Respiratory Management Following Spinal Cord Injury - 23

CLINICAL PRACTICE GUIDELINE

Psychosocial Assessment and Treatment
Although there are few supportive studies within the psychosocial domain, the panel nevertheless thought it essential to note areas of clinical significance in the assessment and treatment of individuals with ventilator-dependent tetraplegia. The following recommendations are not meant to be exhaustive, but rather reflective of seminal issues that deserve special attention. The psychosocial evaluation and treatment of individuals with ventilator-dependent tetraplegia are truly complex. The reader is invited to become familiar with other applicable Consortium of Spinal Cord Medicine Clinical Practice Guidelines by visiting www.scicpg.org.

members (Lanig et al., 1996). Unfortunately, most health-care professionals—and mental health-care providers in particular—are trained in the pathology model, which tends to focus on a person’s liabilities and weaknesses. Although this stance may be beneficial in some circumstances, it does not fully reflect the uniqueness of the individual and his or her support system. To achieve balance, the treatment team should build on the strengths and assets of the individual and family. Instruction in health-enhancing techniques and skill acquisition is recommended. This approach can foster a more constructive working alliance among patient, family members, and treatment team.

Affective Status
28. Monitor the patient’s post-injury feeling states, specifically for the emergence of depression and anxiety.
(Scientific evidence–V; Grade of recommendation–C; Strength of panel opinion–Strong)

Adjustment to Ventilator-Dependent Tetraplegia
26. Consider the manner in which the individual is accommodating to the spinal cord injury, including the individual’s post-injury psychological state.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong)

It is imperative for the treatment team to consider the manner in which an individual is accommodating to the spinal cord injury. The patient’s post-injury psychological state is one of the most significant factors in the achievement of a successful outcome and in the perception of a heightened quality of life. As a result, general aspects of adjustment, accommodation, and tolerance to traumatic injury have been widely investigated (Richards, 1986; Rohe, 1998). Several of the following areas can be viewed as subtopics of the global realm of adjustment, accommodation, and tolerance to traumatic injury and compromise.

Enhancement of Coping Skills and Wellness
27. Assist the patient and family in the development, enhancement, and use of coping skills and health promotion behaviors.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong)

Successful management and regulation of feeling states are an important variable in the postinjury adjustment process. Principal concerns relate to the emergence of depressive or anxiety states, which can impede rehabilitative progress and lead to secondary complications (Elliott and Frank, 1996; Kennedy and Rogers, 2000; Craig et al., 1994). It is imperative for the treating professionals to appreciate that many false positives occur in this domain. Specifically, if the treatment team focuses exclusively upon formal DSM-IV diagnoses without an appropriate understanding of SCI, the number of individuals with SCI who receive an inaccurate diagnosis precipitously rises. For example, an individual with SCI very frequently presents with a myriad of clinical features inaccurately construed as vegetative depressive signs. As a result, the clinician should attend judiciously to the cognitive domain (e.g., feelings of worthlessness, emptiness, and hopelessness). For more specific information on this topic, please refer to the Consortium for Spinal Cord Medicine Clinical Practice Guideline: Depression Following Spinal Cord Injury (1998), as well as the companion consumer pamphlet, Depression: What You Should Know: A Guide for People with Spinal Cord Injury (1999).

Substance Abuse
29. Assess the patient for the presence of comorbid substance abuse beginning in the acute rehabilitation setting.
(Scientific evidence–V; Grade of recommendation–C; Strength of panel opinion–Strong)

Given the magnitude of the injury and its associated compromise, it is imperative that the clinical team assists in the development, enhancement, and use of coping skills and health promotion behaviors for both patient and family

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Respiratory Management Following Spinal Cord Injury

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