Pushin' On: UAB Spinal Cord Injury Model System Digital Newsletter Volume 33 | Number 1 | Page 2

HEALTHY LIVING For Better or Worse, The Times Have Changed by Phil Klebine I have witnessed a lot of changes over my 30+ years of living with spinal cord injury (SCI) and nearly 20 years working as a professional in SCI. I recently asked myself a few questions about the impact of some of those changes for people with SCI. I did some research, and here is what I found out. How has healthcare changed? There are typically four stages of healthcare after SCI. 1. Acute hospitalization manages 2. 3. 4. the major trauma-related complications in the early days after injury. Physical medicine and rehabilitation (inpatient rehab) aims to restore or improve the functional ability lost after injury. Outpatient rehab is an extension of inpatient rehab to better prepare patients for daily living. Lifetime follow-up keeps patients healthy and active. There have been dramatic changes in the first three stages of care over the years. In the late 1970s and early 80s, patients with SCI spent an average of about 24 days in acute hospitalization and about 98 days in inpatient rehab. That was about 17 weeks of treatment before they were discharged home. They now receive an average of about 11 days in acute hospitalization and about 36 days in inpatient rehab. That is about 7 weeks of treatment before being discharged home. Most people now have a lower level of functional ability after they leave inpatient rehab than they once had. They now need outpatient rehab to reach the same levels of functional ability that they used to reach during inpatient rehab. Are people with SCI healthier? No one knows if these shorter lengths of stay have impacted the health of people with SCI. We do know that at least two trends have emerged in recent decades. First, the chances of medical complications have decreased during inpatient rehab, but they have increased after discharge. People with SCI are always at risk of being re-hospitalized after they leave inpatient rehab, but that risk is highest in their first year after injury. About 1 out of 3 people with SCI are re-hospitalized within that first year. Urinary tract infection (UTI), pressure ulcer (PU) and pneumonia are the most common reasons they are rehospitalized. These three conditions are largely preventable. Second, the chances of dying within the first year of injury are now much lower, but the overall life expectancy for people with SCI has not improved since the 1980s. It is no surprise that the leading causes of death after SCI are also relate to the most common reasons they are re-hospitalized. Diseases of the respiratory system (mainly pneumonia) are the leading cause of death for people with SCI. The second leading cause of death is infective/parasitic diseases, which are usually an infection in the blood (septicemia) caused by UTI, PU, or another respiratory infections. Has patient education changed? Most people with SCI want to learn from SCI professionals. After all, those professionals are best qualified to teach people with SCI how to manage their health and prevent medical problems. Participate in Research Pregnancy, Labor, Delivery and Postpartum Outcomes of women with and without a SCI This is a study io document care received and pre- and post-birth outcomes in women with spinal cord injury. Spain Rehabilitation Center is coducting research involving people with spinal cord injury and pressure ulcers This research study will assess how well Microcyn™ works on Stage 3 and Stage 4 pressure ulcers. Eligible participants must having a spinal cord injury and: • be over 18 years of age • having Stage III or Stage IV pressure ulcers; and • willing and able to attend monthly follow-up clinic visits at Spain Rehabilitation Center for 6 months. Participants will receive payment. Go to website, call 205-934-3330 or email [email protected] for more information. Participants will receive up to $110 in payment for completing the study protocol. Go to website, call 205934-3329 or email [email protected] for information. uab.edu/sci more than a high school/GED level of education at the time of their injury; about 9% have no more than an 8th grade level of education; and 24% have no more than an 11th grade level of education. A 2014 assessment of information provided by SCI experts on the internet had an average grade level of 11.9. This suggests that many people with SCI cannot fully understand materials being provided by SCI professionals. These materials may or may not be similar to those utilized in inpatient rehab. Has long-term care changed? The Americans with Disabilities Act has given people with SCI greater access to healthcare. Most of them have annual follow-up visits with a rehab specialist ( \