1. Jennifer Hastings PT PhD NCS
Maximizing Spinal Cord Injury Rehabilitation: What Has Happened to Rehabilitation?
Jennifer Hastings PT PhD NCS
May 31, 2018
3:00-4:00pm ET
Notes go here

2. Presenters
Jennifer Hastings, PT, PhD Board Certified Neurologic Clinical Specialist
Professor, School of Physical Therapy University of Puget Sound
Alexandra Bennewith, MPA
Vice President, Government Relations
United Spinal Association

3. United Spinal Association
United Spinal Association is dedicated to enhancing the quality of life of all people living with a spinal cord injury or disease (SCI/D).
Advocacy – Federal and State
Roll on Capitol Hill
Resource Center
New Mobility Membership Magazine
Chapters, Support Groups, Rehabilitation Facilities & Hospital Partners
Products & Service Directory
Accessibility Services
VetsFirst

4. Roll on Capitol Hill #ROCH2018
Join 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 Disabilities
Protect the Americans with Disabilities Act
Save healthcare benefits: prescription drugs; assistive and rehab technologies; medical supplies as well as community supports and services
Improve disabled veterans life insurance
Support VA Choice Program – veterans community provider healthcare

5. What happens with a sudden onset spinal cord injury?
Loss of Walking
General moving around- personal independence
Challenges to circulation, respiration and skin health

6. What happens with a sudden onset spinal cord injury?
Changes in bowel and bladder function
Sexual ability is changed
Body Image and self worth are challenged
Challenges to relationships

7. What happens with a sudden onset spinal cord injury?
Immediate financial challenge
Accessing one’s living space
Transportation challenges
Challenges with return to work

8. Comprehensive Rehabilitation after SCI
Should address ALL of these issues

9. Rehabilitation
Means Return to Life
As LIVED

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

11. Poll Question 1
"Do you think you left inpatient rehabilitation with all the skills you needed for success at home?"
Yes No

12. Rehabilitation
Should be delivered by a TEAM of experts working together
Physicians: rehab medicine, urology
Therapists: physical, occupational, speech, recreation
Social Work and Psychology
Rehab Nurses

13. Education This should be a key component of Rehabilitation
Understand their care needs and direct anything they cannot do
Autonomic Dysreflexia
Health, wellness and weight management

14. Equipment Appropriate equipment for safe function at home
Appropriate bladder management
Padded bathroom equipment that the individual has the skills to use
An appropriately sized and configured wheelchair
Safely egress in an emergency

15. Poll Question 2
Were you able to receive the appropriate evaluation and equipment for your needs?
Yes No

16. Expected Outcomes

17. In 2011 we presented findings from a cross sectional study
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 study
We collected current function, wellness and participation
We collected date of injury and LOS for inpatient rehabilitation
For 39 respondents the median inpatient rehab LOS was 150 days
Currently 34 days (SCI Facts and Figures- 2018)

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

20. Mobility
Mastery of wheelchair skills is vital to full community participation
Mobility transitions after rehabilitation
Ambulation  wheelchair vs. Wheelchair ambulation

21. LOS
Looking 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 126
Independence in Mobility significantly correlated with QOL
Goulet & Mac-Thiong, Topics of Spinal Cord Injury Rehabilitation 2018, Vol 24 Sup. 1 p

22. Requirements for Inpatient Rehabilitation
Need intensive therapy minimum 3 hrs/day 5 days a week
Multidisciplinary specialists
Fulltime access to or close supervision by a physiatrist
Continuous or full time rehabilitation nursing
Medicare maximum of 100 days

23. Insufficient rehabilitation
The MYTHOLOGY of outpatient care
Inadequate professionals

24. Poll Question 3
“Immediately after discharge from inpatient rehabilitation, were you able to access outpatient therapy at least three times a week?” 
Yes No

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

26. What is needed? we need to prove that this will give better outcomes
Less rehospitalizations
Fewer wounds
Higher return to work

27. QUESTIONS Jennifer D Hastings: jhastings@pugetsound.edu
Alexandra Bennewith:
Bill Fertig: