Spinal cord injury (SCI) can be devastating. It is important to understand the prevalence and how to prevent injury. At WakeMed, our Spinal Cord Injury Program can help. Spinal Cord Injury Awareness Month gives us the opportunity to educate the community, recognize those living with SCI and offer support to organizations that are striving to improve the lives of persons with SCI and their caregivers.

In recognition, we sat for a chat with Diane Gilewicz, MSN, RN,CRRN, who has been a part of WakeMed Rehabilitation Hospital for more than 30 years. She serves currently as the Director of WakeMed’s Spinal Cord Injury Program.

Please tell us about WakeMed’s Spinal Cord Injury Program.

In our Spinal Cord Injury Program, we recognize that a SCI is life-changing but not life-ending, and through our multi-disciplinary care, we help our patients open new doors to bright futures.

Because WakeMed is home to one of North Carolina’s six Level 1 Trauma Centers, the WakeMed Spinal Cord Injury team offers a level of comprehensive care unmatched by other facilities. Patients at all stages of recovery are welcome to join the WakeMed Spinal Cord Injury Program and to experience our focus on building lifelong supportive relationships to foster confidence, independence and vitality.

Our inpatient Rehabilitation Hospital and outpatient Spinal Cord Injury Programs are accredited for adults, children and adolescents by the Commission on Accreditation of Rehabilitation Facilities (CARF).

What should someone look for in a rehabilitation center?

There is no question that SCI is a life-changing event. The rehabilitation hospital/provider you choose can change your life as well. WakeMed Rehabilitation Hospital provides highly specialized care and therapies for people with spinal cord injuries, helping them achieve the best possible outcome and quality of life.

For many people, the earlier rehabilitation begins, the better the recovery and overall outcome.

At WakeMed, the Rehabilitation team begins working with patients in the acute care setting — before they even reach the Rehabilitation Hospital where the intensive therapy starts. This is an important factor to consider when deciding on a provider and facility for SCI rehabilitation.

Below are suggestions on questions to ask a rehabilitation provider when choosing a SCI rehab program.

• Is the program accredited?
• Is the program comprehensive?
• Will patients receive three or more hours of the specific therapies every day?
• Do they accept patients with tracheostomies?

The WakeMed Rehabilitation Spinal Cord Injury Program is topnotch. In fact, several members of the WakeMed Rehab leadership team are surveyors for CARF, which means they see and share best rehabilitation practices throughout the country and world.

How do I decide between Rehab Hospital Care vs. Nursing Home Care?

For those who qualify, research proves that individuals treated in acute inpatient rehabilitation facilities (IRFs), such as WakeMed Rehabilitation Hospital, have better long-term clinical outcomes than those treated in nursing homes or skilled nursing facilities (SNFs).

The following information will help you and your family understand the benefits of rehab hospital care over nursing care.

WakeMed Rehabilitation Hospital

• It feels like a hospital unit, but it is an acute inpatient rehabilitation facility (IRF) that is licensed as a hospital.
• A physiatrist (doctor specializing in rehabilitation) sees patients every day and directs patient care.
• Nurses specialize in treating patients of all ages with multiple physical and medical issues.
• The day shift, nurse-to-patient ratio is one to six to ensure nurses can provide complex care.
• Patients receive intensive therapy — two or more therapies for a minimum of 15 hours per week, which helps build strength, endurance, mobility and balance.
• Patients are admitted to an IRF from different locations, such as hospital units, observation units, emergency departments or even home.
• Physicians, nurses, therapists, case managers, patients and their families work together in a coordinated manner.

Nursing Home

• Also called skilled nursing facilities (SNFs), they are licensed as long-term care facilities.
• An internal medicine physician must see patients every 30 days.
• Nurses specialize in care related to elderly patients.
• Nurses provide care to more patients per day than IRF nurses do — patient care is not as complex.
• Patients may receive one or more therapies not considered intensive from as little as 45 minutes per week to a maximum of 12 hours per week.
• Patients can qualify for admission to a nursing home after they have spent at least three days in a hospital.
• Coordinated care is not a feature that defines nursing home care.

An evaluation is the only way the WakeMed Rehab team can determine if a patient qualifies for IRF care. For patients who do qualify, there is no better level of care available. The intensity of services — physical, occupational and/or speech therapy — they receive at an IRF maximizes recovery, independence, and quality of life.

Even if your physician or discharge planner feels another level of care might be right for you, WakeMed Rehab Admissions welcomes the opportunity to do an evaluation to determine your eligibility for our program or to answer any questions about your post-acute care needs. Please call them at 919-350-7876.

How does treatment help a person with SCI?

For many people, the earlier rehabilitation begins, the better the recovery and overall outcome. Some SCI survivors may find they can live completely independently, while others may only need a caregiver for a few hours a day.

Rehabilitation after SCI helps patients regain their strength, reduce pain and maximize neuroplasticity for optimal recovery. In addition, participation in a program can help persons with SCI build lifelong supportive relationships.

What causes SCI?

SCI usually happens because of a sudden, severe blow to the spine. Often this is the result of a car accident, fall, gunshot or sports injury. Sometimes the spinal cord is damaged by infection or narrowing of the spinal canal (spinal stenosis), and some people are paralyzed from the time of birth because of birth defects.

Why is SCI serious?

SCI is damage to the spinal cord. The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs throughout the spinal canal, a tunnel formed by holes in the bones of the spine (vertebrae). The bony spine helps protect the spinal cord and the spinal cord carries messages between the brain and the rest of the body. These messages allow you to move, feel and touch, among other things. SCI stops the flow of messages below the site of the injury. The closer the injury is to the brain, the more the body is affected. Each injury is different, and injuries can affect the body in many different ways.

In most injuries, the backbone pinches the spinal cord, and it becomes bruised or swollen. After an SCI, most nerves above the level of injury keep working the way they always have. Below the level of injury, however, the spinal cord nerves can no longer send messages between the brain and parts of the body the way they did before. This is what causes paralysis and numbness that a person with SCI may experience.

What are the types of severity levels of SCI?

Spinal cord injuries can be classified based on the function (how much feeling and movement you have) or on where the damage occurred. When a nerve in the spinal cord is injured, the nerve location and number are often used to describe how much damage there is.

For example, a C7 injury is associated with the seventh cervical nerve of the neck and its effect on the feeling and movement. C7 is known as the functional level of injury. These classifications are often used by people who have an SCI to describe their injury and capabilities. The spinal cord is surrounded by protective rings of bone called vertebrae. The vertebrae and spinal nerves are organized into segments, starting at the top of the spinal cord. Within each segment, the vertebrae and nerves are numbered.

The segments are as follows:

• Cervical — The neck area contains 7 cervical vertebrae (labeled as C1-C7) and 8 cervical nerves (C1- C8). Cervical SCI usually causes loss of function in the chest, arms and legs. Cervical injuries can also affect breathing and bowel and bladder control.
• Thoracic — The chest area contains 12 thoracic vertebrae (labeled as T1-T12) and 12 thoracic nerves (T1-T12). The first thoracic vertebra, T1, is the vertebra where the top rib attaches to the spine. Thoracic SCI usually affects the chest and the legs. Injuries to the upper thoracic area can also affect breathing. Thoracic injuries can also affect bowel and bladder control.
• Lumbar — The lumbar area (between the chest area and the pelvis) contains 5 lumbar vertebrae (labeled as L1-L5) and 5 lumbar nerves (L1-L5). Lumbar SCI usually affects the hips and legs. Lumbar injuries can also affect bowel and bladder control.
• Sacral — The sacral area (from the pelvis to the end of the spine) contains 5 sacral vertebrae (labeled as S1-S5) and 5 sacral nerves (S1-S5). Sacral SCIs also usually affect the hips and legs. Injuries to the upper sacral area can affect bowel and bladder control.

What is an ASIA/I0SCoS score? What does this mean for a patient’s future recovery?

The American Spinal Injury Association Impairment Scale is a standardized neurological examination used by the rehabilitation team to assess the sensory and motor levels which were affected by a SCI. While every SCI is different, this scale helps to predict functional outcomes.

What are the next steps in caring for SCI?

Recovery from SCI is a lifelong journey. Patients at all stages of recovery are welcome to join the WakeMed Spinal Cord Injury Program and to experience our focus on building lifelong supportive relationships to foster confidence, independence and vitality.

• Our Facilities
• Our Team
• Admissions
• Advanced Technology
• Dedicated Clinical Case Management
• Fitness Program

References and Additional Resources

SCI Rehabilitation Patient and Family Guide (wakemed.org)

Rehab & Physical Therapy, WakeMed Health & Hospitals, Raleigh & Wake County, NC

Mayo Clinic

Injury Prevention, WakeMed Health & Hospitals, Raleigh & Wake County, NC