Spinal cord injury rehabilitation

Coordinated process and multispecialty collaboration yield strong patient outcomes

For more than 40 years, Mayo Clinic has served individuals with spinal cord disorders through its comprehensive spinal cord injury (SCI) program. About 140 to 150 patients with spinal cord dysfunction are treated in the acute rehabilitation unit yearly. Traumatic SCI accounts for 15 to 20 percent of those served.

Mayo physiatrists who provide care for patients with SCI have supportive, collegial and cooperative relationships with surgeons, oncologists, neurologists, and multiple other medical specialists and subspecialists throughout Mayo Clinic. This collaboration, as well as Mayo's integrated medical record, serves to enhance communication and supports timely, efficient patient care.

Beyond creating a smooth-running system, this care model produces measurable patient outcomes. The need to prevent complications in patients with neurogenic bladder, for example, illustrates the benefits of this multispecialty collaboration.

Only decades ago, neurogenic bladder problems were the No. 1 cause of mortality among SCI patients. "Working with our colleagues in urology, we have found that implementing a system that uses more extensive monitoring, assessment and feedback has helped us diagnose bladder problems earlier and prevent the onset of serious neurourologic complications," explains Mayo Clinic physiatrist Mark W. Christopherson, M.D., medical director for the SCI program in Rochester, Minn. "We now have neurourologic rounds where we meet and discuss cases on a regular basis and provide close follow-up, all of which have greatly reduced the incidence of these problems."

Patients with traumatic SCI have access to a broad array of coordinated, specialized care designed to help each individual reach optimal functional ability, level of wellness, quality of life and re-entry into the community. Mayo Clinic's spinal cord system of care often begins with a preoperative outpatient consultation and continues through the acute hospital and rehabilitation settings, a subsequent comprehensive interdisciplinary coordinated outpatient program, and lifelong follow-up.

The initial phase of treatment focuses on compensatory strategies and education to re-establish basic life skills:

  • Self-care activities
  • Mobility, transfers and gait
  • Learning to live a fulfilling life

In addition to the compensatory strategies, new restorative interventions are also used to achieve the highest possible functional outcome. These interventions may include:

  • Functional electrical stimulation for upper and lower extremity function
  • Biofeedback
  • Locomotor training, including robotic-assisted locomotor (Lokomat) training and over-ground ambulation with or without body-weight support

More than 20 occupational and physical therapists skilled in SCI treatments and technology support these innovative services.

Treatment of patients with nontraumatic spinal cord dysfunctions

Each year, about 100 to 120 patients with a diagnostically diverse array of nontraumatic spinal cord dysfunctions (NTSCD) travel to Mayo Clinic from all over the world. This group of patients includes those diagnosed with unresectable vascular malformations, sarcomas, and other tumors that cause cervical, thoracic, lumbar or sacral spinal cord dysfunction. Many of these patients have secondary complications similar to those associated with traumatic SCI, but they also tend to have additional comorbid conditions.

Patients with NTSCD are seen and treated in the acute hospital by the SCI team and also benefit from Mayo Clinic's unique model of care. "Our staff uses a well-defined process to identify patients early as candidates for comprehensive inpatient rehabilitation," explains Lisa A. Beck, R.N., C.N.S., a clinical nurse specialist on Mayo's SCI team. "This process allows our staff to decrease the time between symptom onset and rehabilitation admission."

According to Dr. Christopherson, this coordinated process also helps yield excellent outcomes for patients with NTSCD served in the comprehensive acute rehabilitation program. "Once admitted, our patients have exhibited greater than average functional changes, on the basis of the Functional Independence Measure, and shorter than average lengths of stay. As a result, many of our patients have a greater level of independence on discharge."

Despite the extreme complexity and severity of the spinal cord impairment and large array of comorbid conditions present in these patients, more than 77 percent of patients with NTSCD who are discharged from Mayo's acute rehabilitation unit return to their homes.

Points to remember

  • A unique collaborative model of care and integrated medical record help Mayo Clinic rehabilitation staff work with other specialists to identify and prevent potentially serious problems.
  • Mayo's acute rehabilitation unit serves one of the largest populations of nontraumatic spinal cord injury patients in the U.S. Despite the extreme complexity and severity of spinal cord impairment and the large array of comorbid conditions present in these patients, more than 77 percent of patients discharged from Mayo's acute rehabilitation unit return to their homes.