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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”). Quality of care. Cost containment. Quality of life. Patient. Provider. Payor. The patient.

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spinal cord injury rehabilitation model
Spinal cord injury rehabilitation model

G. Zeilig, MD, Department of Neurological Rehabilitation,

Sheba Medical Center, Tel Hashomer

meeting the needs the 3 p s
Meeting the needs (the 3 “P’s”)

Quality of care

Cost containment

Quality of life

Patient

Provider

Payor

what s a spinal cord injury
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
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
slide6

ASIA

American Spinal Injury Association (ASIA ) Classification

sci multi systems failure
CARDIO-VASCULAR

METABOLIC

MUSCULO-SKELETAL

PSYCHIATRIC

SKIN

REPRODUCTIVE

SCI = multi-systems failure
  • RESPIRATORY
  • NERVOUS
  • ENDOCRINE
  • IMMUNE
  • GASTO-INTESTINAL
  • GENITO-URINARY
sci related medical conditions
SCI – related medical conditions
  • Spinal shock
  • Spinal cord syndromes
  • Autonomic dysreflexia
  • Neuropathic pain
  • Spasticity
  • Heterotopic ossification
  • Syrinx
  • Gynecomastia
sci multi functions failure
SCI = multi-functions failure
  • B-ADL
  • E-ADL
  • Mobility
  • Ambulation
  • Socio – economic
living with sci12
Living with SCI
  • Acute restoration phase
  • Maintenance phase
  • Decline phase
conflicting goals
Conflicting goals
  • Quality of life
  • Independence
  • Preservation of function
long term survival
Long-term survival
  • Diminished life expectancy (?)
  • Life expectancy has been improving
spinal cord injury numbers
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
slide21
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
A Model

Inpatient rehab

Outpatient rehab

Respiratory

Acute care

Clinics

Day care

Amb. therapies

SCI program

CBRP

living with sci lifetime follow up
Living with SCILifetime follow-up
  • Prevention:
    • Secondary impairment
    • Secondary disability
  • Early intervention
  • Education
    • Health promotion/wellness education
the 2 re s
The 2 “RE’s”

Community re-entry program

Re-rehabilitation program

new rehabilitation tools

New rehabilitation tools

ד"ר גבי זייליג

המחלקה לשיקום נוירולוגי

neure@sheba.health.gov

slide28
Methods/techniques of training
  • Medications
  • Devices
home adjustment
Home adjustment
  • Accessibility
  • Accessories
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

Memento
slide34
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.