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Spinal cord injury rehabilitation model
G. Zeilig, MD, Department of Neurological Rehabilitation,Sheba Medical Center, Tel Hashomer
Meeting the needs (the 3 “P’s”)
Patient
Provider
Payor
Quality of care
Cost containment
Quality of life
WHAT’S A SPINAL CORD INJURY?
•Loss of motor and sensory function bellow the level of injury•Spasticity•Pain•Sexual dysfunction•Loss of bowel & bladder control
International Standards for Neurological Classification of Spinal Cord Injury
ASIA (American Spinal Injury Association) Neurological level of injury (NLOI) Completeness of the injury (ASIA
impairment classification)
72 hour exam - reliable prognostic time
SCI = multi-systems failure
RESPIRATORYRESPIRATORY
NERVOUSNERVOUS
ENDOCRINEENDOCRINE
IMMUNEIMMUNE
GASTO-INTESTINALGASTO-INTESTINAL
GENITO-URINARYGENITO-URINARY
CARDIO-VASCULARCARDIO-VASCULAR
METABOLICMETABOLIC
MUSCULO-SKELETALMUSCULO-SKELETAL
PSYCHIATRICPSYCHIATRIC
SKINSKIN
REPRODUCTIVEREPRODUCTIVE
SCI – related medical conditions
Spinal shock Spinal cord syndromes Autonomic dysreflexia Neuropathic pain Spasticity Heterotopic ossification Syrinx Gynecomastia
SPINAL CORD INJURY:Numbers
> 10.000 SCI/year
30-50/1.000.000 new SCI/year
200.000 living SCI in USA
Annual cost : $ 5 billion
Most frequent SCI
TetraplegiaComplete
(%)
TetraplegiaIncomplete
(%)
ParaplegiaComplete
(%)
ParaplegiaIncomplete
(%)
17.531.228.223.1
Average Yearly Expenses
(in 2005 dollars)
Severity of InjuryFirst Year
Each Subsequent Year
High Tetraplegia (C1-C4)$710,275$127,227
Low Tetraplegia (C5-C8)$458,666$52,114
Paraplegia$259,531$26,410
Incomplete motor at any level$209,324$14,670
The Cook Dietician Nurse Occupational
therapist Orthotic technician Psychologist Physical therapist
Physician Rabbi Recreational
therapist Engineer Secretary Social worker Speech therapist
urologist, orthopedic, neurosurgeon, plastic surgeon, ID, ENT, medicine, pain,
psychiatrist………
A Model
Inpatient rehab Outpatient rehab
Respiratory
Day care Clinics
Amb. therapies
CBRP
SCI program
Acute care
Living with SCILifetime follow-up Prevention:
Secondary impairment Secondary disability
Early intervention
Education Health promotion/wellness education
Memento Main causes of morbidity &
mortality: Infections Pressure sores Respiratory failure Cardio-vascular Suicide
The annual cost of treating pressure sores alone is estimated at $1.2 billion (Byrne and Salzberg 1996).
Hospital length of stay
Equipment Accessories Psych Housing Accessibility
Committee on Trauma. Resources for Optimal Care of the Injured Patient. American College of Surgeons, 1990.
“….It is illogical to develop sophisticated prehospital and hospital care to resuscitate and treat severely injured patients only to transfer them to custodial facilities after acute care without adequate rehabilitation…..The designation of rehabilitation facilities with the necessary staffing skills and programs to comprehensively serve people with spinal cord injury is as important as the need for specialized trauma services.