National Spinal Cord Injury Association Resource Center
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.
a Spinal Cord Injury Rehabilitation Facility
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
A Quick Word about
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
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 Factsheet #11). 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
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.
SCI PROGRAM CHECKLIST
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.
- Are the beds for people with SCI in the same area
of the facility?
- Are there people in the SCI program of the same
age and sex as the person considering admission?
- Do the people in the SCI program have similar
levels and kinds of spinal cord injury e.g.,
quadriplegia, paraplegia, incomplete and
- 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.)
- 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
- Are there treatment specialists in the SCI
program who speak the primary language of the
individual seeking treatment?
- Will the treatment team develop a rehabilitation
plan with both short and long term goals?
- Will an experienced case manager be assigned to
help family members obtain medical payments and
other benefits from public and private insurance?
- Will a team member be assigned to coordinate
treatment and act as a contact for staff and
- 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?
- Is there physician coverage seven days a week?
Twenty-four hours a day?
- 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
- Does the program ensure the availability of
rehabilitation nursing and respiratory care on a
twenty-four hour basis?
- 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.
- 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.
- Are other specialties such as driver education,
rehabilitation engineering, chaplaincy, and
therapeutic recreation available if needed?
- Are activities planned for SCI program
participants on weekends and evenings?
- 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?
- 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?
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
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.
- Are the beds for children with spinal cord
injuries in one area or in the same location as
children with similar disabilities?
- Are children of the same sex and similar age
currently in the program/facility?
- 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?
- How many children with SCI does the
program/facility admit on an annual basis?
- 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?
- 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).
- Are young siblings and friends allowed to visit
- Does the program/facility offer adaptive
technology to help children communicate and
- Is counseling available for siblings and families
- Is the equipment used by therapists, i.e.
physical therapists and occupational therapists,
appropriate for children?
- Does the facility/program provide patient
education materials for children and family
(See Factsheet #12 for more information on ventilator
- Is the physician who directs the program a board
certified Pulmonologist or a Physiatrist? Does
he/she have experience with SCI?
- Are ventilator users treated on the same unit?
- How long has the facility been providing
treatment for ventilator users?
- 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?
- Are people in the unit similar in age to the
person considering admission?
- Will they have the opportunity to meet ventilator
users who have returned to the community and
maximized their independence?
- 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
- Does the facility offer sexuality and fertility
- Do facility policies encourage family members
including siblings regardless of age, to
participate in rehabilitation programs?
- Are there living arrangements for family members
participating in training? What other services,
parking, meals and etc. are provided?
- Are counseling and other social services
available to family members?
- Are SCI program participants given educational
self-care manuals when they are discharged?
- Will staff members develop a formal discharge
plan with program participants and their
- Does the facility and discharge planner work with
local Independent Living Centers? Do they
incorporate referrals to these centers into their
- Is there an independent living unit available for
program participants and families to practice
self-care skills? Can family members stay there
- If the facility does not have an independent
living unit do they encourage overnight
therapeutic leave prior to discharge?
- Will someone be assigned as a liaison to provide
- Will a staff member visit or make arrangements
for someone locally to evaluate the home for
- Will the follow-up plan include:
- Referral to an appropriate physician and
other medical specialists in the
- Regular follow-up visits with this
physician or a spinal cord injury unit
- Regular urological evaluations?
- Scheduled equipment evaluations?
- If appropriate, a thorough vocational
evaluation and referrals to a vocational
- Referrals to other services and resources
in the community, e.g. elder services?
Before Making the Final
- Were staff members helpful and friendly when
information was requested?
- 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?
- Did you have an opportunity to speak with people
currently participating in the program? If so,
were they satisfied with their rehabilitation
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.
This Factsheet is offered as an
information service only. It is not intended to include
every facility nor is it an endorsement of the medical
facilities listed. Any information you may have to offer
to further update this Factsheet would be greatly
appreciated. The National Spinal Cord Injury Association
Resource Center (NSCIRC) provides information and
referral on any subject related to spinal cord injury.
Contact the resource center at 1-800-962-9629.
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