Congress on Spinal Cord Medicine and Rehabilitation

Highlights from the annual gathering of three associations of SCI medicine professionals meeting in Orlando in August.

By Tom Scott

Before the keynote address for the combined annual conferences of the American Association of Spinal Cord Injury Nurses (AASCIN); American Association of Spinal Cord Injury Psychologists and Social Workers (AASCIPSW); American Paraplegia Society (APS); and the Therapy Leadership Council on Spinal Cord Injury, Paul J. Tobin received a standing ovation for over 20 years of his organization’s unparalleled support and generosity.

“Without the support of United Spinal, that basically allowed the associations to rise up on the shoulders of giants, we would not be here,” said Indira S. Lanig, MD, chair of the Joint Program Committee. “We thank United Spinal so very, very much for bringing us to this point and we look forward to continuing our relationship.”

“I am very well aware as an individual with a spinal cord injury of the importance of this conference,” Tobin said. “Without the interdisciplinary collaboration that you foster, without the networking that goes on at this meeting, quite frankly my quality of life would not be where it is today. I thank all the leaders and members of the associations for dedicating so much of their time and effort into putting this truly unique program together. What we have here is something that is not replicated anywhere else and I hope and pray that this continues well into the future.”

The conference, titled Congress on Spinal Cord Medicine and Rehabilitation, brought together the leading professionals that promote research to improve the quality of life of people living with spinal cord injuries and disorders (SCI/D). It offers professionals from a multitude of disciplines within the field of SCI/D the chance to meet face-to-face and discuss some of the extraordinary research they are undertaking through poster and paper presentations. The three- day conference, which preceded the consumer/Independence Expo portion of this year’s festivities, highlighted months and years of hard work from thousands of professionals who strive to advance spinal cord medicine and rehabilitation.

Psychosocial Aspects of Polytrauma

Jay M. Uomoto, PhD, addressed the signifi cant psychological, interpersonal, and social consequences following combat- related blast injuries that are common among those with consequent polytrauma and frequently serve as functional obstacles to community reintegration. The intricate field of polytrauma specializes in treating individuals that have been subjected to multiple traumatic injuries such as head injuries, spinal cord injuries (SCI), hearing loss, burns, and blindness through a multi-disciplinary approach.

“This population of veterans is very complex. When we talk about traumatic brain injuries, it’s never TBI in a vacuum, it’s never SCI in a vacuum, and it’s never a vision issue in a vacuum. It’s often in the context of marital, family, and social support disintegration; academic challenges; work challenges etc. As health care professionals we are trained to come up with a diagnosis, find a treatment, apply that treatment, and evaluate the outcomes. It’s a little harder to do within this population where there are so many overlapping entities and that a collaborative and integrated response is needed in rehabilitation of these individuals,” said Uomoto, who works closely with returning veterans as director of the Center for Polytrauma Care at VA Puget Sound Health Care System.

Uomoto described a typical situation for a returning veteran who has experienced traumatic injuries, one which is rarely discussed in mainstream media. “You have a 21-year-old kid who is expected to come back from active duty and return to civilian life. For that kid, civilian life may have only been high school. To come back and forge another life, that itself is a huge challenge on top of having experienced some significant stressors,” Uomoto said. “Sometimes we see a lot of alcohol use, marijuana use, and recreational drug use. There can be a significant amount of irritability and anger issues. There can be a lot of environmental triggers. The Fourth of July can be very difficult for some. I have had veterans tell me they can’t even go to the grocery to buy meat because it reminds them so much of what they had experienced in theater. Disabled vehicles on the side of the freeway can often be diffi cult for many individuals. There is a lot of social withdrawal associated with these triggers and many will often isolate themselves so that they are not exposed to them.”

Often the people closest to these veterans must deal with the consequences of combat, experiencing first-hand, its impact on their friend or loved one. This leads to a variety of family and relationship problems, sometimes leading to divorce, homelessness, and employment-related issues. Uomoto added that he has seen many parents become caregivers and young families fall apart. The stressors experienced by the veteran can even affect the health care providers involved in these difficult polytrauma cases. This is known as “provider compassion fatigue,” due to witnessing the suffering of others on a daily basis.

These psychosocial problems frequently serve as functional obstacles to the reintegration of this population in the community. Uomoto identified the importance of interventions for psychological and interpersonal dysfunction, caregiver support, and family interventions as key components to future comprehensive polytrauma rehabilitation efforts.

Responding to Natural Disasters: Practices of Providers and SCI Veterans

Recent national events highlight the diverse needs of patients with spinal cord injury (SCI) and the professionals who care for them during natural disasters. Little research, however, exists regarding the ways that providers and patients with SCI respond to disasters.

Francis M. Weaver, acting director of Research and Development at the Edward Hines VA Hospital, presented the findings of her study that identifi ed practices for disaster preparedness and response at several VA facilities that care for patients with SCI. “Across health care settings, planning efforts [for natural disasters] are often insufficient. There are a number of pressing challenges for disaster management that continue to exist including how best to communicate between providers, between systems, and with our patients. Do we have adequate staffing when we need it and do we have the ability to provide basic resources and services?” Weaver said.

The critical question Weaver presented is whether the standards and plans set by government agencies for emergency management truly address the needs of specific patient groups, such as veterans with spinal cord injuries and disorders (SCI/D). “Individuals with SCI/D are at particular risk in the midst of natural disasters with their physical impairments and mobility limitations, their dependency on equipment and medical technology, and the complexity of their secondary conditions that can be made worse in these types of crisis. For example, pressure ulcers can be brought on by poor transfer, inadequate equipment, or having to be a single position for long periods of time; disruptions of bowel management; lack of supplies; and concerns of respiratory impairment in terms of air quality, lack of equipment, and increase risks of infection,” Weaver added.

To find out how government agencies could improve disaster management efforts, in particularly within the Department of Veterans Affairs (VA), Weaver collected experiences of not only patients with SCI/D, but also health care providers who have experienced natural disasters to identify some lessons learned to take into the future. She highlighted some of the needs among providers during the course of a natural disasters, including personal work-related needs, dependent care for children and pets, lodging and transportation, and unbalanced workloads. One study participant/health care provider explained, “We developed a nursery that was not necessarily just for babies but for your young children because the parents/ staff had to bring them in if they were working. We had to develop a system of taking care of the children and watching them to make sure they were safe. The same thing evolved for our pets.”

In regards to the care of veterans with SCI/D during natural disasters, some of the issues included the importance of sharing information about status and expectations, promoting positive emotions, keeping patients calm and re-assured, keeping the family members of the veteran informed, and maintaining communication between facilities in terms of the pending disaster and ongoing updates. “It’s important to promote a coordinated care experience, ensuring the availability of necessary resources no matter where we are going to be managing our patients, in terms of staff and appropriate equipment, supplies, medication, medical records, etc.,” Weaver said.

Some of the key barriers identified during coordinated care in times of natural disasters were: patients and providers were often dispersed, as were equipment and supplies; there were staff shortages, so patients would be relocated but staff wouldn’t necessarily be able to go with the patient due to family concerns; and unfamiliar providers due to patient’s being relocated to other facilities. Some aspects that positively impacted coordinated care were: teamwork; benefi ts of keeping providers and patients paired if they were relocated; and access to medical records.

One of the biggest challenges to disaster management is overcoming the idea from individuals with SCI/D who survived prior natural disasters and feel they did not have to evacuate and can stay within their community. The challenges in providing care for these individuals included assessing and gathering resources to maintain a constant power supply for medical equipment, etc.; supplying food, fresh water, and medications; coordinating with local emergency agencies; and providing material, information, and emotional support.

Tom Scott is staff editor.