Selecting Rehab


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Fact Sheet: Selecting a Rehabilitation Center for Spinal Cord Injury The following are guidelines which may be helpful in evaluating rehabilitation facilities for the treatment of a new spinal cord injury (SCI). Whenever possible, it is advisable to visit any center that you are considering and ask to see the program in action. Accreditation Is the center CARF accredited for SCI? The Commission on Accreditation of Rehabilitation Facilities (CARF) offers several types of accreditation, so it is important to be specific. Accreditation for General Rehabilitation (or other non-SCI programs) is good, but does not indicate any special expertise in the care of SCI. A center that is accredited for spinal cord injury has met a series of standards that are considered important in the care of these patients. The CARF requirements for SCI are listed below. If a center is not accredited, it may be helpful to ask which of these services are available. How many SCI patients are treated? CARF recommends a minimum of 30 new SCI admissions per year in order to maintain a viable SCI program. Provision for peer interaction of patients How many SCI patients are currently in the hospital? In addition to the medical staff, patients benefit from interaction with other SCI patients. Is there a designated area (beds) within the nursing unit where SCI patients are assigned? Specialized SCI rehabilitation team with training and experience in the unique needs of SCI The rehabilitation team should consist of at least a rehabilitation nurse, physical therapist, occupational therapist, social worker, physician, respiratory therapist and recreational therapist. Each of these should have special training or experience with SCI because it is significantly different from other disabilities. Attending physician Does the physician who will be in charge of the rehabilitation program have special interest and competence in the care of SCI? Is there twenty- four hour physician coverage seven days per week? Bladder management Is there an organized program for urological examination (including Urodynamics) and bladder management? Is it under the direction of a Urologist (or other qualified physician) with special interest and competence in the care of SCI? Equipment Is there access to a supply of specialized wheelchairs, cushions and other equipment which can be used for trial until individual needs can be determined? Patient and family education Is there a formally organized program (with mandatory attendance) for education of the patient and family about the unique medical problems of SCI, including such things as: • Bladder Management and Prevention of Complications • Bowel Management • Skin Care and Prevention of Pressure Sores • Autonomic Dysreflexia • Sexuality and Fertility • Instruction in Medications and Drug Abuse • Nutrition • Equipment Care and Community Resources for Availability and Repair Sexual counseling Since most SCI's are young adults and SCI has a significant effect on sexual function, accurate information is essential. Medical consultation Are specialists available for consultation (if needed) in specialities such as Neurosurgery, Orthopedics, Urology, Plastic Surgery, Internal Medicine, Pulmonary Medicine, General Surgery, and Pediatrics? Acute care hospital Is there immediate access to and safe transport to acute hospital services in the event of medical emergencies? Community integration services Is there an organized program to help patients adapt to activities outside the hospital? This includes supervised community excursions, and provisions for overnight therapeutic home visits prior to discharge. Other services The following services should be provided by the rehabilitation center staff or through consultation arrangements: • Psychological Evaluation and Counseling • Vocational Counseling • Driver's Training • Special Education for School Age Children • Orthotics (Braces and Splints) Follow-up Is there an organized program for long term follow-up to maintain and/or improve health status after discharge? The SCI program should provide follow-up care for patients remaining in the geographical service area. A specific written plan should be provided for each patient on discharge. Developed by: Shirley McCluer, MD, Medical Director, Arkansas Spinal Cord Commission. Date: March 1993. Published by: Arkansas Spinal Cord Commission, 1501 North University, Suite 470, Little Rock, AR 72207. Phone: (501) 296-1788 (voice) / 296-1794 (tdd)