February 2002

# VA and Spinal Cord Injury

Approximately 250,000 people in the United States have spinal cord injuries and 10,000 more sustain these injuries every year.  About 40,000 are veterans eligible for Department of Veterans Affairs (VA) medical care.  About 60 percent of veterans with spinal cord injuries are eligible not only for health care but also for monetary or other benefits because they have a service-connected disability, meaning that it occurred or worsened during military service.  In the other cases, their injuries are not related to their military service, though these veterans still can receive VA medical care. Among health care workers and veterans advocates, spinal cord injuries are commonly referred to by the acronym, SCI.

## What Is It?

The spinal cord is the main pathway for transmitting information between the brain and the nerves that lead to muscles, skin, internal organs and glands.  Injury to the spinal cord disrupts movement, sensation and function.  Paraplegia results from injury to the lower part of the spinal cord, causing paralysis of the lower part of the body, including the bowel and bladder.  Quadriplegia results from injury to the spinal cord, in the neck area, causing paralysis to the lower body, upper body and arms.  

# Compensation

VA pays disability compensation to about 25,000 veterans for service-related disabilities in which the spine column or nearby structures are affected.  A veteran rated by VA as 100 percent disabled may receive additional compensation if the injury resulted in loss of use of hands or feet or in other disabilities.  About a third of veterans with SCI are compensated $2,163 per month for being 100 percent disabled.  Their disability rating may include other service-connected disabilities not related to their spinal injury.  Many veterans with service-connected disabilities are also entitled to vocational counseling, grants for adapted housing and automobiles, a clothing allowance and payment for home and attendant care. 

## Health Care for Veterans with SCI

VA has the largest single network of SCI care in the nation and provides a full range of care annually to 15,000 veterans with catastrophic spinal cord injury and specialty care to 9,000 of these veterans.  Nearly 1,400 more veterans were served in VA SCI Centers in 2000 than in 1996.  More than 80 percent of veterans with SCI suffered trauma.  The rest have disorders that caused neurologic damage.

A study conducted by a major consulting firm in 2000 comparing VA's SCI services to those funded by several private and public health insurers showed that VA's coverage 

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was more comprehensive.  It integrates vocational, psychological and social services 

within a continuum of care and addresses changing needs throughout the veteran's life. 

VA provides supplies, preventive health care and education for veterans with SCI.  VA also maintains their medical equipment. 

Because the average age of a veteran at time of injury is 32, specialized care is lifelong. Technology and treatment have improved so that people with SCI have increasingly longer life expectancies.  As they age, they risk developing secondary conditions as well as other diseases; therefore, maintaining health is an important part of VA's life-long care.

VA services are delivered through a "hub and spoke" system of care, extending from 23 regional SCI centers offering primary and specialty care by multidisciplinary teams, 40 SCI outpatient support clinics and 120 SCI primary care teams at non-SCI VA medical centers.  Each of the primary care teams has a physician, a nurse and a social worker.  Newly injured veterans and active-duty members are referred to a VA SCI center for rehabilitation after being stabilized at a trauma center.  Each year, approximately 350 newly injured veterans and active duty members begin treatment and rehabilitation at VA's SCI centers.  The centers provide outpatient, inpatient and home care.  Lifelong care focuses on preventing secondary conditions through annual evaluations of health and functioning. 

VA's SCI centers are located in VA medical centers at the following locations:  

Long Beach, Palo Alto and San Diego, Calif.; Miami and Tampa, Fla.; Augusta, Ga.; Hines, Ill.; and West Roxbury, Mass.; St. Louis, Mo.; East Orange, N.J.; Albuquerque, N.M.; Bronx and Castle Point, N.Y.; Cleveland; San Juan, P.R.; Memphis, Tenn.; Dallas, Houston and San Antonio, Texas; Seattle; Milwaukee; and Hampton and Richmond, Va. 

# Research

VA leads the health care profession in defining new methods of rehabilitation through research and engineering.  In fiscal year 2000, VA spent $9.7 million to fund 84 research projects dealing with SCI.  VA investigators conducted another 95 SCI projects supported by $7.7 million in grants from other sources. 

VA's SCI research covers a wide range of topics.  VA researchers are studying whether transplanting into a patient's central nervous system the cells that conduct nerve impulses from peripheral nerves in one part of the body to another part can restore nerve function in the brain and spinal cord.  Others are developing a hand-grasp system that stimulates the forearm muscles that close and open fingers, offering better control.  More examples:

· At the VA Medical Center in San Diego, investigators are studying whether a small number of nerves at the injury site, spontaneously sprouting new connections with other cells, can be enhanced for better recovery. 

· Electrodes implanted under the skin, sending impulses to muscles through peripheral

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nerves, can move muscles in arms and legs paralyzed by spinal cord injury.  Using an

outside control box, this electrical stimulation enables people to flex their hands, stand and sometimes walk to a limited degree. The Cleveland VA Medical Center pioneered this technique.

## National Recreational Events

Staying active is as important to the physical and emotional well-being of people with SCI as it is to other people.  VA sponsors two annual athletic events that offer camaraderie with other SCI veterans and the opportunity to enjoy and participate in competitive sports.  

One event, the National Veterans Wheelchair Games, cosponsored by VA and the Paralyzed Veterans of America, draws nearly 600 veterans.  At the 2001 games, athletes also participated in studies to learn how to determine healthy levels of exercise in people with SCI in order to tailor exercise and diet to burn more calories; how to design activities that encourage wheelchair users to exercise; and how to improve wheelchair design. 

A second event, the National Disabled Veterans Winter Sports Clinic, cosponsored by VA and the Disabled American Veterans in Colorado, has a large portion of its 350 participants drawn from veterans with SCI. 

# Bringing Research to Treatment

In the late 1990s, VA began a special effort to identify gaps in knowledge about SCI treatment and to share findings with its clinicians nationwide.  The goal is to improve the quality, effectiveness and efficiency of care.  

VA is one of 18 professional organizations in the Consortium for Spinal Cord Medicine, which was founded by the Paralyzed Veterans of America to develop guidelines that improve care for all Americans with SCI.  The Consortium represents physicians and other health care providers, consumers and reinsurance firms and has disseminated several clinical practice guidelines.  Among them are guidelines for preventing skin breakdown and blood clots in the legs.  One of the results expected from using the guidelines is more consistent treatment and greater awareness by veterans of how to care for themselves.

VA clinicians nationwide have access to a computer database for sharing treatment and outcome information that enhances the coordination of health care. This registry also helps make referrals to treatment locations.

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# Continuing Education

In addition to identifying research on the best approaches to treatment, VA continually strives to improve its expertise.  The Rehabilitation Accreditation Commission, the standard setting and accrediting authority for organizations providing rehabilitation services, has accredited 19 of 20 VA SCI centers that provide acute rehabilitation. 

Eleven of these centers are training sites certified by the Accreditation Council on Graduate Medical Education, which accredits post-graduate medical training programs in the United States. All VA physicians can take an independent study course on medical care for people with SCI.  Three SCI training programs are held annually for VA health care professionals.

For veterans, VA prepared a guide published by the Paralyzed Veterans of America that explains how to handle problems and where to turn for help.  It is called "Yes, You Can!" and is available at VA's SCI Centers and from PVA.

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