Collaborative care model provides measurable outcomes for patients with spinal cord injury

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 people with spinal cord dysfunction are treated in the acute rehabilitation unit yearly, with traumatic SCI accounting for 15 to 20 percent of those served.

Mayo Clinic 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 Clinic's integrated medical record, enhances 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 colleagues in urology, Mayo Clinic physiatrists have found that implementing a system that uses more extensive monitoring, assessment and feedback has helped them diagnose bladder problems earlier and prevent the onset of serious neurourologic complications.

The SCI program in Rochester, Minn., now has neurourologic rounds where staff 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 his or her 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 of self-care activities; mobility, transfers and gait; and learning to live a fulfilling life. In addition to the compensatory strategies, new restorative interventions also are 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 (NTSCDs) 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. Using a well-defined process to identify patients early as candidates for comprehensive inpatient rehabilitation allows staff to decrease the time between symptom onset and rehabilitation admission.

According to Mayo Clinic physiatrists, this coordinated process also helps yield excellent outcomes for patients with NTSCD served in the comprehensive acute rehabilitation program. Once admitted, these patients have exhibited greater than average functional changes, based on the Functional Independence Measure, and shorter than average lengths of stay. As a result, many 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 the patients with NTSCD who are discharged from Mayo Clinic'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 Clinic's acute rehabilitation unit serves one of the largest populations of nontraumatic spinal cord injury patients in the United States. 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 Clinic's acute rehabilitation unit return to their homes.