NEW - Returning Home After a Spinal Cord Injury
Spinal Cord Injury Outpatient Discharge & your Multidisciplinary Rehab Team
A traumatic spinal cord injury no doubt causes a major life change and raises many questions, concerns and fears about a victim’s present and the future. Your inpatient rehabilitation, which probably lasted for a few months, is a time of major adjustments and transitions in terms of your emotions, body, and lifestyle. Part of what you will do, or have begun to do, during your rehabilitation stay is to make plans to go home. Your discharge from the hospital can be thought of as a transition to another level of care or rehabilitation. As discussed below, your continuing care should include physician follow-up and home or outpatient care.
Getting ready to go home may seem like something you would do at the end of your hospital stay, but the earlier you begin to plan for your transition to home, the more smoothly your return to home will be. In fact, this process should start as early as your admission to the rehabilitation hospital. As difficult as it may be for you to focus on your departure from the hospital, your case manager, social worker, and other team members will need to discuss your living situation when you go home and transition to outpatient services. As difficult as it may be for you to focus on your departure from the hospital, your case manager, social worker, and other team members will need to discuss your living situation when you go home. They will ask you questions such as:
The answers to these questions are important because they will help to plan for your discharge. This chapter discusses several key factors in making your post-hospital plans. These factors include:
At home and in an outpatient setting, you may receive health care services, such as nursing care, physical therapy, occupational therapy, speech therapy, social work services, individual therapies, participate in a day treatment program, or receive physician care. You and your rehabilitation team, including your case manager or social worker, will plan for follow-up care based on your individual needs and your insurance benefits.
After discharge from rehabilitation, people with SCI often return to their homes or a family member’s homes. Many people continue to receive nursing care and other therapy at home. Home health care providers are trained to teach skills and provide ongoing treatment. They may recommend changes and adaptations to improve your level of independence and safety and to conserve your energy. The types and amount of home health services provided will no doubt depend in part on the availability of insurance funding and the accident benefits that your Hamilton spinal cord injury lawyers will help you and your family put into place.
Typically, the primary care physician is the doctor who renews home health orders and works with the patient and the home health agency on the plan of care – however, the outpatient management of an individual with SCI is complex and lifelong requiring a multidisciplinary approach.
Outpatient rehabilitation services may be prescribed if you need ongoing or periodic medical care and therapy. Depending on your needs and community resources, outpatient services can be received from different sources, including the rehabilitation hospital, hospital outpatient clinics and centers, private therapy services, and physicians’ practices. Outpatient services may include these services and people, but are not limited to:
Home Health Nursing – home nursing services may be provided with the expectation that a caregiver will be trained to provide services that might include bowel and bladder management, wound care, PEG (feeding) tube care, provision of intravenous medication, monitoring of vital signs, and more. Usually, the home nursing staff’s goal is to teach the caregiver(s) to provide the care and then to follow up two or three times a week to answer questions and respond to concerns.
Physical Therapy – The physical rehabilitation of an SCI during the acute phase depends on the level and location of injury on the spinal cord. For SCI patients, Physiotherapy is vital to this process. Physiotherapy is necessary to prevent the weakening and possible wasting of muscles as well as focusing on goals related to motor tasks such as walking, pushing a wheelchair, transferring and using the upper limbs. When does physiotherapy start? Individuals with a spinal cord injuries often need initial treatment in an intensive care unit followed by extended treatment in a dedicated Spinal Injury Unit. The inpatient management can last from 2 to 6 months, followed by outpatient rehabilitation for normally 3 – 12 months, generally followed by yearly medical and functional reviews.
Aquatic (aqua) Therapy – otherwise known as pool therapy, aqua therapy can yield many benefits to spinal cord injury victims, such as regaining movement, balance and strength, reeducating muscles to stand and walk after a brain injury. Because of water’s buoyancy, therapists are able to help spinal cord injury victims increase resistance and move the person partially out of the water to gradually increase the intensity of the training.
Vocational Rehabilitation – Designing effective vocational programs for persons with spinal cord injury (SCI) is essential for improving return to work outcome following injury. Vocational specialists are experts who can help you assess your job interests and skills, academic abilities, personal characteristics & qualities, and physical capabilities as related to work and getting back into the job market. Vocational specialists can help you to set career goals and define ways for you to achieve these goals.
Therapeutic Recreation – Therapeutic recreation is an integral part of the total rehabilitation process. Following spinal cord injury (SCI), certified therapeutic recreation specialists (CTRSs) normally work with spinal cord injury victims during rehabilitation to re-create leisure lifestyles. Peer reviewed medical studies have shown that Greater participation in therapeutic leg leisure skill and community activities throughout rehabilitation is an absolute positive predictor to a productive and healthy life after an SCI.
Orthotics and Prosthetics Services: orthodists can assist victims who suffer spinal cord injuries by providing orthotic and prosthetic solutions to increase the victim’s functionality. Throughout rehabilitation, orthotists normally work closely with all multi-disciplinary members of the team, but especially the occupational therapist, physiatrist, psychologist, and physician if acceptance and use of orthotic devices is to be attained. Successfully fitted orthoses are tremendously useful not only for self-care, but they also play a major role in achieving the ultimate goal of rehabilitation, the return to gainful employment. Many types of electronic devices, including computers, are manipulated more easily with an orthosis.
Hand Therapy – Loss of hand function is one of the most overwhelming consequences of spinal cord injury The most important factor which influences the range of hand function is the level and degree of the cord lesion. A 2018 study by Dr. Kiwerski our of the Medical University of Warsaw, Poland indicates that cord lesions on the level of C5 is usually accompanied with functional paralysis of the limb. Intensive hand training may enhance neural recovery and hand function to some degree. Hand therapy may include traditional hand therapy using therapist guided facilitation techniques, splinting and Functional Electrical Stimulation.
Physiatrists – physiatrists are physicians who specialize in physical medicine and rehabilitation, and are responsible for your overall medical care. They coordinate rehabilitation therapies, services, and the care you require from other physicians.
Psychologists Rehabilitation – severe emotional negative reactions following SCI are common which can threaten both psychosocial integration and emotional security, requiring therapeutic attention to the long-term psychological adjustment of individuals following SCI. Also, post-traumatic stress reactions are common in persons following a major stressful life event like a diving incident or motorcycle or automobile crash. There are many rehab psychologists who are trained in the psychology of adjustment to disability. Rehabilitation psychologists assess how you are coping. They work with you and your family, and other members of the rehabilitation team to help you adjust to your disability and plan for the future. Frequent areas of intervention include stress management, coping with loss, sexuality, and vocational planning.
Rehabilitation Nurses – the nursing staff includes registered nurses (RNs) who have specialized education in spinal cord rehabilitation, licensed practical nurses and patient care assistants. Rehabilitation RNs assess your ongoing psychosocial status, physical adjustment and progress with functional rehabilitation. Nursing staff assist with all aspects of your care, including preventive respiratory care, bowel and bladder management, and both therapeutic and preventive skin care. The RN’s primary goal is teaching you about spinal cord injury, how to direct others in your care and how to be as independent as possible. The RN works with other members of your health care team in discharge planning and coordinating your transition to the next level of care.
Occupational Therapists – Occupational therapists help you develop the functional abilities needed in daily life, such as self-care and home management. Occupational therapists also address swallowing, upper extremity functioning, cognition and safety, and visual perception. Occupational therapists have special expertise in wheelchairs, rehabilitation after upper extremity functional restoration surgery, and driving after SCI.
Respiratory Therapists and Respiratory Therapy Technicians – If your spinal cord injury involves the neck or upper back, you may have difficulty coughing effectively. If you have cervical injuries affecting C1–C4 vertebrae, you may also have difficulty breathing. Respiratory therapists evaluate, treat and care for patients with breathing disorders, and are responsible for respiratory care treatments. If you require a ventilator to breathe after SCI, respiratory therapists help ensure that you, as well as your family, friends or support system, know how to use the ventilator.
Recreational Therapists – A critical part of recovery after SCI is the ability to return to social, family and recreational activities. In many instances, SCI changes how someone can participate in hobbies and family activities. A recreational therapist will help you adjust to the hobbies and activities you participated in before your injury, to develop new skills and interests, and get involved in the community through re-integration trips. Recreational therapists provide opportunities to apply learned skills from other therapies to leisure activities.
Speech-Language Pathologists – Some spinal cord injuries can affect speech, or may occur with a brain injury. In these situations speech-language pathologists will evaluate speech and language abilities. The speech pathologist assists with the skills necessary for communication, or possibly develops alternative methods of communication. Speech therapists are also trained in day-to-day interventions and training to improve communication.
Social Workers – Medical social workers can assist you and your family in various ways, by counseling you and your loved ones, providing emotional support, and offering information about financial resources and community agencies. Social workers can help you identify your needs and your families needs on admission and reassess these needs throughout your rehabilitation process. The social worker’s ultimate goal is to prepare you and your family for a safe and effective discharge by maximizing knowledge and identifying / addressing physical, economic, and emotional barriers to optimal discharge home. The social worker can also assist with community re-entry and can identify resources in the community to increase your independence. For example, the social worker could help you identify transportation or grocery delivery services. Home health social work services are usually limited. You and your caregiver will need to follow up and complete forms on the resources provided by your social worker. The case manager is responsible for communicating to your health insurance provider your progress and the functional changes you are making. He or she will also talk with you about any home health services that are not covered benefits (and therefore your financial responsibility).
Chaplains – Caring for your spiritual needs is very important. Chaplains provide spiritual or religious support for you and your family throughout the recovery process.
Dietitians – Adequate nutrition is critical to recovery after SCI. A registered dietitian can help you make healthy food choices and to manage any special dietary needs you may have.
Some larger and more specialized outpatient rehabilitation providers, such as St-Johns or the Hamilton Rehabilitation Unit might also offer seating and mobility, fertility, wound care, and other clinics. Depending on your needs, you might receive only one of these services, or you might receive a menu of services as your rehabilitation progresses. Lyndhurst Centre, one of 5 Toronto Rehab sites, is a leader in revolutionizing rehabilitation for people with spinal cord injuries and sees about 325 inpatients per year.
Many people with SCI (up to 40 percent) need extra help with daily activities after they go home. Often, family members provide the required assistance. Think about personal care assistance as early as possible. Discuss with your rehabilitation team members if and how much assistance you might need. As you think about personal care assistance, think about what your daily needs will be within a 24-hour period. These needs may include assistance with activities of daily living (bathing, dressing, using the toilet, grooming, and eating), getting into and out of bed, preparing meals, and using transportation. Think about who can assist with each specific task. Some people are most comfortable with assistance from family members or friends. Others choose to hire personal care assistants or a combination of family, friends, and paid help.
Family Members – When making decisions about who will be your primary caregiver(s), you will need to think about who in your family is willing to assist, the time needed from the caregiver, and who is physically able to perform the more labor-intensive activities (such as transfers). Most often, family members serve as primary caregivers for persons with SCI.
PSW’s and Personal Care Assistant – In some instances, family members acting as caregivers may need to hire additional help. a family member may be able to help with bathing and dressing but unable to help the person with transfers from the bed to the wheelchair, bedside commode toilet, etc. In such cases, a personal care assistant (PCA) could be hired to take care of the daily routine needs of a person with a disability. Accident benefits personal care assistance is covered under the attendant care provision of the legislation.
While the return home is usually eagerly anticipated through most of their hospitalization, as the date nears spinal cord injury victims almost, in our experience, begin almost to dread it. Discharge means facing all the unknowns knowns awaiting them in the “real world.” The physical return home is one thing; the psychological adjustment to life as someone one with a spinal cord injury is another. Before this point, therapists usually visit the persons home and make various recommendations mendations on how to improve the accessibility of the residence. Partners or loved ones complete training in how to help the newly paralyzed individual get in and out of the car, bed, or shower. Despite this preparation, spinal cord injury victime frequently became quite anxious and often seem to lose much of the confidence they have worked so hard to gain during their long weeks or months in rehab. Just as so many people do at the onset of hospitalization, they often begin to wonder again if they can make it in the real world. Once someone returns home, however, they are no longer within the “safe walls” of their rehab unit. It’s at this point that the real adjustment, the anxiety and the worry begins. In our experience, you will no doubt be excited to go home but once you arrive, you might tend to experience the stages of grief all over again ( such as sadness, anger, frustration, anxiety and resentment.) This is when most spinal cord injury victims really come to grips with their disability.
If you’ve suffered a spinal cord injury as a result of someone’s negligence it’s important that you speak to a qualified Hamilton spinal cord injury lawyer that specializes in neuro-trauma cases. It’s important that your return home is properly funded by the appropriate insurance company. During your emotional adjustment, you will need help ensuring that you are financially taken care of in order to afford the proper outpatient services and providers to help you not only during your return, but throughout your entire life. Our paralysis and spinal cord injury lawyers have been representing traumatic spinal cord injury victims since 2003. Estimating the compensation a paralyzed victim deserves can be quite complex and at times. At the Lalande Personal Injury Lawyers, our personal injury lawyers will always use all possible resources in order to accurately estimate the amount that your spinal cord injury case is worth. Please do not hesitate to call our Hamilton office for a free consultation today at 905-333-8888 or 1-844-LALANDE today.
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