Spinal Cord Injury Rehabilitation and the ICU

Abstract

Spinal cord injury, previously regarded as a fatal illness, now affects approximately 265,000 survivors today in the United States. Due to improved medical technology and trauma response systems, the spinal cord-injured patient has a longer life expectancy than previously observed. The rehabilitation of a patient with an acute spinal cord injury (SCI) begins in the intensive care unit. A comprehensive neurological exam is performed early during the hospitalization of the SCI patient. The American Spinal Injury Association's Impairment Scale is widely used for classification of severity of injury for tetraplegia and paraplegia. This tool can also be used as an aid for prognostication of neurological and functional recovery, as well as for patient and caregiver education. Rehabilitation efforts require a team approach led by a rehabilitation specialist. Early rehabilitation goals include prevention of complications of immobility. Such complications include contracture, pressure ulcer formation, orthostatic hypotension, and respiratory complications. Physical and occupational therapists work closely with the SCI patient in the ICU setting. Common medical issues in the SCI patient are also addressed in the rehabilitation plan of care. Issues such as autonomic dysreflexia, neurogenic bowel and bladder, spasticity, pain, heterotopic ossification, and psychological adjustment are treated by the rehabilitation team. Each SCI patient requires an individualized plan of care based on his or her physical, psychological, and social needs. Early rehabilitation is vital to achieving long-term functional goals.