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Spinal Cord Injury Paralysis Resource Center

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Overview/How to Pick a Rehab

Locomotor Training

How do you choose the right rehab setting once you or your loved one is past the very early or acute phase of paralysis or disease? While the nearest facility may be the most convenient, and may offer many advantages in terms of support from family and friends, it may not offer the level of service needed in a complex injury or disease.

Some questions to consider: Does the facility have experience with the particular diagnosis or condition? Usually the more patients a facility treats, the higher the expertise level of the staff. Is the place accredited – that is, does it meet professional standards of care for your specific needs?

Generally speaking, a facility with accredited expertise is preferable to a general rehabilitation program. For example, accreditation by the Rehabilitation Accreditation Commission (CARF) for spinal cord injury indicates that the facility meets a minimum standard level of care. Programs seek CARF accreditation when they feel their programs are exceptional.

CARF promotes outcomes-driven, value-based services for people with disabilities due to disease or injury. CARF accreditation is important for both privately and publicly financed rehabilitation care.

Another aspect of good rehab is the breadth and quality of the professional staff on hand.

Among the professions you can expect to find on a rehabilitation team:

Physiatrist

A physiatrist (fizz-ee-AT-trist, or more commonly pronounced fizz-EYE-a-trist) is a doctor specializing in physical medicine and rehabilitation. Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. They treat acute and chronic pain and musculoskeletal disorders. They may see a person with back pain, an athlete who sprains an ankle or a typist who has carpal tunnel syndrome.

Physiatrists coordinate the long-term rehabilitation process for patients with spinal cord injuries, cancer, stroke or other neurological disorders, brain injuries, amputations and multiple sclerosis.

A physiatrist must complete four years of graduate medical education and four years of postdoctoral residency training. Residency includes one year spent developing fundamental clinical skills and three years of training in the full scope of the specialty.

Rehab Nurse

Nurses with special training in rehabilitative and restorative principles work collaboratively with the rest of the rehabilitation team to solve problems and manage complex medical issues. Rehabilitation nurses are experts in bladder, bowel, nutrition, pain, skin integrity, breathing, self care, coordination of medical regimens and related issues. They provide ongoing patient and family education, set goals for maximal independence and establish plans of care to maintain optimal wellness.

Rehabilitation nurses begin to work with individuals and their families soon after the onset of a disabling injury or chronic illness and they continue to provide support after return to home, work or school. According to the Association of Rehabilitation Nurses, "rehabilitation nursing" is a philosophy of care, not a work setting or phase of treatment. Rehabilitation nurses take a holistic approach to meeting patients' medical, vocational, educational, environmental and spiritual needs.

Occupational Therapy

An occupational therapist (OT) is skilled in helping individuals learn, or relearn, the day-to-day activities they need to achieve maximum independence. OTs offer treatment programs to help with bathing, dressing, preparing a meal, house cleaning, engaging in arts and crafts or gardening. They make recommendations and offer training in the use of adaptive equipment to replace lost function.

OTs also evaluate home and job environments and make recommendations for adaptations. The occupational therapist also guides family members and caregivers in safe and effective methods of caring for people. Occupational therapy not only helps to restore basic physical skills, but also facilitates contact with the community outside of the hospital.

Physical Therapy

The physical therapists (PT) treat disabilities that result from motor and sensory impairments. Their aim is to help people increase strength and endurance, improve coordination, reduce spasticity, maintain muscles in paralyzed limbs, protect skin from pressure sores and gain greater control over bladder and bowel function.

PTs also teach paralyzed people techniques for using assistive devices such as wheelchairs, canes or braces. In addition to "hands-on" exercises and treatments, physical therapists also educate people to take care of themselves. PTs may also work with joints and assure their range of motion. Physical therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs and ice.

Other therapists you should find on the rehab unit include:

Recreation therapists help people discover the wide range of recreation options available in their community.

Vocational therapists help people assess their job skills and to work with the state Vocational Rehab or other agencies to obtain equipment, training and placement.

Many rehab facilities have seating and positioning experts to help people select the best wheelchair, cushion and positioning gear.

Most facilities have rehab psychologists to assist people with the often-dramatic life changes that follow disease or trauma.

Sex and family counseling are integral to most rehab programs, in order to help patients better understand sexual function, family planning, etc.

 

Sources:

American Occupational Therapy Association, American Physical Therapy Association, American Academy of Physical Medicine and Rehabilitation, Rehabilitation Accreditation Commission, Association of Rehabilitation Nurses

A Reeve Foundation Fact Sheet on Rehabilitation (PDF)

A Reeve Foundation Fact Sheet on Rehabilitation - Choosing facility (PDF)

A Reeve Foundation Fact Sheet on New Injury Top 10 Questions (PDF)

American Academy of Physical Medicine and RehabilitationAs the premier medical society for the specialty of physical medicine and rehabilitation, AAPM&R is the only organization exclusively serving the needs of practicing PM&R physicians. With more than 7,500 members, the Academy represents more than 87 percent of US physiatrists and international colleagues from 37 countries.

American Physical Therapy Association (APTA)Main membership organization for the PT profession, furthering the prevention, diagnosis and treatment of movement dysfunctions.

American Therapeutic Recreation Association (ATRA)ATRA is the largest, national membership organization representing the interests and need of recreational therapists. Recreational therapists are health care providers using recreational therapy interventions for improved functioning of individuals with illness or disabling conditions.

American Speech-Language-Hearing AssociationASHA is the professional association for audiologists, speech-language pathologists, as well as speech, language and hearing scientists.

The American Congress of RehabilitationServes people with disabling conditions by promoting rehabilitation research and the transfer of technology.

Association of Rehabilitation NursesPromotes and accredits rehab nurses and promotes the philosophy of care of the nursing professional.

American Occupational Therapy Association (AOTA)Advances the field of occupational therapy through standard-setting, advocacy, education, and research.

The Centre for Ambulatory Rehabilitation Research and Education (CARRE)Based in Alberta, Canada, CARRE is a research translational facility that examines various treatments for walking after spinal cord injury.

Model Systems Centers for Spinal Cord InjuryA federally funded program of 14 specialty medical and/or rehabilitation centers across the US. The SCI Care System collects and submits acute, rehabilitation and follow-up (annual, long-term post-discharge) data on SCI patients who received care in the these centers following injury.

National Rehabilitation Association (NRA)Not long after Congress passed the National Rehabilitation Act of 1920, the National Rehabilitation Association (NRA) began its commitment to persons with disabilities. As the oldest and strongest advocate for the rights of persons with disabilities, NRA's mission is to provide advocacy, awareness and career advancement for professionals in the fields of rehabilitation. Their members include rehab counselors, physical, speech and occupational therapists, job trainers, consultants, independent living instructors and other professionals involved in the advocacy of programs and services for people with disabilities.

Paralysis Resource Center The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm ET. You may also schedule a call or send a message online.

Reeve Foundation Online Paralysis Community Connecting people living with paralysis, families, friends and caregivers so we can share support, experience, knowledge, and hope.

Quality of Life Grants DatabaseFind resources within the PRC Quality of Life Grants Database. Search by Zip Code, State or an Entire Category.

Library Books and VideosFind resources within the PRC library catalog.

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The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

This project was supported, in part by grant number 90PR3001, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.