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Thread: Who wants to walk? Preferences for recovery after SCI

  1. #1

    Who wants to walk? Preferences for recovery after SCI

    I found this article to be very compelling. The conclusion is highlighted in red below.



    Original Article
    Spinal Cord (2008) 46, 500–506; doi:10.1038/sj.sc.3102172; published online 22 January 2008

    Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study
    P L Ditunno1, M Patrick1, M Stineman2 and J F Ditunno1

    1Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA
    2Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Correspondence: M Patrick, Department of Rehabilitation Medicine, Thomas Jefferson University, 132 South 10th Street, 375 Main Building, Philadelphia, PA 19107, USA. E-mail: Mary.Patrick@jefferson.edu



    Abstract
    Study design: Cross-sectional and longitudinal direct observation of a constrained consensus-building process in nine consumer panels and three rehabilitation professional panels.

    Objectives: To illustrate differences among consumer and clinician preferences for the restoration of walking function based on severity of injury, time of injury and age of the individual.

    Setting: Regional Spinal Cord Center in Philadelphia, USA.

    Methods: Twelve panels (consumer and clinical) came to independent consensus using the features–resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) at different stages of recovery.

    Results: Walking is given priority early in the game by eight out of nine consumer panels and by two out of three professional panels. The exception consumer panel (ISCI<50) moved walking later in the game, whereas the exception professional panel (rehRx) moved wheelchair early but walking much delayed. Bowel and Bladder was given primary importance in all panels.

    Conclusions: Walking is a high priority for recovery among consumers with spinal cord injury irrespective of severity of injury, time of injury and age at time of injury. Among professional staff, walking is also of high priority except in rehabilitation professionals.


    Eric Harness, CSCS
    Founder/President
    Neuro Ex, Inc
    Adaptive Performance and Neuro Recovery

  2. #2
    Senior Member fishin'guy's Avatar
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    Interesting snow, esp;" except in rehab. professionals".

  3. #3
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    This is were I went and Ditunno was my doc. He was great. The rehab view is telling though.

  4. #4
    My though about it was that the priority of rehab - at least initially - was to make sure the individual met their functional goals before being discharged (or before insurance runs out!). I don't think they would disagree that recovery to the point of walking would be optimal.

  5. #5
    Unfortunately I can't post the entire article, but I will include some info here.

    "To begin the game, panelists are each asked to imagine that they are unable to eat, groom, dress, control their bladder, walk, etc. The first panelist is asked to select the MFIM item he/she would want to begin to recover first."

    So they are being asked what their priority would be if "they" were injured not what their priorities are for someone else.

    On the clinician side you have acute care, rehab, and follow up. The AC and FU clinicians all move walking to high priorities throughout the game. Rehab moves wheelchair to the highest priority and walking is only moved ever so slightly at the end. This kind of cuts to the heart of the problem, Rehab clinicians wouldn't make walking one of their own goals if they were injured. So how can they accept that as a goal for someone else?

    I do agree that focusing on wheelchair independence is important in inpatient care, however I believe this begins to show why when someone shows movement below the level of injury they are not quick to attack it.

    Also this was a single center trial so there could be bias from just those clinicians, but anecdotally I would say it is very prevalent.

    "In this study, comparisons between panels (cumulative discrepancy scores) also demonstrated differences between professionals and consumers recovery preferences. It is apparent that as early as stage 3 rehRx moved wheelchair and not walking, and most other panels at this point have moved walking and not wheelchair. Thus the item discrepancy related to walk/wheelchair differential is also reflected between panels. One important note is that this study reports only results from one group of rehabilitation professionals in the United States. To adequately address this issue, it is important to design a multicenter study, and if this is a confirmatory and consistent finding, we must examine strategies for remedial system change. Perhaps we should begin to investigate a shift in treatment and research activities towards restoration of walking."

    "These findings suggest that clinical programs and research directed at improving walking function should be given as high a priority as bowel and bladder functions."


    Eric Harness, CSCS
    Founder/President
    Neuro Ex, Inc
    Adaptive Performance and Neuro Recovery

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    It is kind of sad to read this. My rehab. experience was all about wheelchair, etc. not walking. I was labeled 'complete" so there was no use in trying. When I visited PW last year, they found at least trace amounts of muscle movement in my knees, hips and ankles. What if my PT's found this? What if I had been told this? I makes me wonder what I could have been working on in addition to become independent "in my chair".

  7. #7
    Senior Member fishin'guy's Avatar
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    My rehab gal's were complete opposite, I wanted to get familiar w/where I was at the time till one lady said baloney, she saw that i had partial muscle twiches--she was on me like stink on maneur--"you should do your exercises not 1x a day, not 2x, but if ur dedicated to walking--3x a day. All 3 of the ladies I had were very supportive and worked to the nth degree with me, in the bars, the gait walker, etc, till my rehab ins ran out month and a half ago--so trying to do it on my own now.Can stand on left leg, the knee locks, but no ankle or foot help yet.

  8. #8
    The article is sad, but not surprising.
    Ugh, I've been kissed by a dog!
    Get some hot water, get some iodine ...
    -- Lucy VanPelt

  9. #9
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    Not very shocking or very new.

    Think on this:

    On average, how many folks would attend costly college, grad school or med school, etc. and knowingly support something that would 'obviously' undermine their future income security?

    The REAL crime is their ignorant short-sightedness. Humans will ALWAYS break their neck/back and ALWAYS need rehab of some type or another. A cure for SCI will ONLY change the LENGTH of rehab, etc. Imagine the job satisfaction those rehab workers will experience when they help some achieve true 'rehabilitation' : a restoration to original condition.
    Futurewalker

  10. #10
    Senior Member soonerborn's Avatar
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    Did I miss something? Does that say consusmers of SCI, because I did not buy into this by any means. If I did it was a F N accident I would like a refund. SCI is not a product to buy into. You are givin it not by choice.

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