Chapter 3 - Telerehabilitation in Spinal Cord Injury

Abstract

Spinal cord injury (SCI) causes severe disability and secondary complications with an associated high burden of care. The estimated annual global incidence is 40 to 80 cases per million population. Many of the consequences associated with SCI do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social, and policy environments. Common associated conditions experienced in persons with SCI are neurogenic bladder and bowel, pain, spasticity, pressure injury, orthostatic hypotension, autonomic dysreflexia, and metabolic and cardiovascular disorders. Within the first year after discharge from inpatient acute rehabilitation, persons with SCI develop two to three distinct SCI-related complications. Prevention of secondary conditions is important since such conditions affect health, “self-management,” and quality of life as persons with SCI age. Many individuals with SCI live in rural areas without rehabilitation services and must travel hours to see an SCI specialist. There is also a lack of providers in the community who have knowledge and experience treating persons with SCI. These barriers can lead to delays in diagnosis and treatment of secondary complications and may ultimately impede the patient’s ability to reintegrate back into the community. Barriers to self-management in persons with SCI include physical limitations, secondary complications, lack of accessibility, caregiver burnout, and lack of funding. In 2016 SCI and telehealth were coined the term “telespinalcordinjury” or “teleSCI” at the International Spinal Cord Society Meeting. Performing rehabilitation visits via telehealth can mitigate barriers by reducing or eliminating burdens such as the time it takes to travel, the need for caregiver support to travel, and the costs of transportation itself. This chapter describes teleSCI applied for persons with SCIs throughout the continuum of care.