It is very important to be confident about the quality of care you or a loved one will receive when entering a rehabilitation program. Very few people have prior experience with rehabilitation or the effects of a spinal cord injury (SCI), thus, assessing the quality of a rehabilitation program is difficult.

Although the final decision will ultimately depend upon individual circumstances such as insurance and location, all rehabilitation programs have features which can be evaluated, regardless of your prior knowledge of rehabilitation or SCI.

It is vital to select a high quality rehabilitation program with skilled professionals to help a newly injured person develop the skills needed to maintain physical and emotional health throughout his/her lifetime.

A Quick Word about Rehabilitation Programs

In order to develop and maintain quality services for individuals with spinal cord injuries, rehabilitation staff and programs MUST specialize in treating SCI. This expertise is best acquired and maintained when staff members treat people with SCI on a regular basis. High quality rehabilitation programs are often located in facilities devoted exclusively to providing rehabilitation services, or in hospitals with designated SCI units.

In-patient SCI rehabilitation programs have features which distinguish them from the hospital programs where most people receive initial treatment. Rehabilitation programs are designed to serve people with a wide variety of skills and must address complex social and community issues. A rehabilitation team comprised of specialized medical personnel is used to accomplish these goals.

Teams should include social workers, occupational and physical therapists, recreational therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists and other specialists. The team is usually directed by a physiatrist, a physician specializing in physical medicine and rehabilitation (see What is a Physiatrist?). Team members are jointly responsible for working with individuals and their families to develop effective rehabilitation and discharge plans.

The team should assign a program manager who will function as a contact with the rest of the team. This contact should meet with the person undergoing rehabilitation on a regular basis to discuss the rehabilitation plan and to address personal or family concerns.

Rehabilitation programs and acute care units may also differ in their emphasis on family and patient participation. Although many factors can contribute to someone's successful return to the community following a spinal cord injury, the education and active involvement of the newly injured person and the family is crucial. Rehabilitation programs should focus on maximizing a person's ability to be independent and should assist in making decisions about treatment and goals.

The following questions were developed to assist you in your decision making process. They can be used as a checklist to obtain the information required to make an informed decision when choosing a rehabilitation program.

General Considerations

Peer support and contact with others who have a SCI can be extremely important in helping a person adjust to the injury. Peer support is generally most helpful and accepted when people share similar problems and issues. This is an especially important consideration when choosing programs for women. It is often difficult for women to find peer support because the incidence of SCI among women is much lower than it is for men.

1. Are the beds for people with SCI in the same area of the facility?
2. Are there people in the SCI program of the same age and sex as the person considering admission?
3. Do the people in the SCI program have similar levels and kinds of spinal cord injury e.g., quadriplegia, paraplegia, incomplete and complete?
4. What is the average number of people admitted annually to the SCI program? (program staff should treat people with SCI on a regular basis to acquire and maintain expertise.)
5. Is the SCI program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? Has it been designated as a Model Spinal Cord Injury Center by the National Institute of Disability Research and Rehabilitation (NIDRR)? Is the SCI program part of a SCI rehabilitation system operated by the state?
6. Are there treatment specialists in the SCI program who speak the primary language of the individual seeking treatment?
7. Will the treatment team develop a rehabilitation plan with both short and long term goals?
8. Will an experienced case manager be assigned to help family members obtain medical payments and other benefits from public and private insurance?
9. Will a team member be assigned to coordinate treatment and act as a contact for staff and family members?

1. Is the physician in charge a Physiatrist? If not, what credentials does he/she have? How long has the physician in charge been directing programs specializing in SCI?
2. Is there physician coverage seven days a week? Twenty-four hours a day?
3. Do the regular nursing staff and other specialists responsible for providing treatment in the SCI program have specific training in treating SCI? Is the nursing staff employed by the hospital or employed through an outside agency?
4. Does the program ensure the availability of rehabilitation nursing and respiratory care on a twenty-four hour basis?
5. Are there consultants available at the facility or nearby medical centers? These should include neurosurgery, neurology, urology, orthopedics, plastic surgery, neuropsychology, internal medicine, gynecology, speech pathology, pulmonary medicine, general surgery and psychiatry.
6. How often and for how long each day will participants get treatment by specialists such as occupational and physical therapists? Treatment should be no less then three hours per day.
7. Are other specialties such as driver education, rehabilitation engineering, chaplaincy, and therapeutic recreation available if needed?
8. Are activities planned for SCI program participants on weekends and evenings?
9. How much time is spent teaching SCI program participants and their families about sexuality, bowel and bladder care, skin care and other essential self-care activities?
10. Does the SCI program offer training in the management and hiring of personal care assistants? If so, how much time is spent by staff on this topic?
    
    

Pediatric Programs

Because incidence rates of SCI among children are relatively low, rehabilitation hospitals and programs usually do not maintain a separate program or unit exclusively for children with SCI. As an alternative, caregivers may consider facilities/programs which place children with SCI in rehabilitation units with other children with chronic disabilities. Hopefully, this will provide families and children with opportunities to share common experiences and information with each other, and may lead to the development of support networks in the community.

It is possible that children may be placed in units with other children who are too ill for rehabilitation. Children generally derive greater benefit if they undergo rehabilitation with other children who are actively involved in the rehabilitation process.

1. Are the beds for children with spinal cord injuries in one area or in the same location as children with similar disabilities?
2. Are children of the same sex and similar age currently in the program/facility?
3. Is the physician in charge an individual with experience in rehabilitation? Does this physician have experience with children? If not, what are his/her qualifications? Do the other staff members specialize in pediatrics?
4. How many children with SCI does the program/facility admit on an annual basis?
5. Does the program/facility offer educational programs for children and young adults undergoing treatment? If not, does the facility coordinate tutoring programs with local schools? If so, who is responsible for payment?
6. Are there child life or therapeutic recreation specialists on staff? (Child life specialists develop programs for children and families which strive to maintain normal living patterns and minimize the clinical environment. Therapeutic recreation specialists focus on teaching persons with disabilities new leisure and sports skills to maximize their independence).
7. Are young siblings and friends allowed to visit the unit?
8. Does the program/facility offer adaptive technology to help children communicate and learn?
9. Is counseling available for siblings and families members?
10. Is the equipment used by therapists, i.e. physical therapists and occupational therapists, appropriate for children?
11. Does the facility/program provide patient education materials for children and family members?

1. Is the physician who directs the program a board certified Pulmonologist or a Physiatrist? Does he/she have experience with SCI?
2. Are ventilator users treated on the same unit?
3. How long has the facility been providing treatment for ventilator users?
4. If the treatment team determines that an individual cannot breathe independently, what kind of services are offered to assist them in living as independently as possible?
5. Are people in the unit similar in age to the person considering admission?
6. Will they have the opportunity to meet ventilator users who have returned to the community and maximized their independence?
   
   

Psychosocial/Counseling Services

1. What types and how many hours of psychosocial services are available? These should include peer support, individual and group psychotherapy, couples, vocational and substance abuse counseling.
2. Does the facility offer sexuality and fertility counseling?

1. Do facility policies encourage family members including siblings regardless of age, to participate in rehabilitation programs?
2. Are there living arrangements for family members participating in training? What other services, parking, meals and etc. are provided?
3. Are counseling and other social services available to family members?

1. Are SCI program participants given educational self-care manuals when they are discharged?
2. Will staff members develop a formal discharge plan with program participants and their families?
3. Does the facility and discharge planner work with local Independent Living Centers? Do they incorporate referrals to these centers into their discharge planning?
4. Is there an independent living unit available for program participants and families to practice self-care skills? Can family members stay there also?
5. If the facility does not have an independent living unit do they encourage overnight therapeutic leave prior to discharge?
6. Will someone be assigned as a liaison to provide follow-up services?
7. Will a staff member visit or make arrangements for someone locally to evaluate the home for modifications?
8. Will the follow-up plan include:
• Referral to an appropriate physician and other medical specialists in the community?
• Regular follow-up visits with this physician or a spinal cord injury unit physician?
• Regular urological evaluations?
• Scheduled equipment evaluations?
• If appropriate, a thorough vocational evaluation and referrals to a vocational rehabilitation program?
• Referrals to other services and resources in the community, e.g. elder services?

1. Were staff members helpful and friendly when information was requested?
2. Were you offered an opportunity to tour the facility? If you were able to make a tour, what were your impressions of the overall atmosphere?
3. Did you have an opportunity to speak with people currently participating in the program? If so, were they satisfied with their rehabilitation programs?

NSCIA is committed to assisting individuals with SCI and other concerned individuals find quality rehabilitation services. If you would like further assistance during the decision making process, please contact us to discuss your concerns.