After I was injured in the summer of 1979, my in-patient rehab at the University of Washington Medical Center (in Seattle) lasted from early July ’79 to early February 1980. During that time, my P.T. and O.T. skills had been pushed as far as they could go. By the time I was discharged, my “new quad” training had been maximized, and I was ready to face the real world with the highest level of independence I was capable of achieving.
It’s now 34 years later, and I’m still using most of those skills on an everyday basis. During the 1980s and ‘90s, as I attended college and found gainful employment in corporate America, my rehab docs and therapists called me “Super Quad,” and we all beamed with pride over the goals we’d achieved together.
To this day, I still enjoy an above-average degree of independence that is entirely attributable to the progress I made during rehab. In decades past, it wasn’t unusual for newly-injured paras and especially quads to go through several months of rehab. My own deeply beneficial time in rehab lasted almost exactly seven months.
Sent Home after Seven Weeks
Here’s a shocker for you: Today, most paras and quads are being discharged from rehab after seven weeks or less. In many cases they’re being sent home as early as one month post-injury. This is nothing less than criminal neglect, and many quads return home with a life-long shortage of independent skills and abilities. Even the life-changing choice of a wheelchair falls under suspicion: If you’re a lower-level quad (like I am), using a manual chair instead of a powered chair could lead to many years of greater strength, endurance and overall fitness. You should never let doctors or insurance companies force you to use a powered chair if you can live a good life without one.
Over the course of decades, rehab hospitals and miserly insurance companies have gradually shortened rehab to the point where quads and even paras are routinely being sent home in a state of maximum dependency. Instead of being discharged from rehab only after they’ve reached optimum levels of independence, many SCI patients are sent home prematurely, convinced by the “prevailing wisdom” of their physicians and insurance agents that they’ll gain additional skills at home.
For the most part that’s a load of hogwash. As any SCI patient will tell you, rehab is an intensely rigorous yet utterly vital experience, fraught with physical and psychological aftershocks on the road to recovery. It’s a crucially essential time of radical adjustment, when we and our families desperately need the guidance of reliable experts in a clinical environment. We’re in a vulnerable state, and we need to trust that these learned professionals have our best interests in mind.
Whose “Best Interest” is Served?
So you have to ask yourself, how does drastically shortened rehab qualify as having “our best interests in mind”? How can we justify expensive, round-the-clock caregiving that could have been reduced or even avoided by more progressive months in rehab? Has your insurance coverage (assuming you have any) properly ensured that you’ll gain maximum independence, or does your health-care plan kick you out of rehab as early as possible?
While it’s certainly true that in-home therapy and outpatient rehab sessions can yield ongoing progress, they’re no substitute for the immediate benefits of intense, longer-term post-injury rehab. That’s where we learn the good habits and self-care regimens that lead to a lifetime of increased independence and the sense of pride and achievement that goes along with it.”
We can’t allow strict, bottom-line policies to dictate the quality and duration of our rehab. We owe it to ourselves, and to society at large, to start our new lives in wheelchairs with (pardon the pun) our best foot forward. We need to leave rehab feeling completely confident in the quality, duration and efficacy of the costly education we’ve received from our doctors, nurses and therapists.
Obviously, this doesn’t apply equally to everyone who’s newly injured: If you’re a high-level quad you will obviously be more dependent, and there’s a limit to what rehab can accomplish. But in the final analysis, it makes physical, psychological and especially financial sense to front-load the expense of paralysis as much as possible during rehab. If hospitals and insurance companies could rip a page from history and recall the lasting benefits of longer-term rehab, we’d all be better off. Unless, of course, you prefer a life of higher expenses, diminished health and increased dependency. In which case, why bother with rehab at all?
How did you react to Jeff’s post? Please share your thoughts below.
So true! Without the intense rehab I had, my reentry into a mainstream world would have been much more difficult. One month of rehab cannot prepare a new SCI with the skills necessary to survive. One month barely allows for the time of self-realization and the motivation to learn to adapt.
I’m a C5-6 quad injured in 1984 while visiting family and friends in North Dakota. I had to stay at the rehab in Grand Forks, ND for four months until my halo was removed. I didn’t know it at the time, but the care and rehab I received there was phenomenal.
I returned to Hawaii, my home at that time, where I spent another couple of months in rehab at The Rehab of the Pacific. For several more months, I continued with outpatient rehab. Again, excellent care. I had the time to learn how to problem solve and practice living with a disability in an environment where I didn’t have to be overwhelmed by reality of the life that awaited me when I left the doors of the rehab.
In addition to longer rehab stays, I also believe quads should have the opportunity to return every once in awhile to brush up on skills and be introduced to new practices.