Two Patients with Spinal Cord Injury Undergo Continuing Care at the Rehabilitation Institute of Chicago

Visiting a friend one day in 1993, Charles Kay, an operations manager at O’Hare Airport in Chicago, slipped while jumping into a swimming pool, and in his fall he hit his head and broke his neck.

Kay had injured his C4 and C5 vertebrae and spinal cord,resulting in tetraplegia,or paralysis in the majority of his body. After weeks spent in traction at an acute care hospital, a nurse suggested he consider the Rehabilitation Institute of Chicago (RIC). Designated as a Model System Spinal Cord Injury Center by the National Institute on Disability and Rehabilitation Research, RIC fosters basic research as well as medical and technological advancements for people with spinal cord injuries.

Kay followed up on the referral.Paralyzed from the shoulders down, he relied on therapists and caregivers for transferring in and out of his wheelchair, for feeding and for bathing. In Kay’s case, as in all others, it was a difficult life adjustment.

Today he continues to look to the people and services of RIC to help him achieve his goals. Kay received a letter from RIC about the new Second Look program, a rehabilitation management program designed so that people with spinal cord injuries can, after discharge, at any point in their life return for a “tune-up.” The program is designed to help maintain patients’ health and provide any additional therapy or treatments available to help them achieve their goals after spinal cord injury.

Picking Up the Loose Ends

Patients such as Charles Kay are now surviving injuries with more complex conditions,as well as undergoing shorter length of stay at acute care facilities. Pressure from insurance payers and concerns of hospital-acquired infections are among the factors that limit institutional treatment. Patients are not always ready to go home or to move on to vocational rehabilitation. Second Look is a way to go back and pick up the loose ends.

A comprehensive medical evaluation constitutes an integral component of Second Look. This evaluation includes assessment and recommendations for preventing and managing secondary medical conditions and complications associated with spinal cord injury. Second Look is intended for people with all levels of spinal cord injury, including those using ventilators.

RIC Second Look participants also receive updates in nursing care procedures, therapy techniques and advances in technology and community resources from the expert clinical and medical staff.Second Look is recommended every 18 to 24 months for all people with spinal cord injury, or as new goals or challenges arise. The inpatient length of stay typically lasts two to four weeks and is potentially followed by outpatient services, if they are relevant.

Patients have a variety of reasons to return for a second look. They may be in a better frame of mind,gaining from experience and confidence. Some may have experienced a significant amount of neurological return, prompting a reevaluation of their status and goals. Some patients may have regressed, undergoing the consequences of aging or deconditioning. These patients may be more at risk for skin complications and fractures, while at the same time experiencing more dependence with caregivers. Second Look provides a platform for adjusting and improving a course of care. Caregivers can be called in for training updates. Physicians and nurses can help update medications. Therapists may introduce new adaptive equipment and techniques to maximize independence.

Patients come to Second Look with clear,individualized goals that they list as part of their initial evaluations. These goals might include living alone, feeding themselves,decreasing the burden of care from caregivers,or transitioning out of an institutional setting and living in the community. This is their second chance to move forward. The Second Look program allows patients an opportunity to experience programs and services of a model center that they may not have had during their initial care.

Patients are often physically and psychologically better prepared to advance their capabilities. Strengthened with positive coping skills, these patients usually begin to focus on community living issues, such as return to work, return to school and recreational activity goals.

A multidisciplinary care team is designed to provide a continuum of care and is made up of physiatrists, nurses and physical, speech, occupational and recreational therapists. The team expands to include consultations with internists, neurologist,neurosurgeons,orthopedic surgeons and urologists as needed. From a patient’s initial pre-admission evaluation, RIC’s Second Look staff knows who will be involved, and appointments are arranged ahead of time. Patients typically see one of the ancillary services right away on their first full day.

Over the course of their stay,most patients take advantage of four or five of these ancillary services. They can use the pool or have their wheelchair reevaluated. The Helen M.Galvin Health and Fitness Program and Wirtz Sports Programs allow access to adaptive sports and recreational opportunities. The Sexual Dysfunction Clinic offers evaluation and treatment for men with spinal cord injury who are experiencing problems in the area of sexual functioning and reproduction. Second Look offers a centered program where individuals can trial new techniques and strategies to live with their spinal cord injury and experiment with the efficacy of a number of technologies, resources and therapies.

While at RIC for the Second Look program, Charles Kay was fitted with hand splints to help promote functional positioning in his hands. This allowed him to do things like use a phone and change the channel on his TV with greater ease. He tried new methods of shifting in bed and was able to learn about new tools and technology that make everyday life activities like eating and reading easier.

Kay also worked with specialists in RIC’s Technology Center to develop new assistive devices designed to help him with daily activities.He learned some computer skills and plans to join one of the many computer classes RIC offers to help train patients in the newest computer technologies.

His chief goal in the program was to accomplish a standing transfer, using his legs to stand and move from bed to chair. He was able to train on the Lokomat®, a robot gait-trainer that provides assisted walking therapy. This device is often used to help patients who have walking impairments learn how to walk again. It helped Kay develop strength and balance in his legs. He is continuing therapy on an outpatient basis.