Rehabilitation after spinal cord injuries: the sooner, the better

Beginning rehabilitation soon after a spinal cord injury seems to lead to improvements in functioning for patients, according to a new study.

Researchers analysed data from nearly 4,000 people in the United States who suffered a spinal cord injury between 2000 and 2014. The patients’ average age was 41 and the average time to start rehabilitation was 19 days.

It found that early rehabilitation following a traumatic spinal cord injury may lead to better functional outcomes for patients at the time of their discharge and in the subsequent year.

“This study shows, following spinal cord injury, patients might benefit from entering inpatient rehabilitation at the earliest, clinically appropriate opportunity,” said lead investigator Kurt Herzer, a fellow in the Medical Scientist Training Program at Johns Hopkins School of Medicine in Baltimore.

“Patients and caregivers can discuss with their medical teams the plan and timing for transfer to rehabilitation and any concerns they may have about delays. Health care providers could similarly consider the value of additional days in the hospital as it relates to their treatment plans.

“In other areas of medicine, we tend to recognise that the time between an acute health event and treatment matters. For example, many patients are familiar with the adage that ‘time is muscle’ following a heart attack, and that delays in treatment increase the likelihood of damage to the heart.”

The findings concluded:

• Patients who experience longer acute-care stays before starting rehabilitation may be losing out on the positive impacts of neuroplasticity, which allows the body to adapt to neurological changes.
• Patients who underwent earlier rehabilitation experienced “modest improvements in function and physical independence.”
• Patients who had a 10 per cent greater amount of time to rehabilitation post-injury, had about a 4 per cent decline in the Functional Independence Measure score and a 5.3 per cent decline in the Craig Handicap Assessment and Reporting technique score, one year after the injury.

However, the researchers caution that this observational study and said additional research is needed to confirm a cause-and-effect relationship between rehabilitation timing and outcomes.

They did, though, suggest enhanced communication between hospitals and rehabilitation providers.