Episode 23: Optimizing Care for Spinal Cord Injury. A Conversation with Dr. Steven Kirshblum

Dr. Maxwell Boakye
June 1, 2022

How does greater access to specialized care optimize the treatment of spinal cord injuries? On this episode, Dr. Steven Kirshblum dives into the differences between general and specialized rehabilitation for SCI patients, why specialized care is critical for better patient outcomes, and the challenges of integrating specialized care for spinal cord injuries into the medical system.

You will want to hear this episode if you are interested in…

Advancements and challenges in the treatment of spinal cord injury [3:14]
Are rehabilitation centers certified to treat spinal cord injuries? [6:04]
Why do specialist rehabs get better results? [8:45]
Examining racial and ethnic disparities in spinal cord injury care [12:30]
The integration of spinal cord injury care into the medical system [14:24]
Exploring trends in spinal cord injury care [16:55]
Dr. Kirshblum’s take on polypharmacy in SCI care [19:17]
Discussing natural recovery after traumatic spinal cord injury [21:40]
Causes of mortality in SCI patients [27:10]
Why steroid treatments have failed to translate to human trials [31:39]
Developing resilience in SCI patients [34:18]
Managing bladder issues in SCI care [36:41]
Neuromodulation as an FDA approved treatment for spinal cord injury [39:00]
Dr. Kirshblum answers the magic wand question [43:27]

Greater integration

One of the great challenges in optimizing care for spinal cord injuries is that the field is fairly siloed. Spinal cord injury specialists are often cut out of the primary care process for their patients. Not intentionally, of course, but from a logistical standpoint, there needs to be a greater level of integration and collaboration between primary care physicians and spinal cord injury specialists. This includes understanding that primary care for the disabled population is extremely important to their overall outcome. By nature, spinal cord injury brings with it so many other prevalent issues. For example, neurogenic bowel, bladder spasticity, and pain that most primary care physicians don’t see. However, it’s the bread and butter of a spinal cord physiatrist. The greatest benefit of integration for patients is that it should create higher quality outcomes for their care, which is a top priority.

Greater access and awareness

Before this conversation, I assumed everyone with spinal cord injuries could go to a level one trauma center and that most people had access to that kind of care. But Dr. Kirshblum made me aware that denial of specialty spinal cord injury rehabilitation care, significantly shortened lengths of stay, and denial of needed equipment and adaptive devices are some of the biggest challenges preventing the optimization of spinal cord injury care. Due to a lack of awareness and/or coverage, patients will go to any kind of rehab when what they need is specialized care for people with spinal cord injury. The greatest benefit of specialized care includes the experience of staff, treatment of secondary medical issues, psychological and neuropsychological support if needed, and greater opportunity for spinal cord-specific technology, education, and peer support. All of which directly impact patient outcomes.

Optimized for equity

When we talk about optimizing care for spinal cord injury patients, we can’t avoid the racial and ethnic disparities found in the field. People of color are referred to life-changing rehabilitation at an overall lower rate than their caucasian counterparts. Race also statistically impacts discharge placement, follow-up services, and needed adaptive equipment such as lighter weight wheelchairs, depending on coverage. All of these factors negatively impact the medical condition of the patient, their mood, and their quality of life. It doesn’t help that there is already a disparity and unconscious bias towards the disabled community, giving people of color a double burden while navigating spinal cord injury in the healthcare system. Optimized spinal cord injury care means addressing these disparities and creating equity for all patients within the field.