A strategic approach to the rehabilitation of patients with cervical SCI.

Background. This article presents an evaluation of the strategic approach to managing rehabilitation for patients with high spinal cord injuries. The strategic approach is founded on the assumption that particular rehabilitation procedures should be applied in accordance with a strategic plan, which is developed in terms of the overarching goal of rehabilitation, understood as enabling the appropriate mechanism of adaptation and compensation. Consistent pursuit of this goal, instead of merely reacting to successive crises and problem situations as they arise, enables the patient to achieve greater independence, and thus a better quality of life. In order to adjust the strategic plan to the individual needs of the patient, it is developed in a series of steps: 1) comprehensive analysis of the patient's current status and situation; 2) establishment by negotiation of a target situation (overarching goal); 3) selection of subordinate goals leading systematically to the realization of the overarching goal; 4) establishment of a schedule for the realization of subordinate goals; 5) regular monitoring of goal performance and performobility.
Material and methods. The effectiveness of the strategic approach was evaluated in a clinical experiment involving 68 patients wit tetraplegia, who underwent surgery subsequent to spinal cord injury (SCI) at the level of the cervical vertebrae (C2-C7), and were treated in the centers represented by the authors. The patients were divided by matching for age and sex into two groups: a control group (K) of 34 patients whose rehabilitation was conducted without reference to a strategic plan, and an experimental group (E)of 34 patients who had such a plan. The methods used to measure the outcomes obtained by the patients in rehabilitation included clinical observation, the Polish version of the standard Functional Independence Measure (FIM), and a Self-Evaluating Scale of Progress in Rehabilitation. The patients were tested twice, once before beginning rehabilitation, and again 6 months later.
Analysis of results. In both group similar progress was recorded in certain parameters of the FIM scale, which points up the effectiveness of the therapeutic procedures used in comprehensive rehabilitation; in group E, however, much greaterprogress was noted in terms of functional independence and psycho-social functioning. The patients from group E were much more content with the results they had achieved in rehabilitation.
Conclusions. The results reported here justify the assertion that the strategic approach to the rehabilitation of patients with high cervical SCI makes the most of the benefits provided by the procedures applied, without the necessity to make fundamental changes in procedures or employ additional personel, acquire new equipment, etc. The strategic approach helps the patient attain better results in becoming independent, and gives grounds for greater satisfaction with the results obtained in rehabilitation, which in run increases motivation to take an active part in exercises and other procerdures. It also assures the patient the basic right to make fundamentally important decisions in the course of his own treatment, which is consistent with the Patient Bill of Rights and the requirements of 21st-century medicine.