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T - New Perspectives From E-Scan

Resolve the Disconnect between Evolving Evidence Regarding Rehabilitation Efficacy and Current Service Models Emerging and established evidence shows that the volume and intensity of rehabilitation services dramatically influences functional outcomes – specifically, the ability of individuals with AIS C and D impairment to return to walking, within their homes and communities, and the ability of functional electrical stimulation therapy to augment hand function in those with tetraplegia. Ironically, this evidence comes at a time of unprecedented system pressures to reduce rehab onset days and rehabilitation lengths of stay. As individuals with SCI are being discharged earlier from inpatient rehabilitation settings, structures and services to support optimization of rehabilitation outcomes, and access to the right type and intensity of rehabilitation service, in an outpatient or community setting, is imperative. Current administrative structures and processes appear overly focused on the flow of individuals (from acute care to inpatient rehabilitation), with little thought or attention on the impact of early system efficiency, or the back half of the continuum of care - inpatient rehabilitation through transition to community living. Provincial Delisting of Rehabilitation Services Overwhelming Tertiary Outpatient SCI Services Substantial portions of individuals with SCI attribute the etiology of their injury to a motor vehicle or work-related accident. They have, therefore, sufficient accident or work-related injury benefits to fund participation in third party physical therapy, occupational therapy, nursing and/or counselling services, from a psychologist or social worker. However, individuals without these benefits, who rely on federal disability support, face long waiting lists for provincially funded services, or are turned away from tertiary outpatient therapy services, with no financially feasible therapy alternative. For example, an individual with SCI may develop an episode of acute shoulder pain, which makes wheeling difficult about his or her home and community. Their untreated shoulder injury can contribute to poor transfers, and lead to skin breakdown or development of an ischial pressure sore, followed by months of bed rest to enable wound healing. This, in turn, contributes to a first episode of depression due to social isolation, and results in bed rest-induced global deconditioning. A cascade of events and costs that likely would have been prevented with eight to ten weeks of conventional physiotherapy, therefore ensues. Triaged access to provincially funded, community rehabilitation service providers should self-limit the course of these events, and prevent initiation of cascades of secondary health conditions that plague individuals living in the community, who are dependent on tertiary outpatient services. Inadequate Services to Support Informed Self Management and Emotional Wellbeing Current staff-to-patient ratios of patient educators, psychologists, psychiatrists, social workers, and recreation therapists for outpatients with SCI, are inadequate. Dramatic increases, in availability of resources to support the biopsychological care of individuals with SCI living in the community, are needed. Programs, which empower the individual through provision of self-management strategies and counselling, are currently low priority – although these services are likely the interventions with the greatest yield, and most likely to reduce the frequency of health service utilization. There is a need for a dramatic paradigm shift in service delivery, acknowledging the value of pre-emptive models of care versus the current reactionary models, where provincially funded services become available once an individual is in crisis. Include Support Providers as Crucial Members of the Care Team Individuals with SCI have smaller social networks, with more intense bonds, than those with chronic disease. Family members, neighbours and friends play significant roles in assisting the individual with SCI to remain independent in the community. Services to support these crucial, unpaid members of the care team are absent and particularly problematic, given the inability of the healthcare system to absorb the associated burden of care, in the absence of these support providers. When a member of an individual’s care network becomes ill or incapacitated, increased respite care, supportive emotional and logistical resources for care providers, and access to short-term attendant care, are crucial to sustained community living. 204 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


T - New Perspectives From E-Scan
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