The Systems Approach

Universal access to coordinated systems of care that integrate treatment from the site of the injury through long-term community follow-up is recognized as essential for mitigating the short-term effects of SCI and TBI and for controlling the effects of long-term disabling conditions. The four basic elements of such a coordinated approach are summarized below:

  • Emergency Medical Services (and Acute Medical/Surgical Care): Prompt recognition and treatment of the injured person at the scene with rapid transport to a designated trauma center specifically designed to treat individuals with neurological injuries.

  • Acute (Medical) Rehabilitation: Begins in the acute phase and continues with an integrated, comprehensive inpatient rehabilitation care facility specifically designed to care for SCI and TBI survivors and their families. These services focus on physical and cognitive restoration of the individual.

  • Psychosocial and Vocational Rehabilitation Services: Services aimed at preparing the individual for independent living and community reintegration. Although initiated during the inpatient phase of acute (medical) rehabilitation, the majority of these services are delivered within the structure of a transitional living center, day program, or outpatient services.

  • Lifelong Comprehensive Follow-up: Includes medical, social, psychological, and vocational follow-up on a regularly scheduled basis.

The scope and volume of services required at each stage of the system of care will, of course, depend on the nature and severity of the injury. However, some general statements can be made. For example, emergency services and acute care for an individual with SCI should be designed to prevent a second injury to the spinal cord, necessitating appropriate stabilization of the spine before arriving at the hospital. In the hospital, definitive stabilization of the spine and measures to prevent such complications as deep vein thrombosis, pulmonary emboli, pneumonia, contractures, and decubiti must be performed by experienced personnel. Medical rehabilitation services should begin immediately in the acute phase to minimize physical deterioration and prevent further impairment and functional limitation due to loss of strength and range of motion, bladder and bowel incontinence, and inadequate or inappropriate training and provision of equipment. Accurate assessment and preparation for return to work and independent living during acute care can help alleviate some of the feelings of hopelessness and depression that an injured person often experiences. Psychosocial and vocational rehabilitation should continue the effort to prevent medical complications and increase functioning. Upon returning to the community, the individual can benefit from proactive community outreach programs in housing, transportation, recreation, employment, and other activities.

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