04 | Health Behaviour

Health Maintenance - A Patient-Provider Partnership

General Introduction

Health maintenance is considered a key outcome in the long-term care of persons with spinal cord injury (SCI). An person's health behaviour plays a major role in maintaining his or her health. Such behaviour encompasses a range of strategies that can be undertaken by the person and supported by the rehabilitation team. A key strategy toward health maintenance is the prevention of adverse events and comorbidities.1 2

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Monica's Story

During my first rehabilitation following the onset of spinal cord injury (SCI), I shared a room with a person who was suffering from pressure ulcers (PUs). Seeing her suffer, I promised myself that I would not allow that to happen to me. But just three months after I returned home, I acquired my first ulcer. And now two years later I’m back here again with my second ulcer.

Monica, January 2007

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In the assessment phase of the Rehab-Cycle®, Monica’s perspective was considered important and complimentary to the perspective of her rehabilitation team.

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Assignment and Intervention


Monica’s rehabilitation team consisted of her physician, nurse, a physical and an occupational therapist and a psychologist. Each team member was assigned to attend to specific intervention targets.

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Against medical advice and at Monica's insistence she was discharged pre-maturely. Consequently, the (re-)evaluation of her health status took place only five weeks after starting intervention.

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Health maintenance is a critical factor that contributes to the quality of life of persons with spinal cord injury (SCI). While rehabilitation professionals can do much to influence a person’s health maintenance efforts through interventions such as routine clinical monitoring, the person's own health behaviour is equally important, if not more.

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  1. Chiodo AE, Scelza WM, Kirshblum SC, Wuermser L-A, Ho CH, Priebe MM. Spinal Cord Medicine. 5. Long-term medical issues and health maintenance. Arch Phys Med Rehabil 2007; 88 (Suppl. 1): S76-83.
  2. Stucki G, Reinhardt JD, Cieza A, Brach M, Celio M, Joggi D, Villiger B, Zäch GA, Krieg W. Developing Swiss Paraplegic Research: Building a research institution from the comprehensive perspective. Disability and Rehabilitation. 2008; 30 (14): 1063-1078.
  3. Center for Research on Women with Disabilities. Health maintenance behaviours:National study of women with physical disabilities. Jan 1999.
  4. Krause JS, Broderick L. Patterns of recurrent pressure ulcers after SCI: Identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil 2004; 85: 1257-1264.
  5. McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic SCI: A regional model system analysis. Arch Phys Med Rehabil 1999; 80: 1402-1410.
  6. Paker N, Soy D, Kesiktaş N, Bardak AN, Erbil M, Ersoy S, Yilmaz H. Reasons for hospitalization in patients with spinal cord injury: 5 years’ experience. International J of Rehabil Res. 2006, 29:71 – 76.
  7. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization; 2001.
  8. The International Spinal Cord Society (ISCoS). Overview for the whole team: Early and late complications in SCI. [Internet]  Available from: www.elearnsci.org/intro.aspx?id=6&category=Overview+for+the+Whole+Team. Accessed November 2014.
  9. National Pressure Ulcer Advisory Panel (NPUAP). NPUAP Pressure Ulcer Stages/Categories. [Internet]. Available from: www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-ulcer-stagescategories/. Accessed November 2014
  10. Niezgoda JA, Mendez-Eastman S. The Effective management of pressure ulcers. Advances in Skin & Wound Care. 2006; 19(Supplement 1): 3-15.
  11. Thomas DR. Prevention and treatment of pressure ulcers: What works, what doesn’t. Cleveland Clinic Journal of Medicine. 2001; 68(8): 704-722.
  12. Hsieh J, McIntyre A, Wolfe D, Lala D, Titus L, Campbell K, Teasell R. (2014). Pressure ulcers following spinal cord injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 5.0. 1-90.[Internet] 2010. Available from: www.scireproject.com/rehabilitation-evidence/pressure-ulcers. Accessed November 2014.
  13. Raghavan P, Raza WA, Ahmed YS, Chamberlain MA. Prevalence of pressure sores in a community sample of spinal injury patients. Clin Rehab 2003; 17: 879-884.
  14. New PW, Rawicki HB, Baily MJ. Nontraumatic spinal cord injury rehabilitation: Pressure ulcer patterns, prediction and impact. Arch Phys Med Rehabil Jan 2004; (85): 87-93.
  15. Chen Y, DeVivo MJ, Jackson AB. Pressure ulcer prevalence in people with SCI: Age-period-duration effects. Arch Phys Med Rehabil 2005; 86: 1208-1213.
  16. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden scale for predicting pressure sore risk. Nursing Research. 1987; 36(4): 205-210.
  17. Braden BJ. The Braden scale for predicting pressure sore risk: Reflections after 25 Years. Advances in Skin & Wound Care. 2012; 25(2): 61.
  18. Consortium for Spinal Cord Medicine Clinical Practice Guidelines. Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals. L Spinal Cord Med 2001; 24 (Suppl 1): S40-101.
  19. Correa GI, Fuentes M, Gonzalez X, Cumsille F, Piñeros JL, Finkelstein J. Predictive factors for pressure ulcers in the ambulatory stage of spinal cord injury patients. Spinal Cord. 2006; 44: 734-739.
  20. Sørensen JL, Jørgensen B, Gottrup F. Surgical treatment of pressure ulcers. American J of Surgery. 2004; 188 (1A Supplement): 42-51.
  21. Mayo Clinic. Diseases and conditions: Spinal cord injury. [Internet] July 2014. Available from: http://www.mayoclinic.org/diseases-conditions/aortic-aneurysm/basics/definition/con-20043547. Accessed November 2014.
  22. Pruitt SD, Wahlgren DR, Epping-Jordan JE, Rossi AL. Health behaviour in persons with spinal cord injury: Development and initial validation of an outcome measure. Spinal Cord. 1998; 36: 724-731.
  23. Jones ML, Mathewson CS, Adkins VL and Ayllon T. Use of behavioural contingencies to promote prevention of recurrent pressure ulcers. Arch Phys Med Rehabil. 2003; 84(6): 796-802.