nonprofit organizations work tirelessly to support individuals with spinal cord injuries and their families and caregivers.

SPECTRUM OF PREVENTION TO TREATMENT

In delineating the scope of this report, it is useful to consider the framework that has been developed in the field of injury prevention and control to represent the injury process. Injury events are attributable to the uncontrolled release of physical energy (kinetic, chemical, thermal, electrical, or radiation energy) (Haddon, 1968). In considering the events that result in an injury, there are three temporal phases of injury causation: pre-event, event, and postevent (Haddon, 1980). Each phase requires different types of interventions to prevent or treat the resulting injury. In the pre-event phase, efforts are focused on how to prevent the injury from occurring. Examples of pre-event interventions include highway design improvements and the construction of pedestrian crosswalks and overpasses. Research on interventions in the second phase, when the injury is occurring, is focused on the transfer of energy to the individual and the negation or minimization of the injury. Second-phase interventions include the installation of airbags in vehicles, the use of bicycle and motorcycle helmets, appropriate emergency medical services at the time of injury, and rapid transfer and evacuation to definitive care. These are active areas of research that have resulted in innovations that have saved lives and reduced the severities of injuries, including spinal cord injuries.

The third phase—the postevent phase of the injury—is the focus of this report. After the injury has occurred, the goal is to minimize the damage and restore the lost function and former quality of life. As described in greater detail in Chapter 2, the acute-care phase of the injury—the short period of time just after the injury has occurred—is a window of opportunity to minimize the injury and prevent further damage or loss of function from occurring. Once the patient is stabilized, there are opportunities for a range of therapeutic interventions to improve or restore the lost function. Developing acute and chronic care interventions is the challenge facing the spinal cord injury research community.

DEFINING A CURE

Defining what constitutes a “cure” is an integral part of discussions on future directions for spinal cord injury research. In large part, the general public’s perception of a cure for spinal cord injury has been the restoration of motor function—to walk. However, a spinal cord injury affects many systems and functions of the body that are vital to the health and well-being of the injured person. Neural control of motor, sensory, autonomic, bowel,



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