06 | Recovery After Traumatic SCI
As I was tumbling down the mountainside, I thought to myself, ‘My God, when am I going to stop!’ I was totally conscious the whole time I was falling. When I came to a halt, I was freezing and shaking, and I couldn’t move my arms and legs. I was so very afraid. Like the old cliché goes – I saw my life flash before my eyes. I continue to relive this experience over and over again!
Treatment at the rehabilitation unit began with the rehabilitation team’s assessment of Mr. Seiler's functioning. The 4-week assessment encompassed a battery of discipline-specific evaluations (health professional perspective) and also involved gathering information from Mr. Seiler himself (patient perspective).
With use of the ICF Categorical Profile Mr. Seiler's functioning status was discussed during a rehabilitation team meeting. An illustration of the assessment results, the ICF Categorical Profile shows the ICF qualifier rating of the categories that reflect the relevant aspects of functioning observed and evaluated during the assessment phase. Goals were set accordingly.
Each of the intervention targets that were defined in the assessment phase of the Rehab-Cycle® was assigned to the appropriate rehabilitation team members – physician, nurse, physical and occupational therapist.
Four weeks after Mr. Seiler's traumatic accident, the early post-acute Rehab-Cycle® was concluded with an evaluation of progress. The encouraging results showed that Mr. Seiler’s recovery had surpassed his own expectations as well as those of the rehabilitation team.
The case study of Mr. Seiler, who became tetraplegic after falling down a side of a mountain, exemplified that optimal recovery of persons with traumatic spinal cord injury (SCI) does not begin at the early post-acute rehabilitation phase but already at the time of the accident and extends through to acute care and beyond. Moreover, optimal recovery depends on the contributions of health professionals and the injured person alike.
- Ditunno JF, Cohen ME, Hauck WW, Jackson AB, Sipski ML. Recovery of upper extremity strength in complete and incomplete tetraplegia: a multicenter study. Arch Phys Med Rehabil. 2000; 81: 389-393.
- Marino RJ, Ditunno JF, Donovan WH, Maynard F. Neurologic recovery after traumatic spinal cord injury: Data from the model spinal cord injury systems. Arch Phys Med Rehabil. 1999; 80: 1391-1396.
- Bernhard M, Gries A, Kremer P, Böttiger B. Spinal cord injury – Prehospital management. Resuscitation. 2005; 66:127-139.
- Scivoletto G, Morganti B, Molinari M.Early versus delayed inpatient SCI rehabilitation: an Italian study. Arch Phys Med Rehabil. 2005; 86: 512-516.
- Fehlings M, Perrin R. The timing of surgical intervention in the treatment of spinal cord injury: A systematic review of recent clinical evidence. Spine. 2006; 31(11 Suppl.): S28 – S35.
- Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2008; 31(4): 403-79.
- Bickenbach J et al. Chapter 4: Health care and rehabilitation needs. In: Bickenbach J, Officer A, Shakespeare T, von Groote P. Eds. International perspectives on spinal cord injury. Geneva, Switzerland: World Health Organization; 2013. p. 67-91.
- Wuermser L-A, Ho CH, Chiodo AE, Priebe MM, Kirshblum SC, Scelza WM. Spinal Cord Injury Medicine. 2. Acute care management of traumatic and non-traumatic Injury. Arch Phys Med Rehabil. 2007; 88 (Suppl 1): S55-S61.
- Sekhon L, Fehlings M. Epidemiology, demographics and pathophysiology of acute SCI. Spine. 2001; 26(24S):S2-S12.
- Fawcett JW et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007; 45(3): 190-205.
- Boldin C, Raith J, Florian Fankhauser F, Haunschmid C, Schwantzer G, Schweighofer F. Predicting neurologic recovery in cervical spinal cord injury with postoperative MR imaging. Spine. 2006; 31(5): 554 – 559.
- Burns A, Ditunno J. Establishing prognosis and maximizing functional outcomes after spinal cord injury: A review of current and future directions in rehabilitation management. Spine. 2001; 26(24S): S137 – S145.
- Geisler F, Coleman W, Grieco G, Poonian D, and the Sygen Study Group. Measurements and recovery patterns in a multicenter study of acute spinal cord injury. Spine. 2001; 26(24S): S68 – S86.
- Crock HV, Yoshizawa H, Yamagishi M, Crock MC. Commentary on the prevention of paralysis after traumatic spinal cord injury in humans: The neglected factor - urgent restoration of spinal cord circulation. Eur Spine J. 2005; 14: 910-914.
- The International Spinal Cord Society (ISCoS). Spinal cord injury emergency and acute care – Physicians and surgeons. [Internet] Available from: http://www.elearnsci.org/intro.aspx?id=6&category=Overview+for+the+Whole+Team. Accessed November 2014.
- Malik M, Lovell ME. Current spinal board usage in emergency departments across the UK. Int. J. Care Injured. 2003; 34: 327 – 329.
- Porter K, Allison K. The UK emergency department practice for spinal board unloading. Is there conformity? Resuscitation. 2003; 58: 117-120.
- Yeung, JHH, Cheung NK, Graham CA, Rainer, TH. Reduced time on the spinal board – Effects of guidelines and education for emergency department staff. Injury, Int. J. Care Injured. 2006; 37: 53-56.
- Hodgetts T, Smith J. Essential role of pre-hospital care in the optimal outcome from major trauma. Emergency Medicine. 2000; 12: 103-111.
- Mayo Clinic. Spinal injury: First aid. [Internet] 16 March 2012. Available from: http://www.mayoclinic.org/first-aid/first-aid-spinal-injury/basics/art-20056677. Accessed January 2015.
- Unnamed authors. Chapter 1: Cervical Spine Immobilization before Admission to the Hospital. Neurosurgery. 2002; 50(3, Suppl.): S7-S17.
- Bickenbach J et al. Chapter 5: Health systems strengthening. In: Bickenbach J, Officer A, Shakespeare T, von Groote P. Eds. International perspectives on spinal cord injury. Geneva, Switzerland: World Health Organization; 2013. p. 95-120.
- Hall E, Springer J. Neuroprotection and acute spinal cord injury: A reappraisal. J Am Society Experimental Neurotherapeutics. 2004; 1: 80-100.
- Goldsmith H. Can the standard treatment of acute spinal cord injury be improved? Perhaps the time has come. Neurological Research. 2007; 29: 16-20.
- McKinley W, Meade M, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil. 2004; 85: 1818-1825.
- Sumida M, Fujimoto M, Tokuhiro A, Tominaga T, Magara A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Arch Phys Med Rehabil. 2001; 82: 391-395.
- Teasdale G, Murray G, Parker L, Jennett B. Adding up the Glasgow Coma Score. Acta Neurochir Suppl (Wien). 1979; 28(1): 13-16.