Digital Health Rehabilitation Can Improve Access to Care in Spinal Cord Injury in the UK: A Proposed Solution.

Anbananden Soopramanien,Peter W Thomas,Shiva Jamwal

doi:10.5195/ijt.2020.6312

Abstract

Lack of specialist beds, inadequate finance and shortage of skilled staff make it difficult for Spinal Cord Injury Centres (SCICs) in the United Kingdom (UK) to admit all newly injured individuals. Length of stay of those admitted can be too brief. At discharge, follow-up care is sparse and inadequate. We therefore propose that specialist spinal units redefine their roles and act as catalysts to build capacity by enhancing expertise in the wider community. SCICs can devolve certain tasks locally to less specialised units with their support, training, and guidance. This Commentary further proposes that use of Digital Health Technologies, (i.e., to deploy telemedicine, telehealth, and telerehabilitation), can enhance rehabilitation opportunities. The authors set-forth their vision for a comprehensive web portal that will serve as a primary resource for evidence-based practice, information on guidelines, care pathways, and protocols of SCI management. At any stage during the acute management of SCI and following discharge, rehabilitation specialists could conduct remote consultation with persons with SCI and acute care specialists via the web portal, allowing timely access to specialist input and better clinical outcomes. The proposed portal would also provide information, advice and support to persons with SCI and their family members. The strategic use of digital health technologies has been shown to result in cost and time savings and increase positive outcomes.

Highlights

Lack of specialist beds, inadequate finance and shortage of skilled staff make it difficult for Spinal Cord Injury Centres (SCICs) in the United Kingdom (UK) to admit all newly injured individuals
People with SCI are referred to trauma centres or Major Trauma Networks (MTN) (Bonner & Smith, 2013)
Within four hours of their admission, they are referred to a consultant at a linked Spinal Cord Injury Centre (SCIC)

Summary

Introduction

Inadequate finance and shortage of skilled staff make it difficult for Spinal Cord Injury Centres (SCICs) in the United Kingdom (UK) to admit all newly injured individuals. Digital health technologies have the potential to fill a significant void in the provision of rehabilitation as Spinal Centres across the United Kingdom (UK) struggle to find a solution to the lack of access to neurorehabilitation and are unable to deliver what Sir Ludwig Guttman had advocated The latter, a neurosurgeon, opened the National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital in Aylesbury on 01st February 1944. Sir Ludwig Gutman’s model of rehabilitation has been adopted throughout the world and holds credit even in today’s time to deal with the compromise to the spinal cord that can come from a traumatic injury, vascular insult or a disease process (i.e., infection or tumour) This model takes into account that SCI management is complex and requires input from a team of highly skilled professionals offering specialist expertise and a care pathway. There have been a few examples of telemedicine being used in Delhi at the Indian Spinal Injuries Unit (Tyagi et al, 2019) and Nepal, initiated by Leeds University ("Telerehabilitation in Nepal Allows Specialists to Link with Patients, Saving Time and Money," 2020)

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