Spinal cord injury (SCI) rehabilitation practices of today were influenced greatly by the pioneering efforts of Sir Ludwig Guttman who was instrumental in the creation of specialized spinal units to care for injured soldiers returning to England during and after WWII (Guttmann 1967). The eventual adoption of this more specialized and integrated approach followed in many additional jurisdictions (Bedbrook 1979; Bors 1967). They were bolstered by reports of reduced mortality and enhanced long-term survival which was attributed, in part, to more effective management of secondary conditions associated with SCI (e.g., urinary tract infections (UTI), pressure sores, respiratory conditions) (Geisler et al. 1983; Le & Price 1982; Richardson & Meyer 1981).
At present, the “ideal” scenario for modern SCI care is purported to be treatment in specialized, integrated centers with an interdisciplinary team of health care professionals providing care as early as possible following injury and throughout the rehabilitation process with appropriate discharge to the community characterized by ongoing outpatient care and follow-up (Donovan et al. 1984; Tator et al. 1995). This is best facilitated in one location within an organized “system” which is distinguished by seamless transitions as patients proceed from acute care through rehabilitation to outpatient care. While it is generally accepted that this “ideal,” specialized, integrated approach should result in better outcomes, there is very little robust evidence that supports this directly. This is understandable, given the relatively low incidence of SCI, limitations in designing trials with adequate controls, and the inherent difficulty in ascribing potential outcomes to such a multi-faceted process as rehabilitation. For these reasons, we have adopted an alternative approach within the present module with respect to the reviewed articles as compared to most other modules in SCIRE Professional. Many of the articles presented in the current chapter do not investigate a specific intervention, although they do describe rehabilitation outcomes and the various factors that are associated with producing optimal outcomes. Finally, for some included studies, the distinction between acute and rehabilitative care is somewhat blurred as they may have been conducted in centers or systems where these services are integrated. The present chapter is focused on issues associated with rehabilitation care and we have attempted to clearly identify when acute care practice may have been merged within the reporting of rehabilitation research results.