Injury in America A Continuing Public Health Problem (1985) / Chapter Skim
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6 Rehabilitation
6 Rehabilitation
Pages 80-98
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From page 80... ...
In the last decade, improvements In emergency medical systems, in immediate management by trauma centers, and in care of the injured en route to hospitals have increased the survival of persons with nervous system in jur ies, multiple in jur ies of the musculoskeletal system and viscera, or extensive burns. Trauma units have increased the need for defined referral to special rehabilitation programs and follow-up services.
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From page 81... ...
Free-standing and hospital-based civilian rehabilitation hospitals and centers promoted academic development by means of exemplary service, research, and training in medical rehabilitation, physical and occupational therapy, rehabilitation nursing, social work, speech therapy, psychologic services, or thotics and prosthetics, vocat tonal counseling, and rehabilitation engineer ing . These specialized programs rapidly demonstrated the benefits and loss prevention possible through the use of organized restorative and rehabilitative care in controlling disability and maximizing use of residual capabilities.
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From page 82... ...
There are 15 regional spinal cord injury centers, and less than 10 percent of the 5,000-10,000 persons with new spinal cord injuries every year enter a system of care pioneered by these centers.223 Belp to brain-injured persons is even less. For example, in the greater Houston area of 3.S million persons, with three major trauma centers, the incidence of new spinal cord injury is 50 per million of population, or 175 persons per year added to approximately 1,500 survivors on hand.
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From page 83... ...
Rehabilitation and independent-living service can provide deinstitutionalization for more than three-fourths of the patients; the cost of this over a lifetime is estimated at one-tenth the cost of custodial care with repeated hospitalizations. ~ 2 0 ~ 3 3 The data base for the spinal cord in jury center program among the 15 regional centers revealed that the intake and follow-up process sacred one-third of firstcost dollars, achieved home placement in 85 percent of over 6, 000 f irst admissions, and decreased the incidence of complications and later hospitalizations for complications.2 2 3 The relatively low incidence and prevalence of necrologic injuries, multiple musculoskeletal injuries, and burns fail to imply how important and costly the problems that result can be.
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From page 84... ...
Systems of care for patients with spinal cord injuries that coordinate management from the site of the injury through trauma center care, intensive rehabilitative treatment, and transitional services, to independent living are proving more humane and cost-effective than uncoordinated effOrtS.64 133 IS2 Too often, knowledge of effective rehabilitation goes unused. The following discussion illustrates the spectrum of issues and conditions that requires both research and the application of existing knowledge.
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From page 85... ...
Spinal cord injury associated with athletic and recreational activities accounted for 12 percent of 5,635 cases of spinal cord injury in which patients were rehabilitated in spinal cord injury centers from 1973 to 1981. 2 2 3 Musculoskeletal and necrologic in jur ies of all types result in severe work disability (65 percent)
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From page 86... ...
Measurements of motion in normal and injured states in all spinal segments and knowledge of muscular control of segmental motion are needed for a mathematical model to test effects of forces, loads, and supports. B ioengineer ing and Biomater ials Ideas and technologies are needed to predict the interaction of artificial materials and structures with natural biologic tissues - such as cortical bone, cancellous bone, and cartilage -- so that the effects of metallic internal f ixation devices, joint prostheses, etc., can be learned.
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From page 87... ...
Several tertiary referral hospitals with burn centers have added burn rehabilitation programs, as have some rehabilitation centers. An accessible rational system does not exist for all burn victims.
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From page 88... ...
Prevention and Control of Tissue Contractures and Hypertrophic Scarring Comparative evaluation of methods for control of contracture formation -- e.g., early splinting and pressure bandaging -- is needed, as well as basic research on methods for inhibition of excessive collagen formation in scarring. Disabling Pain Disabling pain that retards activity, purposeful movements, and ambulation and that is occasioned by dress ing changes, periodic debridement, reconstructive surgery, and grafting requires basic and clinical research on alternative methods of pain control, including electric stimulation of the spinal cord.
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From page 89... ...
Preservation of Spinal-Cord Function Not all injured spinal cords believed to be completely severed are devoid of residual functional neuroses and connections to higher levels of the brain and lower levels of the spinal cord. Recent clinical neurophysiologic research on 2,000 persons with spinal cord injuries teas shown that nearly two~thirds of so-called complete injuries, in fact, are not complete.
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From page 90... ...
Tissue implants of per ipheral nerves in the central nervous system show some potential for reconnection across surgically produced gaps in neural connections. Pressure Sores Failure to prevent pressure sores in the acute phase of injury or at any time during the course of disability creates misery, debilitation, and social and economic losses.
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From page 91... ...
Injudicious timing of surgical intervention can augment postinjury stress responses and lead to such life-threatening complications as massive bleeding, uncontrollable infections, and respiratory insufficiency and failure. Management of Sequelae Re~searab i'; needed on ways to protect residual neural tissue friability and to control `;er ious complications that make rehabilitation difficult or impossible.
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From page 92... ...
In addition, restructuring of the physical environment to reduce social and economic losses caused by failure to include handicapped persons of all ages in community life will help in jury victims. Long-term institutional ization of able-bodied young adults who could be self-auf f icient the poorest possible solution, but it is the most f request one today.
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From page 93... ...
10. Professional education and exper fence should be revised to include familiarity with model trauma centers and comprehensive rehabilitation centers.
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From page 95... ...
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