Pediatric Spinal Cord Injury Rehabilitation

The spinal cord injury rehabilitation program at Shriners Hospitals for Children® — Philadelphia, under the direction of Randal Betz, M.D., chief of staff and medical director of spinal cord injury (SCI), has been in existence for 25 years. During this time, with an emphasis on pediatric care, it has received recognition as one of the leading spinal cord research programs for children and adolescents with acute and chronic spinal cord injuries. Evidence based practice is a main focus when implementing care, along with the on-going SCI education of patients and their families.

Other adult and pediatric hospitals provide care to children with SCI as a part of their adult and spina bifida programs. Conversely, this program is specifically designed to treat spinal cord injuries in children. Because of this targeted focus, treatment regimes are developed, validated and implemented to prevent secondary complications and optimize patient-desired outcomes. An important aspect of the program is the formal and informal sharing of patient and family experiences, which relates to the holistic and individual care given to each patient and reflects the concern for not only the physical disability but also the health and wellbeing of the child and family.

Once discharged from acute rehabilitation, all patients are followed through the outpatient program. Subsequent admission may be necessary depending upon goals and the child’s needs. Younger children tend to be followed more closely (every three months) until skeletal maturity, particularly to monitor their spines and hips for scoliosis and hip disorders. They are also monitored for developmentally appropriate mobility needs and preventative education.

In summary, the philosophy of the program is both progressive and preventative. Focus is on addressing both the physical and the mental implications of SCI. The program strongly emphasizes the prevention of secondary complications, such as scoliosis, joint contractures and hip instability. As mentioned, education of patients and their families is on-going throughout their hospital stay and continues after discharge.

Children with spinal cord injuries are uniquely different from adults with spinal cord injuries.

The Spinal Cord Injury Program includes:

• Activity-based rehabilitation program
• Care coordination
• Discharge planning and coordination
• Emergency stabilization
• Neurosurgery
• Orthotics & prosthetics
• Patient and family education
• Pediatric critical and intensive care
• Peer support
• Psychology
• Rehabilitation nursing
• Research programs and clinical trials
• Respiratory Managment
• Social work/case management
• Therapeutic recreation/child life
• Ventilator weaning and management

Special programs include phrenic nerve implant,  urodynamic testing and high level tetraplegia clinic.

Spinal Cord Injury Education for Patients and Families

Education is a very important piece of the spinal cord injury rehabilitation process. In conjunction with the daily education from all disciplines, there are two sessions incorporated into the schedule for group classes. The education topics will cover all aspects of SCI care and management. Patients, parents and any caregivers are invited to the class. Along with the education from staff, input from the group is encouraged.

Education of patients and families are a priority A Spinal Cord Injury Discharge Manual will be given to all patients; this manual provides a comprehensive collection of all education related to the care and management of an individual with a spinal cord injury.

Key topics from the manual with a brief overview:

• Assistive technology
• Autonomic Dysreflexia
• Nutrition
• Pain management
• Urology/bladder & bowel training
• Wheelchairs and seating
• Wound Management