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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


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    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. ASIA American Spinal Injury Association (ASIA ) Classification

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

    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

    15. SPINAL CORD INJURY:Statistics

    16. 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

    17. Most frequent SCI

    18. Average Yearly Expenses(in 2005 dollars)

    19. The provider

    20. 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 ………

    21. Spinal cord injury rehabilitation unit ?

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

    23. Living with SCILifetime follow-up • Prevention: • Secondary impairment • Secondary disability • Early intervention • Education • Health promotion/wellness education

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

    25. New rehabilitation tools ד"ר גבי זייליג המחלקה לשיקום נוירולוגי neure@sheba.health.gov

    26. Methods/techniques of training • Medications • Devices

    27. Home adjustment • Accessibility • Accessories

    28. Equipment

    29. Sports & physical activity

    30. The payor

    31. 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

    32. 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.