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Miami VA Healthcare System

Spinal Cord Injury

Program Description

The Miami VA Healthcare System’s Spinal Cord System of care is a medical specialty concerned with evaluating, diagnosing and treating patients with limited function as a consequence of disease, injury or impairment due to a spinal cord disorder. Emphasis is placed on maximal restoration of the physical, psychological, social and vocational functions of the persons. Further emphasis is placed on the maintenance of the person’s health, prevention of secondary complications, activity limitations and the alleviation of pain. The SCI unit also cares for Veterans with non-traumatic spinal problems such as MS and spinal infections resulting in paraplegia or tetraplegia.

Our program provides a continuum of care consisting of both comprehensive rehabilitation services and sustaining medical care. The core interdisciplinary treatment team consists of an SCI staff physician (specialties: Physiatrist, Wound Care, Neurology and Internal Medicine), Psychology, Nursing, Therapy (Kinesio, Occupational, Physical and Recreation), Nutrition, Social Work and Pharmacy. We are further supported by nurse practitioners, licensed vocational nurses, nursing assistants, physician assistants and administration.

Multidisciplinary support is obtained on a consultative basis from a broad array of services, but most frequently includes, Urology, Plastic Surgery, Orthopedic Surgery, Neurosurgery, Infectious Disease, Respiratory Therapy and Vocational Rehabilitation.

The Miami Spinal Cord System of Care also serves as a Spokes and Hub Site to advise and assist the West Palm VA Medical Center with provision of SCI care.

Program Mission

The mission of the Spinal Cord Injury/Disorder (SCI/D) Service at the Bruce W. Carter Department of Veterans Affairs Medical Center is to provide a comprehensive lifelong system of care for Veterans with SCI or SCD and to incorporate research and education into their care as appropriate to ensure that their care is state of the art.

Vision

We will be a center of excellence for SCI care in the VA system demonstrating an interrelationship between the rehabilitation-community integration-medical care and long term care. We will coordinate our services and resources with the University of Miami in order to maximize community resources and ensure optimal patient care and dissemination of information to our patients and staff. Further collaboration may be achieved, through research involvement, at the Miami Project to Cure Paralysis at the University of Miami School of Medicine, which is the world’s largest comprehensive SCI research center. This unique multidisciplinary team utilizes their expertise in research to find a cure for the spinal cord injury population.

Values

  • To promote and ensure high quality, life-long medical and rehabilitative care to our Veterans.

  • To provide optimal community integration for our population by cooperatively working with other federal, state and local healthcare providers to furnish effective and efficient services and to ensure continuity of care and treatment; and ensuring that our customer satisfaction is maintained at the highest level.

  • To continuously monitor the quality of our programs in order to constantly improve them.

Service Philosophy

The unifying philosophy of the SCI/D service is:

  1. to train and assist each SCI patient to gain their maximum level of function and independence

  2. to assist each SCI/D patient in the chronic phase of their injury in maintaining their maximum level of function and independence

  3. to provide optimal medical care to each SCI/D patient so that they can attain these goals.

In turn, we expect each patient to:

  1. actively participate in their care

  2. meet their therapy schedules and

  3. participate in educational opportunities.

Furthermore, the SCI/D interdisciplinary team will work with the patient and their family to together design a treatment plan with the goal of helping the patient return to the community.

Admission to a comprehensive rehabilitation bed:

This is based upon a documented plan, potential for improvement in function and need for therapy, as identified by SCI/D policy (128-04.) The demographics of person’s eligible for admission to our Spinal Cord Injury/Disorder Service are listed below from highest to lowest priority:

  • Acute SCI/D, active military duty

  • Acute SCI/D service connected Veterans

  • Acute SCI/D, non service connected Veterans

  • Veterans with existing SCI/D for acute medical and/or surgical problems

  • Veterans with existing SCI/D for problem oriented admissions

  • Veterans with existing SCI/D for advanced rehabilitation programs

  • Veterans with existing SCI/D for annual evaluation when outpatient annual evaluations are not feasible

  • Non Veterans, age 18 or greater with acute SCI/D under a sharing agreement

  • Respite care for known patients

Offered Services

SCI Inpatient Services: Our Inpatient Staff offer comprehensive and compassionate health care services through a multi-disciplinary approach. Combined with our SCI specialists, the nursing staff and therapists provide the most appropriate care of those with a spinal cord injury or disease.
  • Inpatient Medical: Medical management of all medical issues that can be associated with an acute or chronic spinal cord injury.

  • Inpatient Surgical Care: Referrals are made to specialty services (Urology, Plastic Surgery, Orthopedics) for a comprehensive approach when further surgical expertise is necessary.

  • Rehabilitation Program (CARF Accredited): Multi-disciplinary approach for newly injured or diagnosed persons with new functional goals. The CARF team includes: Physicians, Physical Therapy, Occupational Therapy, Recreation Therapy, Social Work, Psychology, and Dietary. Services are designed to meet the needs of the persons with impairment, limited activity (disability) and restricted participation. The goal of the program is to facilitate the Veteran’s ability to remain in the most independent and least restrictive living environment.

  • Annual Evaluations: Yearly evaluation that addresses general health, cardiovascular, urological, respiratory, and mobility issues. Other areas of concern are skin integrity, bowel and bladder function, the presence and characteristics of pain and nutritional status. Psychosocial needs are also evaluated during that time.

  • Multiple Sclerosis Care: Services are provided to address medical intervention and therapies for recovery of strength, endurance and function.

  • Psychological services: These services are available not only for the SCI patients, but for their families. Counseling is focused on issues related or unrelated to SCI. These issues may include depression, anxiety, social issues, panic, pain, sexuality/martial interaction, etc.

  • Social Work Services: Available to those SCI patients and their families. Counseling and assistance with transition from active duty military to the VA system, disability insurance, housing, appropriate placement (SNH, ALF, CNH) are just a few of the service available.

  • Dietary Services: Comprehensive assessment of the patient’s nutritional status to determine the patient’s most appropriate meal plan. Recommendations for reduction in cholesterol levels, weight loss and diabetes control are also provided.

  • ADL Suite: This is an independent living apartment that is a specially designed living facility for the hospitalized patient and their family/caregiver to practice newly learned rehabilitation skills in a home like setting prior to discharge. The purpose of the suite is practice every day living skills to insure safety and instill a level of confidence.

  • SCI Hospice Program: Provides compassionate and humane care to patients and their families with advanced progressive diseases, which may be life threatening or terminal. End of life care focuses on the relief of suffering and optimizes quality of life.

  • SCI Respite Program: Provides inpatient care for a Veteran who is suffering from a SCI injury or disorder and who resides primarily at home. This program is designed to support the caregiver's role in caring for the Veteran at home. This care will not exceed 14 days and is permitted twice annually.

Outpatient Services: Comprehensive health care continues in our outpatient clinic. Personalized attention is given to each Veteran. Treatment promotes general health care and wellness while focusing on preventing secondary health conditions and functional loss.

Outpatient Clinic: Monday through Friday from 8:00 AM to 4:30 PM (appointment necessary)

Services provided:

  • Primary Care
  • Annual Physical Evaluations
  • Urology Clinic (by referral only). This clinic addresses all urinary track symptoms
  • Urodynamics Studies (by referral only)
  • Wound care (wounds are assessed by our certified wound specialist)
  • Psychological Services (by referral only)
  • Social Work Services (by referral only)

SCI Therapy Services

  • Physical Therapy
  • Occupational Therapy
  • Kinesiotherapy
  • Recreational Therapy
  • Driver Training
  • Vocational Rehabilitation Therapy and Counseling
  • Wheelchair and Seating Evaluation
  • Prosthetic Services

Hospital Based Home Care: SCI/D-HC is a voluntary, post-hospital program designed to enhance the quality of life and independence of newly injured SCI Veterans as well as those Veterans already living in the community. An interdisciplinary team consisting of a doctor, nurse, social worker, dietitian and rehabilitation therapist work together with the Veteran toward achieving goals to enhance functioning in the community. Early recognition of problems and the actions taken by the team often prevent complications and lengthy hospitalizations. The SCI/D Home Care team does not take the place of a caregiver, but provides education, supervision, and support to activities, medical care and home visits as needed. This service is limited to a 100-mile radius of the SCI/D Center.

Helpful Web sites: The following web sites are a small listing of the numerous web site related to spinal cord injury and disorders.

CARF (Commission on Accreditation of Rehabilitation Facilities): http://www.carf.orghyperlink opens in new browser window **

Paralyzed Veterans of America (PVA): http://www.pva.orghyperlink opens in new browser window **
The mission of PVA is to promote quality health care, rehabilitation and civil rights for Veterans and all citizens with spinal cord injuries and diseases. PVA offers numerous publications, fact sheets and clinical practice guidelines for SCI.

Paralyzed Veterans of America Florida (PVAF): http://www.pvaf.orghyperlink opens in new browser window **

Miami Project: http://www.themiamiproject.orghyperlink opens in new browser window **

Christopher and Dana Reeve Paralysis Resource Center: http://www.paralysis.orghyperlink opens in new browser window **

National Spinal Cord Injury Association (NSCIA): http://www.spinalcord.orghyperlink opens in new browser window **

University of Alabama at Birmingham Model SCI System: http://www.spinalcord.uab.eduhyperlink opens in new browser window **

The National Multiple Sclerosis Society: http://www.nationalmssociety.orghyperlink opens in new browser window **

The John Hopkins Hospital Department of Neurology: http://www.myelitis.orghyperlink opens in new browser window **

The National Family Caregivers Association (NFCA): http://www.nfcacares.orghyperlink opens in new browser window **

Contact Information

For further information, please contact the Spinal Cord Injury Service at (305) 575-3174.

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