As innovations in post-acute care help restore greater function for those in the early stages of complex and chronic traumatic brain injury and spinal cord injury, such rehabilitation centers become even more important and valuable.

“Now there’s more to take advantage of,” said Gary Ulicny, former CEO of Shepherd Center in Atlanta, as he explores the latest updates in the post-acute care setting.

Pressure Ulcers and Behavior Modification

About 80% of people with spinal cord injury are going to have a pressure ulcer, 25-30% within the first two years. Some patients have six or seven such wounds.

There’s a profile for these patients: Family and social support networks are minimal, patients are probably socially and psychologically isolated with very limited resources, and most are unemployed.

Shepherd Center monitored a group of these patients for a year, Ulicny told Paradigm Outcomes’ eighth annual Innovation Symposium exploring outliers and medical innovation.

“We brought the patients in, and we trained them how to prevent the sores. We taught them weight-shifts, gave them buzzers for when to shift their weight. We had nurses follow up,” he said.

For another group, the program was the same, except the patients were paid $300 a month to stay healthy.

“During that intervention period of a year, there were dramatic reductions in pressure ulcers. Then we said, ‘OK, the study is over.’ We followed up with them for two years. For some people it stuck, but for the most part, people went right back to the same behavior,” said Ulicny, who is president and CEO of GRU Health Care, an international consulting group specializing in building business and treatment cultures that promote excellence.

“As an industry, our challenge is to understand human behavior and these outlier cases and try to identify what are some creative incentives. Would you pay 300 bucks a month and save $300,000? I would.”

Finding Benefits Where You Never Suspected

Among its other programs, Shepherd Center has a traditional, curriculum-based once-a-week peer support group that is very successful.

To research another approach, the center created more intensive mentorship with former patients operating as peer supporters. Some results we as expected: higher-than-average self-efficacy and control scores thanks to increased confidence from guidance on how to weave their way through society.

“What we didn’t expect is the impact on re-hospitalization of those patients. Just using intensive peer support significantly reduced the number of re-hospitalizations in the patients that received the peer support. This came out of the blue,” Ulicny said. “So, never leave any stone unturned; there might be things that you can do.”

Impact of Recreational Therapy

Looking at the effects of rehab is a very difficult thing to do because of ethical issues.

“You can’t take a group of people and say, ‘You’re going to get PT, you’re not going to get PT.’ Because they’re at their point where functional recovery of rehab is so important,” he said.

So researchers did a large multi-center study called SCI Rehab, where every therapist at the end of every therapy session entered data regarding what they did with that patient and for how long and the intensity.

One thing studied was the effects of recreation therapy, which is very sophisticated, including community reintegration, how to navigate the airport, and social issues.

They randomly signed up two groups. Group 1 got less than 10 hours of recreational therapy, and Group 2 got more than 20 hours. Group 2 patients had significantly higher rates of residing at home, higher community participation scores, fewer pressure ulcers, and participation in recreation activities was much higher, which correlates with health.

“So, a service that most general interest companies do not pay for had significant value. Now, the back-to-work-and-school rate is almost 10%. Remember, out of 500 patients that represents about 50 cases, which can make a significant cost improvement,” Ulicny said.

“Looking ahead, significant long-term savings will be achieved through these advances,” he concluded. “I really believe that.”

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