion in post or grade, professional-title evaluation, pay, social insurance, living welfare, and similar matters. Article 42 of the Legal Aid Law (法律援助法) states that if the applicant has materials showing membership in “specific groups such as minors, older persons, or persons with disabilities with no fixed livelihood,” verification of financial difficulty is waived. Article 45: when legal-aid institutions provide legal-aid services to older persons or persons with disabilities, they shall provide barrier-free facilities, equipment, and services by the actual situation (nationwide)

Two UK spinal cord injury centres reviewed 5483 people with traumatic spinal cord injury. They were injured from 1943 to 2010, all survived the first year after injury, and were followed to the end of 2014. 2322 died; 2170 had reliable causes of death. Leading causes were respiratory 29.3%, circulatory 26.7%, cancer 13.9%, genitourinary 11.5%. After age adjustment, genitourinary mortality was higher than in the general population; it has fallen over the years but remains elevated. Another U.S. study reviewed records of 316 people with traumatic spinal cord injury, mean follow-up 18.3 years after injury, grouped by voiding method. Complication rates: long-term transurethral indwelling catheter 53.5%, clean intermittent catheterization 27.2%, spontaneous voiding 32.4%, suprapubic cystostomy 44.4%. Complications included infection, stones, urethral injury, and imaging abnormalities. This was a chart comparison only, not randomized. The 2026 European Association of Urology guidelines state that transurethral indwelling catheters have many complications and high urinary-tract infection risk — avoid them when possible. Suprapubic cystostomy is similar, only milder. The guidelines also state that long-term follow-up is lifelong, to check upper-tract damage and risk of kidney failure. Recheck intervals in most cases are no longer than one to two years. High-risk people roughly get ultrasound about every half year, and annual physical exam and urine tests. Section 3.4.2.e of the guidelines states that intermittent catheterization and indwelling catheters are both standard for people who cannot empty the bladder, and recommends joint decision by doctor and patient. In people with spinal cord injury, quality-of-life scores on intermittent catheterization are worse than on indwelling catheters, especially with more than 4 urinary-tract infections a year. In one observational study, 42.1% of people on intermittent catheterization stopped within 12 months, mainly for inconvenience, leakage, and more infections. The guidelines state silicone catheters are better because they scale less, and latex allergy is common in neurological disease. Section 3.5.1 lists the most common UTI signals in these patients: fever, new or worse leakage, worse spasms, fatigue, cloudy urine with stronger odour, flank or bladder pain, and autonomic dysreflexia