Rehabilitation is essential for maximizing function and quality of life after spinal cord injury. Comprehensive rehabilitation is a significant component of SCI damages, both for initial intensive programs and ongoing maintenance therapy.

Phases of Spinal Cord Injury Rehabilitation

Acute Rehabilitation

After medical stabilization, patients transfer to acute rehabilitation facilities:

  • Duration—typically 2-6 months depending on injury level
  • Intensity—3+ hours of therapy daily
  • Setting—specialized SCI rehabilitation center
  • Goals—maximize function, learn new skills, prepare for discharge

Acute rehabilitation costs range from $150,000-$500,000+ depending on duration and injury severity.

Outpatient Rehabilitation

Following discharge, ongoing outpatient therapy continues progress:

  • Continued physical therapy
  • Occupational therapy for daily living skills
  • May continue for months to years
  • Frequency decreases as function stabilizes

Maintenance Therapy

Long-term therapy maintains function and prevents decline:

  • Ongoing stretching and strengthening
  • Spasticity management
  • Equipment adjustments and training
  • Typically 1-4 sessions weekly ongoing

Types of Rehabilitation Therapy

Physical Therapy

Physical therapists focus on:

  • Strengthening—maximizing muscle function above injury
  • Range of motion—preventing contractures
  • Transfers—bed to wheelchair, wheelchair to car
  • Mobility—wheelchair skills, standing programs
  • Walking training—for incomplete injuries with potential

Occupational Therapy

Occupational therapists address:

  • Activities of daily living—dressing, grooming, eating
  • Hand function—for quadriplegia, maximizing use
  • Adaptive equipment—tools to increase independence
  • Home and workplace modifications

Respiratory Therapy

Critical for higher-level injuries:

  • Ventilator weaning programs
  • Breathing exercises and cough assist
  • Respiratory equipment training

Speech-Language Therapy

May be needed for:

  • Swallowing difficulties (high cervical injuries)
  • Communication with ventilator
  • Voice strengthening

Recreational Therapy

Helps patients return to enjoyable activities:

  • Adaptive sports introduction
  • Community reintegration
  • Leisure skill development

Expected Rehabilitation Outcomes

By Injury Level

C4 and above:

  • Power wheelchair mobility
  • Dependent for most ADLs
  • Environmental controls for independence

C5-C6:

  • Power or lightweight manual wheelchair
  • Some self-feeding with equipment
  • Limited independence in grooming

C7-C8:

  • Manual wheelchair independence
  • Independent with most ADLs
  • Independent transfers possible

Thoracic paraplegia:

  • Full wheelchair independence
  • Independent in self-care
  • May walk with braces for therapy

Rehabilitation Costs in Legal Cases

Initial Rehabilitation

  • SCI rehabilitation center—$1,500-3,000/day
  • Average stay—60-120 days
  • Total initial rehab—$150,000-400,000+

Ongoing Outpatient Therapy

  • Physical therapy—$150-300/session
  • Occupational therapy—$150-300/session
  • Annual ongoing cost—$10,000-40,000

Lifetime Rehabilitation Costs

Life care plans include rehabilitation costs totaling $500,000-$1+ million depending on injury level and life expectancy.

Choosing Rehabilitation Facilities

SCI Specialty Centers

Model SCI systems and designated SCI centers offer:

  • Specialized staff experienced with SCI
  • Comprehensive interdisciplinary teams
  • Better outcomes research shows
  • Access to latest treatments and equipment

Factors in Facility Selection

  • SCI specialization and volume
  • Staff expertise and credentials
  • Equipment and technology available
  • Outcome data if available
  • Location (family access important)

Insurance and Payment Issues

Rehabilitation payment involves:

  • Health insurance—covers acute rehab with limits
  • Medicare/Medicaid—limited coverage for ongoing therapy
  • Litigation settlement—funds ongoing therapy needs

Insurance often inadequately covers lifetime rehabilitation needs. Settlement funds are critical for maintaining therapy access.

Conclusion

Rehabilitation is essential for maximizing function after spinal cord injury. Both initial intensive rehabilitation and ongoing maintenance therapy are compensable damages. Life care plans should include comprehensive rehabilitation needs to ensure funding for this critical aspect of recovery.