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. Provider. Payor. The patient.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
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 Provider Payor
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
ASIA American Spinal Injury Association (ASIA ) Classification
CARDIO-VASCULAR METABOLIC MUSCULO-SKELETAL PSYCHIATRIC SKIN REPRODUCTIVE SCI = multi-systems failure • RESPIRATORY • NERVOUS • ENDOCRINE • IMMUNE • GASTO-INTESTINAL • GENITO-URINARY
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
Living with SCI • Acute restoration phase • Maintenance phase • Decline phase
Conflicting goals • Quality of life • Independence • Preservation of function
Long-term survival • Diminished life expectancy (?) • Life expectancy has been improving
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
Cook Dietician Nurse Occupational therapist Orthotic technician Psychologist Physical therapist Physician Rabbi Recreational therapist Engineer Secretary Social worker Speech therapist The Team urologist, orthopedic, neurosurgeon, plastic surgeon, ID, ENT, medicine, pain, psychiatrist ………
A Model Inpatient rehab Outpatient rehab Respiratory Acute care Clinics Day care Amb. therapies SCI program CBRP
Living with SCILifetime follow-up • Prevention: • Secondary impairment • Secondary disability • Early intervention • Education • Health promotion/wellness education
The 2 “RE’s” Community re-entry program Re-rehabilitation program
New rehabilitation tools ד"ר גבי זייליג המחלקה לשיקום נוירולוגי email@example.com
Methods/techniques of training • Medications • Devices
Home adjustment • Accessibility • Accessories
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 Memento
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…..Thedesignation 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.