SCI-program at Karolinska University Hospital and Aleris Rehab Station

1. General description

The incidence of traumatic spinal cord injuries (SCI) in Sweden is among the lowest in the world, largely due to infrastructural and preventive factors. With a population of close to 2 million inhabitants, the Stockholm region has an annual SCI incidence of 30 – 40 cases. The regional prevalence population is about 600 individuals. 

The system of care for SCI is highly centralized and arranged according to a defined clinical pathway. The current system of care has been operative for almost 2 decades, with significant further concept improvements and specialization during the last years.

Acute neurosurgical or orthopaedic  treatment as well as intensive care management take place at several hospitals in the region. The acute phase of SCI in patient rehabilitation is centralized to the Spinal Unit, Department of Neurology, Karolinska University Hospital

Aleris Rehab Station Stockholm, has treatment agreements with Stockholm County Council and close cooperation with Karolinska University Hospital. The Spinalis Clinic at the Karolinska University Hospital is located close to Aleris Rehab Station. Together they have  created a network of dedicated specialists in the Stockholm area to cover the need for highly-specialized medical attendance, for SCI patients. This network includes Neurosurgery, General Orthopaedic surgery, Spinal Orthopaedic surgery, Psychiatry, Plastic surgery, Respiratory medicine, Pediatrics, Neuro-urology, Pain specialists, Infection medicine etc

1.1 Rehabilitation

The purpose of the initial rehabilitation – during which the patient’s condition is deemed to require the resources of a fully equipped University Hospital is:

• Identifying the lesion, impairment and disability and subsequently establishing relevant functional potentials and goals
• Prevention and treatment of medical complications, e.g.. thromboembolism, infections, surgical complications, pressure sores, heterotopic bone formation.
• Establishing adequate bladder and bowel emptying regimes
• Pain management
• Respiratory capacity assessment, ventilatory training
• Initiation of physical rehabilitation, e.g.mobilization, transfer skills, activities of daily living
• Adaptation to basic technical aids, e.g. wheelchairs, orthopaedic devices

The purpose of the later-phase in-patient rehabilitation at Aleris Rehab Station Stockholm is:

• Intensified training of functions and skills in preparation for living at home
• Introduction of social, leisure and sports activities as means for further rehabilitation
• Refining and finalizing supportive equipment and technical aids depending on the level of disability
• Starting the process of reintroduction to studies or work
• Counselling and treatment of sexual and fertility dysfunction
• Introduction of role models, i.e. professional staff with SCI, who provide unique insights by way of their own experience of living with this disability

 2. Functional expectations and prognosis.

SCI is not yet a curable disorder. Still, minimization of mortality, morbidity and complication rates, as well as maximization of functional outcomes are highly dependent on expert care. Thus, what can be expected by treatment in Stockholm is not “repair” of the damaged spinal cord, but rather:

• Detection and treatment of spinal instability and/or spinal cord compression
• High quality general medical and nursing care
• Diagnosis and treatment of complications, e.g. pressure ulcers, heterotopic ossification, infections
• Evaluation of neurological, bladder, bowel, ventilatory, musculoskeletal and sexual functions as indicated, and institution of adequate treatment and rehabilitation procedures
• Evaluation of potential for reconstructive hand surgery in tetraplegia
• Modern multi- and interdisciplinary rehabilitation
• Testing, prescription, training the patient to use relevant technical aids
• Social skills training
• Psychological counselling as  indicated
• Specific suggestions for residential and workplace modifications

2.1 Functional goals

The neurological level of the SCI – which does not necessarily coincide with the spinal fracture level, as well as the degree of completeness of the cord lesion – is essential for establishing realistic functional goals. Although functional rehabilitation outcomes obviously vary according to, e.g., age, motivation and general medical status of the individual patient, some general expectations can be defined:

2.1.1 Tetraplegia

C5 lesion complete
Full independency in activities of daily living and transfer cannot be achieved
Independent propulsion in manual wheelchair, at least indoors, possible
Usually partially electrical wheelchair users

C6 lesion complete
Highest lesion that can make basic independence (e.g. living alone, transfer, driving a car) possible
Adaptation of house/flat and working environment essential for independence

C7 lesion complete
Basic independBence realistic goal for the majority

2.1.2 Paraplegia

L3 lesion complete
Highest lesion that allows for reasonably comfortable ambulation with crutches limited distances
Partially wheelchair users

S1 lesion complete
Highest lesion that allows for constant ambulation with or without canes

2.2 Average duration of rehabilitation

Paraplegia Initial rehabilitation/ Karolinska University Hospital:
8 - 10 weeks

Later phase rehabilitation/ Aleris Rehab station:
8 - 10 weeks

Tetraplegia Initial rehabilitation/Karolinska University Hospital:
12 – 14 weeks

Later phase rehabilitation/Aleris Rehab station:
12 - 14 weeks

Our current capacity is about 15 foreign patients annually for the total program, i.e initial and late phase rehabilitation. For later phase rehabilitation only (i.e. for patients referred in a medically stable phase 8-10 weeks or more post injury) an additional 15-20 patients annually can be provided.

English is the working language. Interpreter services are available in most languages.

Aleris Rehab Station Stockholm

Coordinator:

Lars Holmström
Frösundaviks allé 4
SE - 169 89  Solna
Tel: + 46 8 555 44 108
Fax: + 46 8 555 44 151

Karolinska University Hospital

MD/Coordinator:

Björn Hedman
SE - 171 76 Stockholm