Spinal Cord Injury (SCI): Surgical and Non-surgical Management
UW Health Orthopedics and Rehabilitation in Madison, Wisconsin provides comprehensive treatment for spinal cord injury (SCI).
The goal of immediate intervention for spinal cord injury is to realign the spine and stabilize the fracture site to preserve as much neurological functioning as possible. If the spine is found to be properly aligned and stable, surgery may not be indicated. The injured spine is then immobilized using a rigid neck collar or a trunk brace.
Surgery is most often required to restore optimal alignment of the spine and to stabilize the damaged area. Sometimes boney fragments, disk fragments or foreign objects that are placing pressure on the spinal cord are removed. The boney spinal vertebrae that were damaged are stabilized with the insertion of hardware and/or the use of extra bone to eventually create a fusion. Following surgery, a brace is used to support the spine until the damaged area is again stable.
There are many medical issues that must be assessed and treated during hospitalization for spinal cord injury, including respiratory care, bowel and bladder function, the prevention of pressure sores, nutritional needs and pain management. The person may also have sustained other injuries at the time of the accident. There are many specialized professionals that become part of the patient's medical team during their hospitalization and rehabilitation. The goal is to avoid many of the potential complications associated with spinal cord injury.
UW Hospital and Clinics Inpatient Rehabilitation Program
Patients with spinal cord injury will require extensive rehabilitation following the injury to achieve their maximal level of function. Rehab begins in the intensive care unit and the acute unit. When the individual's medical condition stabilizes and they are cleared to participate in more activity, the person is transferred to the inpatient rehab service. The individual then participates in an intensive rehab program which includes therapies, educational sessions regarding spinal cord injury, counseling and discharge planning. The goal is for the person with spinal cord injury to achieve the necessary self cares, transfer skills and mobility to safely return home.
The Rehabilitation Team includes the rehab physician (physiatrist), nurse, physical therapist, occupational therapist, respiratory therapist, speech-language pathologist to assess swallow, pharmacist, dietician, health psychologist, therapeutic recreation specialist, social worker, vocational counselor, orthotist, pastoral staff, and case manager.
There are daily interdisciplinary rounds on the inpatient rehab unit to discuss and update the treatment plan. There are also weekly team conferences to discuss the person's progress and rehab goals. Discharge planning begins when a person is admitted to the inpatient rehab service. Family meetings are scheduled with the patient, their family and the rehab team to discuss the patient's progress in therapy and assist the patient and family in preparing for discharge to home. Home modifications and equipment needs are addressed.
Education related to all aspects of spinal cord injury is an important and significant theme throughout the rehab process. It involves not only the patient with spinal cord injury, but their family and care providers.
Spinal cord injury brings sudden and profound life changes, and the rehab environment provides both support and information to empower the person to meet these new challenges. Each patient participates in an intense daily rehab program to regain independence. If a patient is unable to perform an activity independently, it is important that they learn to effectively direct that care.
Patients also learn how to stay healthy, identify any medical problems and respond appropriately. The rehab nurses instruct patients in:
- Bladder and bowel management
- Sexual functioning
- Skin issues
- Autonomic dysreflexia
Therapists instruct patients in a home program to improve strength, flexibility, functional mobility and endurance. The health psychologist supports patients and their families as they regain control over their lives by developing successful coping strategies. The vocational counselor works with a person to establish a plan to return to work or school. There is also an active SCI mentor program in the UW Hospital and Clinics inpatient program. An individual in the community with a spinal cord injury is partnered with an inpatient and provides both support and personal information related to living with a spinal cord injury.
The UW Hospital and Clinics Rehabilitation program is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).
Following Discharge from the Hospital
In today's health care system, individuals move much more quickly through the inpatient experience. Patients are leaving the hospital before they achieve their highest level of function or independence. This means that rehabilitation continues after leaving the hospital, with an emphasis on community reintegration and further developing skills that will help achieve their full potential.
Upon discharge from the hospital the person most often returns home, frequently with support from a home health agency. They may be transitioned to an extended care facility if their home environment is not yet modified to meet their needs. Most individuals with spinal cord injury benefit from continued therapy, and outpatient physical and occupational therapies are initiated when they are able to safely travel to the rehab clinic. In some cases a person may be readmitted to an inpatient rehab setting when they are more able to fully participate in an intense therapy program, such as when their brace is removed or they have better endurance.
UWH Home Health Services
UW Health provides in-home services to persons with spinal cord injury who are unable to safely leave their home. Services available include skilled nursing, physical and occupational therapy, speech pathology and home care providers. UW Home Health services are an important link between the hospital and outpatient services and clinics.
UWH Rehab Clinic Outpatient Services
The UW Health Rehabilitation Clinic in Middleton provides outpatient services for persons with spinal cord injury. The rehab team includes the physiatrist (physical and rehabilitation medicine physician), rehab nurse, physical therapist, occupational therapist, speech-language pathologist, orthotist and a social worker. Health psychology is available to both persons with spinal cord injury and their families as they continue to adapt to a new life experiences at home and in the community.
Outpatient therapies focus on assisting persons with spinal cord injury to maximize their functional potential. Upon returning to their home and community the person is better able to identify their individual needs and goals. The discharge from the hospital is only the beginning of a lifelong process of learning, adapting and problem solving. The goal is for persons with spinal cord injuries to return to as independent a lifestyle as possible and to resume their role in their family, work environment and the community.