|
| |
|
In October of 1979 the Regional Spinal Cord Injury Care System of Southern California centered at Rancho Los Amigos National Rehabilitation Center (Rancho) was officially designated a Model Spinal Cord Injury System by the Federal government. Since then, it has successfully re-competed for Model System designation on six separate occasions. Even when Rancho was the Los Angeles County poor farm in the late 1800’s, some of the "inmates" were documented as paralyzed or paraplegic. However a focus on spinal cord injury (SCI) at Rancho did not emerge until after polio was no longer a major health threat in the U.S.. The opening of the first categorical spinal injury service at Rancho occurred in 1955. In 1966 Rancho became the first civilian Regional Spinal Cord Injury Rehabilitation Center in the United States. The Center at Rancho under the direction of Shannon Stauffer was established through a Research and Demonstration Grant from the Social and Rehabilitation Service of the U.S. Department of Health, Education and Welfare. It was the precursor and one of catalysts of current Model Spinal Cord Injury Systems Program, which began under the Rehabilitation Services Administration in 1970. While Rancho provided state-of-the-art Rehabilitation, a Model System encompasses all aspects of care from point of injury through lifetime follow-up. In 1979, under Rancho’s leadership, all the components necessary for a Model System in Southern California were brought together. Since the initial funding of the Model SCI System in 1979, the System has served approximately 3,600 newly injured individuals each year, approximately 60 percent of the total number of new spinal cord injuries which occur in Los Angeles County.
The Model System is a research and demonstration project. Research personnel of the Model System conduct continuing evaluation of service delivery and outcomes. For example, there is constant monitoring of specific medical complications to which individuals with spinal cord injury are prone, such as pressure ulcer and urinary tract infections. One positive outcome of this monitoring occurred during the early history of the Model System, when within the first three years of designation, Model System personnel’s efforts led to reduction of acute admission pressure ulcer rates from sixty to less than ten percent.
Beyond service delivery evaluation and research, personnel of the Model System have continually been active in clinical research and have been the catalyst for additional research funding. The personnel of the Model SCI System at Rancho led the first collaborative research project among the Model SCI Systems across the U.S. resulting in a peer-reviewed publication. Model SCI System personnel were also responsible for the longest Field-Initiated Research Project funded by the National Institute on Disability and Rehabilitation Research, which followed the neurological recovery patterns of more than 500 individuals with new spinal cord injuries. This effort led to, among many other things, the definition of complete spinal cord injury used in the International Standards for the Classification of Spinal Cord Injury. The Model System also fostered the newer, currently funded Field-Initiated Research Project on cardiovascular disease in women with spinal cord injury. The Model SCI System personnel were among the first in the country to identify and explore the problems of those aging with spinal cord injury, which served as a vehicle for the establishment of the Rehabilitation Research and Training Center on Aging with Spinal Cord Injury (1993-2001). The Model SCI System was also the primary mechanism fostering the Rehabilitation Engineering Research Center on Spinal Cord Injury, the newest member of the research arsenal at Rancho. Altogether, the Model System personnel have produced more than 80 peer-reviewed scientific publications and 10 book chapters on spinal cord injury topics.
Currently, a new focus of research in the Model System is literacy. The majority of individuals who sustain a spinal cord injury and are treated at Rancho have less than a high school education and for many English is a second language at best. Oral fluency and literacy are not the same things and confusion between the two often leads to problems in training adults whose proficiency with English is limited. Just as an individual who is fluent in English may be functionally illiterate in English, an individual who is fluent in another language may also be functionally illiterate in that other language. In this regard, simple translation of written materials does not resolve all other-language problems.
Recently, a number of investigators have found strong associations between literacy levels and health status where low literacy, poor health and early death are inescapably joined. While health status is derived from a complex assortment of factors, education has been identified as the best predictor among these factors. Individuals with low literacy cannot read medication labels and often take medications incorrectly; cannot read instructions for follow-up care; are more likely to have poor health habits (smoke, exercise less, etc.); live in substandard housing in less safe neighborhoods; and have limited access to health care because they lack information about where and when to seek medical attention because they are less able to understand signage and comprehend written materials concerning medical tests, management of medical conditions, treatment options and protocols. Paradoxically, in the health care arena where chronic disease has become a major cause of illness and death, and patient care has shifted from in- to out-patient venues, health education has taken on a greater importance.
The primary objectives of the Model System literacy investigation are to:
 | examine literacy among those who sustain spinal cord injury; |
| assess the efficacy of adult literacy training for the spinal cord injured; |
| evaluate the impact of literacy training on medical, rehabilitation, and
social outcomes; and |
| develop links with community programs that provide adult literacy training so that necessary training interventions suited to the spinal cord injured individual can be developed and offered. |
Model SCI System Leadership
Robert L. Waters, M.D. has been the Project Director of the Model SCI System since 1980. He received an A.B. degree in chemistry with honors from Indiana University in 1962 and a M.D. degree from the University of Chicago in 1966. In 1971, Dr. Waters joined the staff at Rancho as a Fellow to pursue his research interest in determining the physiologic energy expenditure associated with physical disability. After serving the fellowship at Rancho, Dr. Waters remained as a member of the Attending staff. During his tenure at Rancho, he has served as Chief of the Stroke Rehabilitation Service, Chief of the Spinal Injury Service, President of the Professional Staff Association of Rancho, Chief of Surgical Services, Acting Chief Medical Officer, and Co-Director of the RRTC in Aging with Spinal Cord Injury,. In addition to Model System Project Director, he is currently the Chief Medical Officer of Rancho, Clinical Professor of Orthopedics at the University of Southern California, Executive Secretary of Los Amigos Research and Education Institute, and Co-Director of Rehabilitation Engineering Research Center on Spinal Cord Injury.
Dr. Waters served on the Boards of Directors of the American Paraplegia Society from 1984 through 1988 and the American Spinal Injury Association from 1982 to the present. He was Vice President of the American Paraplegia Society, 1987-1989; President of the Federation of Spine Associations, 1987-1988; served two terms as Secretary/Treasurer, 1985-1989; was the Chairperson of the Program Committee, 1984-1989 and is a past President of the American Spinal Injury Association. He is a member of the Executive Committee of the Southern California Injury Prevention Research Center (IPRC) at UCLA of which Rancho is the Rehabilitation Affiliate, the Clinical Practice Guidelines Committee of the American Paraplegia Society, and Steering Committee for The Consortium for Spinal Cord Medicine, and served as a Governor's appointee to the California Task Force on Spinal Cord Injuries.
He has been on the editorial boards of Clinical Orthopedics and Related Research, Paraplegia, and Orthopedics Today; is currently on the Editorial Board of Topics in Spinal Cord Injury Rehabilitation, and a reviewer for Spinal Cord, the New England Journal of Medicine, and Journal of Bone and Joint Surgery. He has authored more than 200 publications related to pathokinesiology, rehabilitation and rehabilitation surgery with more than seventy-five directly related to SCI.
Rodney H. Adkins, Ph.D. is the Model SCI System Co-Director. Dr. Adkins received an A.B. degree in Psychology with honors from the University of California, Santa Cruz in 1971. He received M.S. and Ph.D. degrees in Experimental Psychology in 1974 and 1977 respectively from the University of Miami. Prior to joining the Model SCI System at Rancho in 1980, he served as Project Coordinator of the South Florida Regional Spinal Cord Injury System. He also served as the Research Director for the RRTC on Aging with Spinal Cord Injury at Rancho.
He is a member of the Research Committee of the American Spinal Injury Association, the Data Committee of the National Model SCI Systems Program and the ad hoc committee on re-design of the National SCI Database. He is a peer review field reader for the National Institute of Disability and Rehabilitation Research, a member of the Institutional Review Board at Rancho and the core management staff of the Rehabilitation Engineering Research Center on Spinal Cord Injury and is currently the Treasurer of Los Amigos Research and Education Institute, Inc. He has authored/co-authored over sixty peer-reviewed publications on spinal cord injury.
Douglas E. Garland, M.D. is the Model SCI System Associate Director for Rehabilitation and Related Research. Dr. Garland received his undergraduate and medical degrees from Creighton University in 1965 and 1969 respectively. In addition, he completed a one-year medical internship in 1970. Following this, and two years in the U.S. Army Medical Corps in Vietnam, he completed his residency in orthopedic surgery at Tulane University in 1976.
After completing a fellowship in Neuromuscular Diseases at Rancho in 1977, Dr. Garland remained at Rancho and became Co-Chief of the Stroke Service and Chief of the Fracture Service. Shortly thereafter, he became Chief of the Adult Head Trauma Service. In 1985, he became Chief of Spinal Injury Services. In this capacity, he served as the primary physician liaison to referral hospitals for spinal cord injury. He is currently the Director of the Division of Neurotrauma at Rancho.
He has published over 50 scientific articles and book chapters. He has become an authority on reconstructive extremity surgery, fracture care, spasticity, heterotopic ossification and osteoporosis in the SCI population. He has been a Member of the Board of the American Spinal Injury Association (ASIA) for 8 years. He has served on ASIA's Program Committee, Chaired ASIA's Committee on Prevention, and is ASIA’s most recent past President.
|
|
