Maximizing Spinal Cord Injury Rehabilitation: What Has Happened to Rehabilitation? - PowerPoint Presentation

1. Maximizing Spinal Cord Injury Rehabilitation: What Has Happened to Rehabilitation?Jennifer Hastings PT PhD NCSMay 31, 20183:00-4:00pm ET

2. Presenters2Alexandra Bennewith, MPAVice President, Government RelationsUnited Spinal AssociationJennifer Hastings, PT, PhDBoard Certified Neurologic Clinical SpecialistProfessor, School of Physical TherapyUniversity of Puget Sound

3. United Spinal AssociationUnited Spinal Association is dedicated to enhancing the quality of life of all people living with a spinal cord injury or disease (SCI/D).www.unitedspinal.orghttps://unitedspinal.org/action-center/Advocacy – Federal and StateRoll on Capitol HillResource CenterNew Mobility Membership MagazineChapters, Support Groups, Rehabilitation Facilities & Hospital PartnersProducts & Service DirectoryAccessibility ServicesVetsFirst3

4. Roll on Capitol Hill #ROCH2018Join the Rolling Revolution:Roll on Capitol Hill is United Spinal’s annual legislative advocacy event that addresses issues that impact the health, independence and quality of life of individuals living with spinal cord injuries and other paralyzing conditions. Approx. 150 members from across the country advocate for legislation that improves the quality of life for people with spinal cord injuries and other paralyzing conditions.Issues to be discussed include:Improve Air Travel for Passengers with DisabilitiesProtect the Americans with Disabilities ActSave healthcare benefits: prescription drugs; assistive and rehab technologies; medical supplies as well as community supports and servicesImprove disabled veterans life insuranceSupport VA Choice Program – veterans community provider healthcarehttps://www.unitedspinal.org/events/roll-on-capitol-hill/4

5. What happens with a sudden onset spinal cord injury?Loss of WalkingGeneral moving around- personal independenceChallenges to circulation, respiration and skin health5

6. What happens with a sudden onset spinal cord injury?Changes in bowel and bladder functionSexual ability is changedBody Image and self worth are challengedChallenges to relationships6

7. What happens with a sudden onset spinal cord injury?Immediate financial challengeAccessing one’s living spaceTransportation challengesChallenges with return to work7

8. Comprehensive Rehabilitation after SCIShould address ALL of these issues8

9. RehabilitationMeans Return to LifeAs LIVED9

10. AFTER SCILIVE! (don’t just survive) THRIVE!10

11. Poll Question 1"Do you think you left inpatient rehabilitation with all the skills you needed for success at home?" YesNo11

12. RehabilitationShould be delivered by a TEAM of experts working togetherPhysicians: rehab medicine, urologyTherapists: physical, occupational, speech, recreation Social Work and PsychologyRehab Nurses12

13. EducationThis should be a key component of RehabilitationUnderstand their care needs and direct anything they cannot doAutonomic DysreflexiaHealth, wellness and weight management13

14. EquipmentAppropriate equipment for safe function at homeAppropriate bladder managementPadded bathroom equipment that the individual has the skills to useAn appropriately sized and configured wheelchairSafely egress in an emergency14

15. Poll Question 2Were you able to receive the appropriate evaluation and equipment for your needs?YesNo15

16. Expected Outcomes16

17. Length of Inpatient Rehabilitation Stay following a C6-C7 SCI and the Effects on Wellness, Function, and Community Participation Jennifer Hastings PT, PhD, NCS; Kelly C. Gillespie SPT; Rachel V. Harris SPT; Michael R. Murphy SPT In 2011 we presented findings from a cross sectional studyWe collected current function, wellness and participationWe collected date of injury and LOS for inpatient rehabilitationFor 39 respondents the median inpatient rehab LOS was 150 daysCurrently 34 days (SCI Facts and Figures- 2018)17

18. Note: in 2010 an individual injured in 1970 was living with SCI for 40 years! 18

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20. MobilityMastery of wheelchair skills is vital to full community participationMobility transitions after rehabilitation Ambulation  wheelchair vs. Wheelchair ambulation20

21. LOSLooking at improvement in function between 6 mo and 1 yr post SCI “identified increased LOS in inpatient rehabilitation as the single most important predictor for improving function” Chatta et al, Topics of Spinal Cord Injury Rehabilitation 2018, Vol 24 Sup. 1 p 126Independence in Mobility significantly correlated with QOLGoulet & Mac-Thiong, Topics of Spinal Cord Injury Rehabilitation 2018, Vol 24 Sup. 1 p 127-12821

22. Requirements for Inpatient RehabilitationNeed intensive therapy minimum 3 hrs/day 5 days a weekMultidisciplinary specialistsFulltime access to or close supervision by a physiatristContinuous or full time rehabilitation nursingMedicare maximum of 100 days22

23. Insufficient rehabilitationThe MYTHOLOGY of outpatient careInadequate professionals23

24. Poll Question 3“Immediately after discharge from inpatient rehabilitation, were you able to access outpatient therapy at least three times a week?” YesNo 24

25. What is needed?A RETURN to inpatient rehabilitation being the place where skills for self management after SCI are learned prior to dischargeAll aspects of psychosocial and physical managementThe time in rehabilitation should be determined by progress toward appropriate goalsShift the language from full time rehab nursing to Multidisciplinary Team of Specialists25

26. What is needed? we need to prove that this will give better outcomesLess rehospitalizationsFewer woundsHigher return to work26

27. QUESTIONSJennifer D Hastings: jhastings@pugetsound.eduAlexandra Bennewith: abennewith@unitedspinal.orgBill Fertig: bfertig@unitedspinal.org27