Nearly 200,000 people in the United States live with a disability related
to a spinal cord injury.
 Approximately
11,000 Americans are hospitalized for a spinal cord injury (SCI) each
year.
- The
leading causes of SCI vary by age. Among persons under age 65, motor
vehicle crashes are the leading cause. Among persons over 65, falls
cause most SCIs.
- SCIs
cost the nation an estimated $9.7 billion each year. Pressure sores
alone, a common secondary condition among people with
SCI, cost an estimated $1.2 billion.
- In
addition to pressure sores, secondary conditions from SCI include
respiratory complications, urinary tract infections, spasticity, and
scoliosis.
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Surveillance begins for SCI
With CDC funding and technical support, seven states—Colorado,
Louisiana, Minnesota, Missouri, Oklahoma, South Carolina, and Utah—began
collecting data about spinal cord injury (SCI) in 2000. These data will
enable CDC to estimate the magnitude and severity of SCI nationally and to
assist states in developing and implementing prevention efforts.
Prevention
education realizes impressive results
Over a one-year period,
participants in an CDC-funded intervention experienced a 46% decrease in
pressure sore occurrence and a 36% decrease in pressure sore severity. The
intervention, part of the Arkansas Spinal Cord Commission's Consumer
Action to Prevent Pressure Sores (CAPPS) project, eliminated sores among
one-third of the intervention group and saved $660,000 in hospital costs
associated with pressure sores. The goal of the CAPPS project was to
determine whether in-home education could prevent new pressure sores and
reduce the number and severity of existing pressure sores among a rural,
underserved population of persons with spinal cord injury. Public health
nurses, trained using a Pressure
Sore
Prevention Education Manual developed by CAPPS project staff, visited
participants' homes to teach them about pressure sore prevention and
treatment. A similar group of persons with SCI who did not receive the
intervention served as a control group. The findings from this project may
shape efforts to prevent SCI-related pressure sores in similar
communities.
Behavioral intervention improves outcomes
CDC funded the Rehabilitation Institute of Chicago to examine the
efficacy of a behavioral intervention to prevent pressure sores after
spinal cord injury. Researchers recruited study participants during acute
rehabilitation and followed them after discharge. The control group
received usual care, while the intervention group received usual care and
a behavioral intervention that included a personal contract for behavior
change and routine feedback to promote self-care after discharge. At
one-year follow-up, only 2.5% of the intervention group had developed
severe pressure sores compared with 19.4% of the control group; and 2% of
intervention participants had been hospitalized, while 18% of the control
group had been hospitalized for pressure sores.
SCI
strategic plan outlined
In November 1999,
approximately 20 SCI researchers and public health officials attended the
CDC-sponsored meeting "Future Directions for Community-Based Spinal
Cord Injury Program Research and Development" in Atlanta. Meeting
participants reviewed community-based methods for preventing secondary
conditions of SCI and began developing a research agenda. One of their key
recommendations was to convene an interagency meeting of professionals to
further develop a strategic plan for addressing SCI; that meeting was held
in March 2001. Participants discussed the progression of health needs
following spinal cord injury and identified gaps in current service
delivery for persons with SCI; developed an inventory of activities being
conducted across federal agencies and explored a coordinated response to
better serve this population; and set
priorities
for CDC to address such needs as increased SCI surveillance, improved
documentation of access to services both following the acute SCI event and
over the life span, assessment of impact of service access on outcome, and
dissemination of prevention information.
Remote-control
device to aid injured persons
In Ohio, CDC's Injury Center supports a research project to develop a
remote-control device to help persons with traumatic brain and spinal cord
injuries open doors. The device, created by grantee TKM Unlimited, can
remotely lock or unlock doors that have a standard door handle and
deadbolt. With the addition of a compact receiver unit, the device can
also operate lights, alarm systems, and other electrical devices. TKM
Unlimited will continue to develop and test this device with the goal of
marketing a convenient, rugged, multifunctional product.
Improving
accuracy and ease of SCI reporting
CDC is studying methods
to improve the accuracy of electronic SCI data reporting. Because current
hospital discharge codes for SCI tend to produce inaccurate or incomplete
data, all states that receive funding for SCI tracking must review
individual medical records to verify SCI cases, a labor-intensive and
costly process. Researchers will develop and test an algorithm that uses
multiple hospital discharge codes to detect SCI cases with greater
sensitivity and accuracy. If successful, this study could eliminate the
need to validate cases of SCI by hand.
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