1. Spinal cord injury rehabilitation model
G. Zeilig, MD, Department of Neurological Rehabilitation,
Sheba Medical Center, Tel Hashomer

2. Meeting the needs (the 3 “P’s”)
Quality of care
Cost containment
Quality of life
Patient
Provider
Payor

3. The patient

4. 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

5. 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

6. American Spinal Injury Association (ASIA ) Classification

7. SCI = multi-systems failure
RESPIRATORY
NERVOUS
ENDOCRINE
IMMUNE
GASTO-INTESTINAL
GENITO-URINARY
CARDIO-VASCULAR
METABOLIC
MUSCULO-SKELETAL
PSYCHIATRIC
SKIN
REPRODUCTIVE

8. SCI – related medical conditions
Spinal shock
Spinal cord syndromes
Autonomic dysreflexia
Neuropathic pain
Spasticity
Heterotopic ossification
Syrinx
Gynecomastia

9. SCI = multi-functions failure
B-ADL
E-ADL
Mobility
Ambulation
Socio – economic

10. International Classification of Functioning, Disability and Health (ICF)

11. Living with SCI

12. Living with SCI Acute restoration phase Maintenance phase
Decline phase

13. Conflicting goals Quality of life Independence
Preservation of function

14. Long-term survival Diminished life expectancy (?)
Life expectancy has been improving

16. SPINAL CORD INJURY: Statistics

17. SPINAL CORD INJURY: Numbers
> SCI/year
30-50/ new SCI/year
living SCI in USA
Annual cost : $ 5 billion

18. Most frequent SCI 23.1 28.2 31.2 17.5 Paraplegia Incomplete (%)
Tetraplegia
23.1
28.2
31.2
17.5

19. Average Yearly Expenses (in 2005 dollars)
Severity of Injury
First 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

20. The provider

21. The
Team
Physician
Rabbi
Recreational therapist
Engineer
Secretary
Social worker
Speech therapist
Cook
Dietician
Nurse
Occupational therapist
Orthotic technician
Psychologist
Physical therapist
urologist, orthopedic, neurosurgeon, plastic surgeon, ID, ENT, medicine, pain, psychiatrist ………

22. Spinal cord injury rehabilitation unit?

24. A Model Outpatient rehab Inpatient rehab Respiratory Clinics Day care
Acute care
Day care
Clinics
Amb. therapies
SCI program
CBRP

25. Living with SCI Lifetime follow-up
Prevention:
Secondary impairment
Secondary disability
Early intervention
Education
Health promotion/wellness education

26. The 2 “RE’s”
Community re-entry program
Re-rehabilitation program

27. New rehabilitation tools
ד"ר גבי זייליג
המחלקה לשיקום נוירולוגי

28. Methods/techniques of training
Medications
Devices

29. Home adjustment
Accessibility
Accessories

30. Equipment

31. Sports & physical activity

32. The payor

33. Memento Main causes of morbidity & mortality: Equipment Accessories
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

34. Committee on Trauma. Resources for Optimal Care of the Injured Patient
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.