Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction

Abstract

Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. This article presents an overview of important clinical rehabilitation principles unique to SCDys. Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.

Prediction of bladder outcomes after ischemic spinal cord injury: A longitudinal cohort study from the European multicenter study about spinal cord injury

“…The study has some limitations that need to be addressed: the number of patients in this study was rather small, despite we used the data of the largest European database. This reflects the relative small number of patients with ischemic SCI admitted to specialized SCI centers . The low number of subjects resulted in broad confidence intervals of the aROCs and in the impossibility of exploring the effects of differences in the clinical composition of the traumatic and ischemic patient groups.…”

“…This reflects the relative small number of patients with ischemic SCI admitted to specialized SCI centers. 24 The low number of subjects resulted in broad confidence intervals of the aROCs and in the impossibility of exploring the effects of differences in the clinical composition of the traumatic and ischemic patient groups. However, based on the validity of the model in the population of traumatic SCIs and on the representativeness of our sample of the entire ischemic population, we believe that the results presented here may be seen as sufficiently relevant to justify application in clinical practice.…”

All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

“…Healthcare systems and NTSCI management models must consider the differential prognoses and mortality outcomes identified between NTSCI etiological groups to aid in the development of specialized inpatient and outpatient rehabilitation programs. For example, individuals with progressive forms of NTSCI (e.g., malignant and benign tumors) can benefit from short-term rehabilitation plans, with optimized goals, aimed at improving vital aspects of functioning (e.g., bladder management and caretaker education) [28][29][30]. Individuals with an infection and cardiovascular etiology additionally require intensive routine checks and up-to-date vaccinations to minimize medical complications that can interfere with rehabilitation [31].…”

“…Individuals with an infection and cardiovascular etiology additionally require intensive routine checks and up-to-date vaccinations to minimize medical complications that can interfere with rehabilitation [31]. Specialized outpatient follow-up care can play a vital role for the prevention and treatment of complications secondary to NTSCI [29]. Outpatient services, such as the Swiss-based ParaHelp [32], can provide individuals with NTSCI with quality advice and counseling and reduce patient burden associated with…”

Trends, Challenges, and Opportunities Regarding Research in Non-traumatic Spinal Cord Dysfunction

“…This applies especially if the desire is to include only one specific cause of SCDys, which is appropriate in some studies because of the differences in outcomes reported between the etiologies. 43,47 The acute hospital management of SCDys and rehabilitation services for these people tend to be decentralized; most people with SCDys are not admitted to specialist spinal cord units in acute or rehabilitation hospitals. 28,29,31,48,49 This creates significant challenges when planning multicenter studies (such as internal and external funding or resource planning and performance monitoring) and makes a population-based registry for these patients extremely difficult.…”