1 History of Spinal Cord Medicine Ibrahim M Eltorai, M.D.
Ancient Egypt
Ancient India
Ancient Greece
Ancient Rome
The Middle Ages (700–1400 A.D.)
The Early Renaissance
The Later Renaissance
Seventeenth and Eighteenth Centuries
Nineteenth Century
Twentieth Century
Surgery
Rehabilitation
Education
Spinal Cord Regeneration
Spinal Shock
Autonomic Dysreflexia
Heterotopic Ossification
Urodynamics
Pharmacotherapy
Pressure Ulcers
Conclusion
References
2 Anatomy and Function of the Spinal Cord Harry G Goshgarian, Ph.D.
Gross Anatomy
Neuroanatomic Organization of the Spinal Gray and White Matter
Blood Supply of the Spinal Cord
References
3 Imaging of the Spinal Cord Roland R Lee, M.D. and Blaine L Hart, M.D.
Spinal Imaging Techniques
Fast-Scanning Techniques: Rationale
Congenital Abnormalities
Degenerative Disease and Postoperative Spinal Imaging
Inflammation and Demyelination
Spinal Infections
Vascular Lesions and Ischemia
Spinal Tumors
Technique
References
4 Epidemiology of Spinal Cord Injury Michael J DeVivo, Dr.P.H.
Overall Incidence
Risk Factors
Etiology of Injury
Prevalence
Conclusion
References
5 Outcomes Following Spinal Cord Injury Ien Sie, M.S., P.T. and Robert L Waters, M.D.
Motor Recovery
Functional Recovery
Conclusion
References
II Acute Spinal Cord Injury Management and Surgical Considerations
6 Prehospital Management of Spinal Cord Injured Patients William Whetstone, M.D.
Evaluation
Resuscitation
Immobilization
Extrication and Transportation
References
7 Acute Medical Management of Spinal Cord Injury Cristina Barboi, M.D. and William T Peruzzi, M.D.
Vertebral Column Stabilization
Pharmacologic Management of Spine Injuries
Corticosteroid Therapy
Axonal Regeneration
Minimizing the Secondary Injury
Airway Management
Respiratory Management
Cardiovascular Resuscitation
Acute Fluid and Electrolyte Disturbances
Gastrointestinal Care
Bladder Care
Skin Care
Deep Venous Thrombosis: Prevention and Treatment
Conclusion
References
8 Factors Affecting Surgical Decision Making Patrick J Connolly, M.D.
Patient Evaluation
General Principles of Treatment
Imaging
Mechanism of Injury and Stability of the Fracture
Classification of Spinal Cord Injury
Spinal Cord Injury
Pharmacologic Treatment of Spinal Cord Injury
Role of Anaterior Decompression
Timing of Surgery
Gunshot Wounds
Pathologic Bone
Conclusion
References
Bibliography
9 Cervical Injuries: Indications and Options for Surgery Christopher M Bono, M.D., Michael J Vives, M.D., and Christopher P. Kauffman, M.D.
Preoperative Evaluation
Spinal Stability
Surgical Treatment Options
Specific Injuries
Postoperative Care
Complications
Conclusion
References
10 Surgical Management for Thoracolumbar Spinal Injuries Paul E Savas, M.D. and Alexander R Vaccaro, M.D.
Clinical Evaluation
Radiographic Evaluation
Spinal Anatomy
Spinal Stability
Nonoperative Treatment
Operative Treatment
Indications and Operative Techniques for Thoracolumbar Injuries
Conclusion
References
III Medical Management
11 Respiratory Dysfunction in Spinal Cord Disorders Catherine S.H Sassoon, M.D. and Ahmet Baydur, M.D., F.A.C.P., F.C.C.P.
Pathophysiology
Management of Respiratory Complications
References
12 Sleep Disorders in Spinal Cord Injury Lawrence J Epstein, M.D. and Robert Brown, M.D.
Normal Sleep
Sleep Patterns in SCI
Sleep Disorders in SCI
Conclusion
References
13 Cardiovascular Dysfunction in Spinal Cord Disorders Sunil Sabharwal, M.D.
Low Baseline Blood Pressure
Orthostatic Hypotension
Bradycardia and Cardiac Arrest
Autonomic Dysreflexia
Reduced Cardiovascular Fitness and Altered Exercise Capacity
Coronary Heart Disease
Venous Thromboembolism
Peripheral Arterial Disease
Drug-Related Cardiovascular Adverse Effects
References
14 Thromboembolism in Spinal Cord Disorders David Chen, M.D.
Pathophysiology and Risk Factors
Clinical Presentation and Diagnostic Modalities
Treatment and Management of Thromboembolism
Preventive Management of Thromboembolism
References
15 Infection and Spinal Cord Injury Rabih O Darouiche, M.D.
Urinary Tract Infection (UTI)
Infections of Soft Tissue and Underlying Bone
Respiratory Tract Infections
References
16 Thermoregulation in the SCI Patient Thomas C Cesario, M.D. and Rabih O Darouiche, M.D.
Mechanics of Temperature Regulation in Normal Individuals
Temperature Regulation in Spinal Cord Disease
Fever in Spinal Cord Disease
References
17 The Immune System and Inflammatory Response in Persons with SCI Frederick S Frost, M.D. and Lily C Pien, M.D.
Inflammatory and Immunologic Responses in the Normal Host
The Inflammatory and Immune Response after SCI
References
18 18 Endocrine and Metabolic Consequences of Spinal Cord Injuries James K Schmitt, M.D. and Diane L Schroeder, M.D.
Effects of Sympathetic Denervation
The Spectrum of Endocrine Abnormalities after SCI
Pituitary Disorders
Thyroid Disorders
Sick Euthyroid Syndrome
Adrenocortical Hormones
Adrenal Medulla
Diabetes Mellitus
Hypoglycemia
Reactive Hypoglycemia
Lipid Disorders
Reproductive Function in Spinal Cord Injury Patients
Conclusion
Acknowledgments
References
19 Primary Care for Persons with Spinal Cord Injury James K Schmitt, M.D., Jennifer James, M.D., Meena Midha, M.D., Brent Armstrong, M.D., and John McGurl, M.D.
Primary Care of SCI Patients Vs. Ambulatory Patients
Periodic Evaluation of the Spinal Cord Injury Patient
Pulmonary Evaluation
Cardiovascular Disorders
Hypertension
Laboratory Values
Diabetes Mellitus
Depression
Colorectal Cancer Screening
Genitourinary System
Substance Abuse
Women's Health Issues
Nutritional Evaluation
Pain
Spasticity
Musculosketal Disorders
Prevention of Accidents and Violence
Conclusion
References
20 Spinal Cord Injury: The Role of Pharmacokinetics in Optimizing Drug
Therapy J. Steven Richardson, Ph.D. and Jack L Segal, M.D., F.A.C.P.
Pharmacotherapy
Pharmacokinetic Changes Induced by Spinal Cord Injury
Pharmacokinetics and Pharmacotherapy in Two Common Clinical Problems in SCI
Patients
Conclusion
References
IV Management of the Bladder, Bowel, and Sexual Dysfunction
21 Normal and Abnormal Micturition John Wheeler, M.D.
Basic Neurourology
Neurourologic Evaluation
Neurourologic Treatment
Conclusion
References
22 Renal Insufficiency in Patients with Spinal Cord Injury Cyril H Barton, M.D. and N.D. Vaziri, M.D., M.A.C.P.
Acute Renal Failure (ARF)
Acute Interstitial Nephritis (AIN) and Hypersensitivity Vasculitis
Crystalluria, Tubular Obstruction, and ARF
Chronic Renal Insufficiency
Conclusion
References
23 Urologic Management in Spinal Cord Injury Donald R Bodner, M.D. and Inder Perkash, M.D.
Neurologic Control of Micturition
Changes with Spinal Cord Injury
Urologic Evaluation
Bladder Management
Pharmacologic Management of the Neurogenic Bladder
Autonomic Dysreflexia
Conclusion
References
24 Urolithiasis in Spinal Cord Disorders Daniel Culkin, M.D. and Michael V Binins, M.D.
History of Urolithiasis in SCI Population
Natural History and Epidemiology
Risk Factors
Etiologies of Stone Formation
Morphology and Location
Clinical Presentation
Diagnosis
Treatment
Pharmacologic Therapy
Conclusion
References
25 The Gastrointestinal System after Spinal Cord Injury Steven A Stiens, M.D., M.S., Noel R Fajardo, M.D., and Mark A Korsten, M.D.
Gastrointestinal Dysfunction: Symptoms, Impairments, Activity Limitations, and
Barriers to Participation
Oral Cavity: Tartar, Caries and Occlusion Problems
The Esophagus: Reflux
Stomach and Duodenum: Incomplete Emptying and Peptic Ulcer Disease
The Pancreas: Increased Risk for Pancreatitis
The Gallbladder: Stasis and Increased Stone Incidence
The Ileum and Jejunum: Ileus Adynamic
The Colon: Fecal Storage, Desiccation, and Elimination
Acknowledgments
References
26 Sexual Dysfunction and Infertility in Men with Spinal Cord Disorders Stacy Elliott, M.D.
Overview of Changes in Male Sexual Function Following SCI
Sexual Neurophysiology of the Able-Bodied Male
Erection
Presentation and Evaluation of Sexual Concerns
Therapeutic Options for Male Sexual Dysfunctions
Fertility Following Spinal Cord Injury
Conclusion
Acknowledgments
References
V Neurologic Aspects of Spinal Cord Care
27 Neurologic Assessment of Spinal Cord Dysfunction Ralph Marino, M.D., M.S.
Purpose of Neurologic Assessment
Elements of Neurologic Assessment
Classification of Impairment: The 2000 Standards
Rapid Neurologic Assessment
Conclusion
References
28 The Electrodiagnostic Examination in Spinal Cord Disorders Asa J Wilbourn, M.D.
Anatomy
Spinal Cord Disorders
The Electrodiagnostic Examination
Pathophysiology
Limitations of the Electrodiagnostic Examination
Advantages of the Electrodiagnostic Examination
Some Specific Spinal Cord Disorders
Conclusion
References
29 Electrophysiologic Evaluation of the Spinal Tracts Mark A Lissens, M.D., Ph.D.
Somatosensory Evoked Potentials
Motor Evoked Potentials
References
30 Acute Nontraumatic Myelopathies Robert M Woolsey, M.D. and David S Martin, M.D.
The Neurologic Manifestations of Spinal Cord Disease
Spinal Cord and Cauda Equina Syndromes
Diagnostic Procedures to Evaluate Spinal Cord Disease
Relapsing-Remitting Spinal Multiple Sclerosis
Spinal Cord Infarction
Intraspinal Hemorrhage
Decompression Sickness
Acute Transverse Myelitis
Intervertebral Disk Herniation
Spinal Epidural Absces
Simulated Paraplegia
References
31 Chronic Nontraumatic Myelopathies Robert M Woolsey, M.D. and David S Martin, M.D.
Amyotrophic Lateral Sclerosis
Post-Polio Syndrome
Hereditary Spastic Paraplegia
Primary Lateral Sclerosis
HTLV-I Myelopathy
Myelopathy Induced by Electric Shock
Spondylolytic Compression of the Spinal Cord or Cauda Equina
Rheumatoid Arthritis of the Cervical Spine
Subacute Combined Degeneration
Friedrich’s Ataxia
Vacuolar Myelopathy
Vascular Malformations of the Spinal Cord
Primary Progressive Spinal Multiple Sclerosis
Arachnoiditis
Syringomyelia
Spinal Epidural Tumors
Intradural Extramedullary Tumors
Intramedullary Tumors
Radiation Myelopathy
References
32 Multiple Sclerosis Jack Burks, M.D., G. Kim Bigley, M.D., and Haydon Hill, M.D.
Pathogenesis
Demographics and Risk Factors for Acquiring Multiple Sclerosis
Diagnosis of Multiple Sclerosis
Multiple Sclerosis Disease Courses
Immune Modulation Therapy
Experimental Therapy
Rehabilitation and Symptom Management
Comparing Multiple Sclerosis and Spinal Cord Injury Issues
Conclusion
References
33 Pain Management in Persons with Spinal Cord Disorders Thomas N Bryce, M.D. and Kristjan T Ragnarsson, M.D.
Clinical Presentation
SCI Above-Level Nociceptive Pain
SCI Above-Level Neuropathic Pain
SCI At-Level Nociceptive Pain
SCI At-Level Neuropathic Pain
SCI Below-Level Nociceptive Pain
SCI Below-Level Neuropathic Pain
Neurobiology of Neuropathic Pain after SCI
Treatment
Nonpharmacologic and Nonpsychologic Interventions
Psychologic Interventions
Conclusion
References
34 Management of Spasticity Patricia W Nance, M.D., F.R.C.P.C.
Etiology
Assessment
Pathophysiology of Spasticity
Goals of Treatment
Physical Modalities
Pharmacologic Treatments
Conclusions
Acknowledgments
References
35 Autonomic Dysfunction in Spinal Cord Disease Brenda Mallory, M.D.
Anatomy of the Autonomic Nervous System
Spinal Cord Reflex Organization of the ANS
Autonomic Pharmacology
Cardiovascular Dysfunction in SCI
Hypotension
Renin-Angiotensin System and AVP
Autonomic Hyperreflexia
Treatment of Autonomic Hyperreflexia
Disorders of Micturition in SCI
Male Sexual Dysfunction in SCI
Female Sexual Dysfunction
Gastrointestinal Dysfunction in SCI
Upper Gastrointestinal Dysfunction
Pulmonary Dysfunction
Thermoregulatory Dysfunction
References
36 Syringomyelia James W Little, M.D., Ph.D.
Posttraumatic Syringomyelia
Chiari Malformation Causing Syringomyelia
Conclusions
References
37 Dual Diagnosis: Spinal Cord Injury and Brain Injury Ziyad Ayyoub, M.D., Fatima Badawi, M.A., C.C.C., S.L.P., Ann T Vasile, M.D., Deborah Arzaga, R.N., Amy Cassedy, M.D., and Vance Shaw, R.N.
Risk Factors for Concomitant Spinal Cord Injury and Brain Injury
Biomechanics of Dual Injury
Degrees of Brain Injury
Pathophysiology
Acute Interventions
Medical Complications
Cognitive Symptoms and Behavioral Problems of Brain Injury and
Interventions
Rehabilitation of the Patient with Dual TBI and SCI
Pharmacologic Consideration
Outcomes
Conclusion
References
VI Musculoskeletal Care
38 Musculoskeletal Pain and Overuse Injuries Michael L Boninger, M.D., Rory A Cooper, Ph.D., Brian Fay, M.S., and Alicia Koontz, M.S.
Alternative Diagnoses
Shoulder Injuries
Elbow Injuries
Wrist Injuries
Musculoskeletal Back and Neck Problems
Treatment and Prevention of Musculoskeletal Injuries in SCI
Prevention
References
39 Management of Long Bone Fractures Douglas Garland, M.D. and Leslie Shokes, M.D.
Fracture in Acute Spinal Cord Injury
Fractures in Chronic SCI (Pathologic Fractures)
Upper Extremity
Conclusion
References
40 Bone Loss and Osteoporosis Following Spinal Cord Injury Beatrice Jenny Kiratli, Ph.D.
Changes in Bone Mass and Structure
Long Bone Fractures—Occurrence And Risk Factors
Therapeutic Interventions
Conclusion
References
41 Functional Restoration of the Upper Extremity in Tetraplegia Vincent R Hentz, M.D. and Timothy R McAdams, M.D.
Historical Perspective
The Shoulder in the Tetraplegic Patient
Classification of the Tetraplegic Upper Extremity
Forming a Team
Palo Alto Experience
General Guidelines for Reconstruction
Orthoses
Surgical Reconstruction
Functional Neuromuscular Stimulation
Results and Conclusions
References
42 The Medical Management of Pressure Ulcers Michael M Priebe, M.D., Melayne Martin, R.N., C.W.O.C.N., Lisa Ann Wuermser, M.D., Teodoro Castillo, M.D., and Jackie McFarlin, R.N., M.P.H.
Incidence and Prevalence
Pathophysiology
Normal Wound Healing
Principles of Pressure Ulcer Management
Adjunctive Treatment for Pressure Ulcers
A Brief Primer on Support Surfaces
Conclusions
References
43 The Surgical Management of Pressure Ulcers Robert E Montroy, M.D., F.A.C.S. and Ibrahim Eltorai, M.D.
The Pressure Ulcer Dilemma
Factors in Cost Escalation
To Do Or Not To Do
The Pressure Ulcer as a Wound
Classification of Pressure Sore Severity
Complications of Pressure Sore Neglect
Indications for Intervention
Indications for Surgical Intervention
Basic Surgical Principles
The Evolution of Pressure Ulcer Surgical Principles
When a Gap, Swing a Flap
Postoperative Complications
Postoperative Care and Ambulation
Conclusions
References
44 Heterotopic Ossification Robert Montroy, M.D., F.A.C.S.
The Genesis of Heterotopic Bone Formation
The Pathogenesis of Heterotopic Bone Formation
The Clinical Pathologic Process
The Benefits of Early Diagnosis
Prevention and Treatment
Conclusion
References
45 Cardiovascular Fitness after Spinal Cord Injury Mark S Nash, Ph.D., F.A.C.S.M.
Altered Central and Peripheral Circulatory Functions after SCI
Exercise Reconditioning of the Circulatory System
Bipedal Ambulation Using Electrical Stimulation
Arm Endurance Training
Arm Resistance Exercise
Unique Exercise Complications and Caveats
Conclusions
References
VII Rehabilitation
46 Wheelchairs and Seating Rory A Cooper, Ph.D., Michael L Boninger, M.D., Rosemarie Cooper, M.P.T., P.T., and Tricia Thorman, M.O.T., O.T.R.
Manual Wheelchairs
The Wheelchair–User Interface
Electric Powered Wheelchairs
Robotic Wheeled Mobility Systems
Selection of Electric Powered Mobility
Access Devices
Wheelchair and Seating Measurement
Cushions
Seating Bases
Postural Supports
References
47 Spinal Orthoses Ed Ayyappa, M.S., C.P.O. and Kelly Downs, B.S.
Emergency Spinal Trauma
Indicators for Mechanisms of Action
Terminology
CO Soft Collar
CO Plastic or Universal Collar
CO Philadelphia and Rigid Collars
Cervical Thoracic Orthosis
SOMI
Thoracolumabar Immobilization
Lumbar Orthoses
Conclusion
References
48 Upper Limb Orthoses Michal Atkins, M.A., O.T.R., Darrell Clark, C.O., and Robert Waters, M.D.
Historic Background
Current Trends, Philosophy and Principles
Evaluation and Treatment Planning
Orthotic Design Principles by Functional Level
Orthotic Fitting
Patient Education and Training
Conclusion
Glossary
References
49 Lower Limb Orthoses and Rehabilitation Ann Yamane
Nomenclature
Patient Evaluation
Goals for AFO Intervention
Biomechanical Controls for AFOS
AFO Designs
Goals for KAFO Intervention
Biomechanical Controls for KAFOS
KAFO Designs
Reciprocating Gait Orthoses
Clinical Situations
Conclusion
References
50 Activities of Daily Living Catherine LeViseur, O.T.R. and Sherry Sonka-Maarek, M.D.
Personal Independence Potential
Personal Independence Based on Other Factors
Challenges
Basic Self-Care
Instrumental Activities of Daily Living
Conclusion
References
51 Recreation and Leisure Skills for People with Spinal Cord Disorders Jo Lemons, T.R. and Nancy C Cutter, M.D., P.T.
The Role of the Recreation Therapist and the Recreation Therapy Program
Conclusion
References
52 Vocational Rehabilitation Kurt L Johnson, Ph.D.
Key Legislation
The Profession of Rehabilitation Counseling
The Vocational Rehabilitation Process
Vocational Rehabilitation Systems
Key Disability Benefit Systems
Conclusion
References
Bibliography
Additional Information
53 Driving with a Spinal Cord Disorder Norman F Simoes, M.S.I.E. and Laurie Lindblom, M.D.
Physical Requirements
Adaptive Equipment
Driving Programs
Preparation for Driving
Wheelchair Selection
Conclusion
References
54 Functional Electrical Stimulation Peter H Gorman, M.D.
Mechanism of FES Activation
Components of FES Systems
General Selection Criteria for FES Systems in SCI
Contraindications
FES Applications in Spinal Cord Dysfunction
Conclusion
References
VIII Recent Advances in Spinal Cord Research
55 Functional Magnetic Stimulation Vernon Lin, M.D., Ph.D. and Ian Hsiao, Ph.D.
Nerve Activation by Magnetic Stimulation
Magnetic Stimulator
Magnetic Coil
Clinical Applications in Patients with SCI
Transcranial Magnetic Stimulation
Safety Considerations
Conclusion
References
56 Mechanisms and Natural History of Spinal Cord Injury Sandra K Kostyk, M.D., Ph.D., Phillip G Popovich, Ph.D., and Bradford T Stokes, Ph.D.
The Mechanism of Injury: Mechanics and Anatomic Relationships in SCI
Neuropathology of Human Spinal Cord Injuries
The Wound Healing Response of the Injured Spinal Cord
Chronic SCI
Conclusion
Acknowledgments
References
57 Acute Treatment Strategies for Spinal Cord Injury Edward D Hall, Ph.D.
Secondary Injury: The Importance of Oxygen Radical Lipid Peroxidation
Protective Effects of the Lipid Peroxidation Inhibitor Alpha Tocopherol in
Experimental SCI
High-Dose Methylprednisolone Therapy in Experimental Sci: Efficacy and
Mechanisms
High-Dose Methylprednisolone Efficacy in NASCIS II
Duplication of Methylprednisolone's Antioxidant Effects with a Non-Glucocorticoid
Steroid: Discovery of Tirilazad Mesylate
Comparison of 24- and 48-Hour Methylprednisolone and Tirilazad in NASCIS
III
Future Approaches to Acute Pharmacotherapy of SCI
Conclusion
References
58 Recent Advances in Neural Regeneration Hans S Keirstead, Ph.D. and Oswald Steward, Ph.D.
Effects of Injury
Regenerative Plasticity
Axonal Regeneration
Conclusion
References
59 Spinal Cord Repair Strategies Henrich Cheng, M.D., Ph.D. and Yu-Shang Lee, M.S.
Pathologic Changes of Spinal Cord after Injury
Unfavorable Aspects for Regeneration in the Injured Mammalian Spinal Cord
Functional Recovery in a Patient with SCI
Strategy to Rescue Neurons from Death
Strategy to Replace Nerve Cells after Neuronal Death
Strategy to Reconnect and Recover Normal Function in Neural Pathways
Conclusion
References
60 Retraining the Human Spinal Cord V. Reggie Edgerton, Ph.D., Susan J Harkema, Ph.D., and Bruce H Dobkin, M.D.
General Concepts: Control of Standing and Stepping
Sensory Information Monitored and Processed by the Spinal Cord
Central Pattern Generation
Is the Spinal Cord Smart?
Can the Spinal Cord Learn?
Plasticity of Interactions between the Spinal and Supraspinal Control
Systems
Pharmacologic Interventions Following SCI
Rehabilitation Goals in Treating Skeletal Muscles
Rehabilitative Strategies for Ambulation
Conclusion
Acknowledgments
References
IX Special Topics in Spinal Cord Medicine
61 Spinal Cord Injury and Aging Susan Charlifue, M.A. and Daniel Lammertse, M.A.
Aging Theory
The Genitourinary System
The Gastrointestinal System
The Integument
The Nervous System
The Musculoskeletal System
The Immune System
Psychosocial Aspects of SCI and Aging
Looking to the Future
References
62 Women’s Health Challenges after Spinal Cord Injury Amie Jackson, M.D.
Reproductive System
Gynecological Issues after SCI
Pregnancy
Sexual Function
Urologic Management
Menopausal Issues
Psychosocial Issues and Wellness
Conclusion
References
63 Spinal Cord Disorders in Children and Adolescents Lawrence C Vogel, M.D., Randal R Betz, M.D., and Mary Jane Mulcahey, M.S., O.T.R./L.
Spinal Cord Injuries
Neural-Tube Defects
Lipomeningocele
Sacral Agenesis
References
64 The Prevention of Spinal Cord Injury Russ Fine, Ph.D., M.S.P.H., Wendy Sykes-Horn, M.P.H., and Katherine Terry, M.P.H.
Injury Prevention and Control: A Frame of Reference for SCI Workers
The Science of Prevention
Costs of Spinal Cord Injury
Etiologically Driven Prevention Programs
Prevention-Oriented Programs for SCIS Resulting from Falls
The Case for Prevention
Prevention Efforts, Needs Assessment, Data Gathering
SCI Prevention Program Directory Update
Conclusion
Appendix: State Injury Prevention Programs
References
X Psychosocial Issues and Support Environment
65 Psychosocial Factors in Spinal Cord Injury Robert A Moverman, Ph.D.
Premorbid Psychologic Issues
Issues in the Rehab Phase
Issues in the Post-Rehab Phase
Psychotherapeutic Interventions
Conclusion
References
66 Social Issues in Spinal Cord Injury Helen T Bosshart, A.C.S.W./L.C.S.W.
Family Relationships
Financial Issues
Productivity
Socioeconomic Status and Cultural Issues
Personal Assistance Services (PAS)
Community Reintegration
Quality of Life
Conclusion
References
67 The Costs of Spinal Cord Injury Monroe Berkowitz, Ph.D.
Data Sources
Methodology
First-Year Costs
Annual Medical Care Costs
Medication and Supplies
Home Modifications
Vehicle Modifications
Wheelchairs
Personal Assistance
Indirect Costs
Conclusion
References
68 Model Spinal Cord Injury Systems of Care Michael J DeVivo, Dr.P.H.
Mission
Model System Requirements
Collaborative Research
Organizational Structure
Conclusion
References
69 VA Spinal Cord Injury System of Care Margaret C Hammond, M.D.
Mission
Structure
70 Consortium for Spinal Cord Medicine Clinical Practice Guidelines Dawn M Sexton, Kenneth C Parsons, M.D., and J. Paul Thomas
History
Clinical Practice Guidelines
Consortium Guideline Development Process
Consortium Successes
New Initiatives
Conclusion
References
71 Subspecialty Certification in Spinal Cord Injury Medicine Margaret C Hammond, M.D.
72 CARF: The Rehabilitation Accreditation Commission Peggy S Neale, M.A., M.B.A.
Accreditation and Quality
Spinal Cord Injury Standards
The CARF Survey Process
Conclusion
References
73 Architectural Considerations for Improving Access Ian Hsiao, Ph.D. and Thomas Hodne, A.I.A.
Background
Operating Environment for Mobility Aids
Outdoor Environments and Accessibility
Indoor Accessibility
Kitchens and Bathrooms
Entrances and Garages
Conclusion
References
74 Health Industry and Product Information Pamela E Wilson, M.D. and Gerald H Clayton, Ph.D.
Scientific Journals
General Information
Adaptive Technology Resources
Organizations Whose Goal Is to Provide Support and Education for SCI Individuals
and/or Fund SCI-Directed Research
