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Rehabilitation of Persons With Spinal Cord Injuries

Background

Traumatic spinal cord injury (SCI) is perhaps the most devastating orthopedic injury, and with prolonged survival being the rule, rehabilitation of these injuries has an increasingly important role. The primary goals of rehabilitation are prevention of secondary complications, maximization of physical functioning, and reintegration into the community.

Rehabilitation following SCI is most effectively undertaken with a multidisciplinary, team-based approach, as follows
:

Physical therapists typically focus on lower-extremity function and on difficulties with mobility

Occupational therapists address upper-extremity dysfunction and difficulties in activities of daily living

Rehabilitation nurses are concerned with the issues of bowel and bladder dysfunction and the management of pressure injuries (pressure ulcers)

Psychologists deal with the emotional and behavioral concerns of the newly injured patient and with any potential cognitive dysfunction

Speech-language pathologists address with issues of communication and swallowing

Case managers and social workers are the primary interface between the rehabilitation team, the patient and his or her family, and the payer source

The rehabilitation team functions under the direction of a physiatrist (ie, a physician who specializes in physical medicine and rehabilitation) or a physician with a subspecialty certification in spinal cord medicine. Each team member has his or her primary responsibilities, but any member of a properly functioning interdisciplinary team can contribute to the resolution of any problem.

SCIRehab project

The Spinal Cord Injury Rehabilitation (SCIRehab) project, a 5-year project led by the Rocky Mountain Regional Spinal Injury System (RMRSIS) at Craig Hospital, used practice-based evidence (PBE) research to identify the rehabilitation interventions most strongly associated with positive outcomes.

The aim of the SCIRehab project was to provide detailed information on treatments delivered by rehabilitation disciplines and to contribute to outcomes-based guidelines for clinical decision-making. The SCIRehab project included 1376 patients with acute SCIs, with outcome data being abstracted from medical records (clinical outcomes data) at six SCI rehabilitation facilities and obtained from patient interviews at 6 and 12 months after injury.
 The final phase (phase 3) of the SCIRehab project was published in November 2012.

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