Rebecca: Hi, thanks for having me. I also really want to appreciate everybody's flexibility. I know we had sort of a last minute cancellation reschedule last week. We had quite a bit of snow up here and although this particular New England girl does not mind the snow, the entire city of Baltimore shuts down if there is more than like two inches of snow. I appreciate all your flexibility.
Introduction
Today we are going to talk about spinal cord injury assessment and intervention. It is a subject near and dear to my heart. I have been working at the International Center for Spinal Cord Injury for the last 12 years now and every day I am learning something new about spinal cord injury. We have 40 therapists, PTs and OTs, and we span the whole continuum of care for patients with spinal cord injury and associated paralysis. We have an inpatient program that goes up to age 21, and then an outpatient program that sees both kids and adults. This building you are looking at here in Figure 1 is our outpatient center where we moved in about seven years ago now. We see mainly spinal cord injury, a handful of MS or CP, and some associated paralysis.
Figure 1. International Center for SCI.
Demographics
Etiology
Some of you have seen some spinal cord injury patients in your practice, but if you haven not this is how spinal cord injury breaks down nationally, as well as my own patient population in Figure 2.
Figure 2. Etiology of SCI.
Most of my patients have been injured in motor vehicle accidents. A little less than 30% have been injured in falls. Falls is the largest growing percentage of causes in spinal cord injury, and mostly these are elderly patients. These patients wind up with incomplete injuries and a different presentation that we will talk about in a moment. Violence accounts for just over 14% of all spinal cord injuries. Sports-related injuries are about 9%, and then other or unknown ideology is about 11%. Our patients are getting older as well. Historically, it has been males ages 16 to 25 because they are engaged in risk-taking behaviors, which is how they have car accidents and sports injuries.
Age and Time
However this trend is starting to skew toward the older population as can be seen in Figure 3.
Figure 3. Age distribution for SCI.
As I said, the largest growing population of patients with spinal cord injury are elderly post-fall patients, and so that accounts for a lot of this increase in age that you are seeing here in this 40 to 49 area. Patients are also living longer with spinal cord injury. Twenty to thirty years ago, we were only seeing patients live about five to 10 years post injury because of secondary complications. Now, patients are living well into their 60's and 80's, and most patients still are clustering around this 20 year age gap.
Lifetime Costs
Spinal cord injury is a major role disruption involving a lot of hospitalization, but it is also super expensive (Figure 4).
Figure 4. Overview of lifetime costs.
The average length of inpatient hospitalization following injury in acute care is only 12 days, and some of you may have seen this in your own settings, but the length of stays are getting really short. If you think about somebody who has gone from near normal function, perhaps as a football player, diving, or driving a car, and now they have gone to little or no function, twelve days is extremely short. They then go to rehab for 37 days, and this is probably a high estimate. The model systems are a little bit less; more like three weeks.
The good news is that about 90% of all spinal cord injury individuals are discharged from hospitals to private homes. Thus, people are making a good effort to take their loved ones home. Only 6% are discharged to nursing homes. However, this is really an expensive proposition. If you have high tetraplegia, this is going to cost the client about a million dollars the first year, and $171,000 for each subsequent year. If you have low tetraplegia, you will most likely still need a power wheelchair and caregiver support for most of your awake hours. It is estimated it will be about $700,000 that first year, and then about $100,000 for each subsequent year. If a client has paraplegia, they most likely will need a manual wheelchair, but can spend the bulk of their day on their own, and might be even able to go back to work. For this type of injury, it is estimated to cost almost $500,000 for that first year, and $66,000 for each subsequent year. If they have incomplete motor function at any level, it is $334,000 that first year and about $40,000 for the subsequent years. You can see it is a lot of money, and as therapists, we then have to be really thoughtful about how we are using people's insurance and DME benefits, what time we are asking them (both clients and caregivers) to take off in terms of time from work.
