Rehabilitation Gazette - Polio Place

Spinal Cord lnjury Centersby Gini LaurieAt long Ian, it ir being recognized again that reojonalcenters are the most effeciive and most economicalmeans 01 treating the psycholo~cal and phyriologicalproblems of catastrophic disabditiei lhsi require treatmentandby an array of ipecialinr.Befar* looking at the npw regiond rpinal cord injurycenters, glance back at the 1950's. Then, with thesuppo* of monies conhibufed by the Amencan pubk totho March of Dimes, a comprehensive system of 17regional respiratory and rehabilitation centerr for polio^myelitir pasenti was developed at teaching hospiialr ofmedical schooii. totaling over 500 beds.The centers demonrt,a,ed the ,remendo". value of anorganized network of centers. staffed by medical andparamedical rpeciaiinr.The team approach and the munificent flaw of monierenabled each cenfer to reintegrate as patients into theircommunitisi, to work with their families, to adapt theirhomer, to arrirt wi,h anendant care. to encourage educationaland vocacmnal rehab~blation, and to furnish acontinuing source of information and supportThe centerr were invaluable means of Improvingmedical management, evolving vocational and prychologicalrehabiiitation, uti1icing group therapy. and develLoping new equipmentIn the 1960's. after Salk and Sabin conquered polio^myelitis. the financial suppoll war channeled elrawhereand the center, were closed. It is hasic that the rise in thenumber of spinal cord injured did not coincide with thedecrease inthe number of polio patient3 for, if ii had. thecenterr would have been a natural hanrltion from polio tospinal cord injury (SCI]. It would not have been necarraryto "reinvent the wheel.'' to revive the center concept forSCI personsIn 1970, the US. Department of Health. Education,and Welfare Initiated the Regional Spinal Cord lnjuryResearch and Demonsiration Syrtem, which now includes11 regional systems or renters, Tho fir* center, theSouthwest Regional Syrtem for the Tieatmen1 ol SplnalCord lnjury in Phoenix, Arimnn, war established by Dr.John 5. Young. He developed a National Spinal Cordlnjury Data Research center to include "ariabias pertaining to SCI and to recnrd accurate, actual costs. Thenational data center has demonstatsd that the neatmentof parapiegir. andat. ryrtems center aved9.5% In the average iknmh of hospltaliration and anaveragecost of 18.8% ($6000 per care1 compared to thefragmented, ""systemized care thatis otherwise prevalentI6the annual cost of care was esbmated at $2.4 billion,bared on the average lifelime corir of a quadat $325.000to $400.0110 and of a paraplegic at $180.000 to$225.000. There cortr have risen, not only because ofinflation, but because SCI now live longer than previourlyand because the ratio of new paraplegics and quadri~pieglcr ir changing lo an increasing percentage of *uadti~pleglcr.Dr. Young estimates ,hat the 11 established regionalsystems are able to accept approximat~ly 750 nee SCIrefenals each year. He recommends that eventually thererhould be approximakly 100 Reguonal SCI Syrtemz Inthe United Stater. He ssfimcter that five new modalIYrtems could be erbblished over" "ear and that with .are rough ertimater." rays Dr Young. "theyruppon the need for development of a national networkof Regional SpmaI Cord Inlury Syrtems at the earliestpos~lble time. Not only can we afford this network. wecannot aHord anything else."Elmer Barieir, a C4-5 quadriplegic, who is Commirrioneiof Vocational Rshabililallan for the State ofMarrachuretfr, emphaske. that loss in human andmonetary terms ar a result of poor oc inappropriate careof SCI is a*onomical. He aduocater a system ~ ith theoveniding goal that "the injured perran rhould be able tohave a future ar a conhibuting member of rociecy andrhould be able to take his or her place back in thecommuniw !,om which he ar ah* came." He alsoadvacrfer the rlshtr of SCI to have quertions anweredhonestly, to have contact with other SCI as models. andto have funds immediately available for treatment andequipment.In the 1977 NPF Conuenbon Journml (901 ArcolaAvenue, Whaston. Maryland 20902). Bcriels compiled alist of basic functions and/or resourc=r that should be panof the SCI system:1 Prevention of iniurv . and oublic . awareness of SCI.2 t, :?,"c.< 3 e., m.., .: .*,I*? C < %> ,c 1 ".?I " lac, I,.* 1 I,,,: . I'lr i~,....lllllrl"..,,. ., ,,< ,,,,,,,?", $C :*. . ., , 0me a< :* nr,,