Pushin' On: UAB Spinal Cord Injury Model System Digital Newsletter Volume 33 | Number 1 | Page 2
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
the major trauma-related
complications in the early days
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
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
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
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
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
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.
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 ( \