Transcript ACUTE REHABILITATION PROGRAM

Spinal cord injury
rehabilitation model
G. Zeilig, MD, Department of Neurological Rehabilitation,
Sheba Medical Center, Tel Hashomer
Meeting the needs (the 3 “P’s”)
Quality of care
Cost containment
Quality of life
Patient
Provide
r
Payor
The patient
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)
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
72 hour exam - reliable prognostic
time
ASIA
American Spinal Injury
Association (ASIA )
Classification
SCI = multi-systems failure
RESPIRATORY
NERVOUS
ENDOCRINE
IMMUNE
GASTO-INTESTINAL
GENITO-URINARY
CARDIO-VASCULAR
METABOLIC
MUSCULO-SKELETAL
PSYCHIATRIC
SKIN
REPRODUCTIVE
SCI – related medical conditions
Spinal shock
 Spinal cord syndromes
 Autonomic dysreflexia
 Neuropathic pain
 Spasticity

 Heterotopic
ossification
 Syrinx
 Gynecomastia
SCI = multi-functions failure
 B-ADL
 E-ADL
 Mobility
 Ambulation
 Socio
– economic
International Classification of
Functioning, Disability and Health (ICF)
Living with SCI
Living with SCI
 Acute
restoration phase
 Maintenance
 Decline
phase
phase
Conflicting goals
 Quality
of life
 Independence
 Preservation
of function
Long-term survival
 Diminished
 Life
life expectancy (?)
expectancy has been improving
SPINAL CORD INJURY:
Statistics
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
Tetraplegia
Complete
(%)
Tetraplegia
Incomplete
(%)
17.5
31.2
Paraplegia
Complete
(%)
28.2
Paraplegia
Incomplete
(%)
23.1
Average Yearly Expenses
(in 2005 dollars)
Each Subsequent
Year
Severity of Injury
First
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
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Cook
Dietician
Nurse
Occupational
therapist
Orthotic technician
Psychologist
Physical therapist
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Physician
Rabbi
Recreational
therapist
Engineer
Secretary
Social worker
Speech therapist
urologist, orthopedic, neurosurgeon, plastic
surgeon, ID, ENT, medicine, pain, psychiatrist
………
Spinal cord injury
rehabilitation unit
?
A Model
Inpatient rehab
Respiratory
Outpatient rehab
Acute
care
Day care
Clinics
Amb. therapies
SCI program
CBRP
Living with SCI
Lifetime follow-up
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Prevention:
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Secondary impairment
Secondary disability
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Early intervention
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Education
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Health promotion/wellness education
The 2 “RE’s”
Community reentry program
Re-rehabilitation
program
New rehabilitation tools
‫ד"ר גבי זייליג‬
‫המחלקה לשיקום נוירולוגי‬
[email protected]
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Methods/techniques of training
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Medications
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Devices
Home adjustment
Accessibility
Accessories
Equipment
Sports & physical activity
Memento
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Main causes of morbidity &
mortality:
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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
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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.