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Medical Rehabilitation of People with Spinal Cord Injury During 40 Years of Academic Physiatric Practice

Ragnarsson, Kristjan T. MD

American Journal of Physical Medicine & Rehabilitation: March 2012 - Volume 91 - Issue 3 - p 231–242
doi: 10.1097/PHM.0b013e3182489f5e
2011 AAP Presidential Address

ABSTRACT: There are many different paths that lead to an academic physiatric career and a lifelong interest in spinal cord injury (SCI) medicine. It is unfortunate that after decades of cellular-based research in multiple laboratories, there are still no interventions available that can reverse the neurologic loss that follows SCI. In contrast, medical rehabilitation research during the last 40 yrs has led to remarkable improvements in the lives of persons with SCI as evident in their increased life expectancy, shorter hospitalizations, fewer rehospitalizations, and more effective treatments for male sexual dysfunction and fertility, as well as spasticity, heterotrophic ossification, and neuropathic pain. Application of modern technology has improved the mobility of persons with SCI with better designed wheelchairs, decreased their dependency on others, facilitated their access to information, made communication and community integration easier, and so on. Although deaths related to urinary tract complications are now rare, better methods of managing the neurogenic bladder are still needed. Furthermore, better management methods are also needed for the neurogenic bowel, SCI pain, and osteoporosis of the paralyzed limbs. Even with proper prophylaxis, deep vein thrombosis and pulmonary embolism are still common, and clinicians have paid too little attention to reducing the risk for persons with SCI of developing obesity, diabetes mellitus, and cardiovascular disease. These challenges need to be met by medical rehabilitation research, by advocating for insurance policies that support the healthcare needs of persons with SCI, and by developing comprehensive disability policies, all with the support and leadership of academic physiatrists.

From the Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, New York.

All correspondence and requests for reprints should be addressed to: Kristjan T. Ragnarsson, MD, Department of Rehabilitation Medicine, Box 1240, Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029.

K. T. Ragnarsson is a member of the Board of Directors for Össur Inc., a consultant and a member of the Data Monitoring Committee for Geron Inc., a consultant for Asubio Pharma, and Vice President for the Foundation for PM&R. The AAP Presidential Address was delivered on April 12, 2011, during the AAP Annual Meeting at the Sheraton Wild Horse Pass Resort and Spa in Chandler, AZ.

Supported, in part, by grant H133N060027 from the National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education Services, US Department of Education to Mount Sinai School of Medicine.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2012 Lippincott Williams & Wilkins, Inc.