Questions

[Tammy1207]

I was wondering what is the average stay for someone that is going to a rehab center? What do they do there? When they are done at the rehab center where do they go next? If they go home, do they continue to go to rehab? If the person is ventilator dependent is there a difference for rehab? Will someone that is quad. be able to marry and have kids?

Thanks!

[SCI-Nurse]

I was wondering what is the average stay for someone that is going to a rehab center?
A lot of this depends upon the insurance. Statistically, in the USA the average length of stay for someone with a tetraplegic (quadriplegic) injury is 6 weeks. This is too short in my opinion. Most people do better with 2-3 months as they can get stronger and learn more in that time period. Those on ventilators usually have the longest lengths of stay.

What do they do there?
A rehabilitation center is a specialized hospital or unit that prepares people with disabilities to live again in the community. She would be expected to work with rehabilitation nurses on developing skin, bowel and bladder programs that work for her, and either being able to do them herself or direct a layperson to do this care for her properly. She would learn about medical complications and how to avoid them, and how to maintain her health. The nurses do most of this teaching, and will provide teaching for family and attendants who will be working with her at home if needed. They will provide any personal and physical care she is unable to do for her self. She probably will also attend formal group classes if she is in a good SCI center. In addition, she will have therapy with occupational, physical and speech pathologists: at least 3 hours daily (including some therapy on weekends). Recreation therapy is important and outings to the community with a group should be done as soon as she is medically able. She would also work with a social worker and psychologist. One team member should function a a case manager to assure that her team is on track and that she and her team have consistant goals. Discharge planning is also very important from day one. Programs vary widely, which is why she needs to go to a major SCI center. Please really push for this. It should be CARF accredited speficically in SCI Rehabilitation, and ideally should be a Model System SCI Center.

When they are done at the rehab center where do they go next?
Most people go home from the rehab center. It is critical that this be well planned so that the transition is smooth. If the home is not ready by the discharge date, or attendant care is not arranged, the rehab center may try to place her in a nursing home (avoid this at all costs!!!) instead.

If they go home, do they continue to go to rehab?
Technically, rehabilitation is a life-long process. It is much more than getting therapy. While many people do continue to get some home or outpatient therapy after discharge from rehab, this is usually time-limited, and the insurance carrier may stop it soon after discharge. It is important to learn a home program that can be continued with help (if needed) when funding for therapists-provided treatment is discontinued, or to use between therapy appointments.

If the person is ventilator dependent is there a difference for rehab?
This just makes the entire process more complex and expensive. A portable ventilator for the wheelchair must be obtained and the person and their family/attendants trained to use this as well as do suctioning, trach care and other pulmonary treatments. A back-up ventilator and ideally a generator should be planned for the home. Most people on ventilators need someone with them at all times, so discharge planning and attendant care is also more complex and expensive.

Will someone that is quad be able to marry and have kids?
Many people with tetraplegia are sexually active, marry (or have committed relationships) and have children. For women, fertility usually does not change, although there are more potential complications with pregnancy and birth. It is ideal to have a high-risk OB for this. A condition called autonomic dysreflexia can be especially dangerous during labor, but can be controlled by a knowledgeable physician. Sensation for physical pleasure and orgasm with sexual activity varies widely with women with SCI, but is possible to some degree for most. Marriage can be an issue for many, and this may cause the person to loose benefits such as Medicaid or Medicare, or assisted attendant services, so this needs to be taken into consideration. For this reason, many people choose to live together instead.

(KLD)