Clinical experience in rehabilitation of spinal cord injury associated with schizophrenia

Objective: To identify the clinical features and rehabilitation outcomes in spinal cord injury (SCI) patients with preexisting schizophrenia. Design: A retrospective study conducted by reviewing the charts of all patients diagnosed with both SCI and schizophrenia hospitalized from 1987 throughout 1994 in 2 rehabilitation units. Setting: Rehabilitation wards of two hospitals in Taiwan. Patients: Seventeen traumatic SCI patients with schizophrenia, including 7 men and 10 women. Patients without neurological deficits were excluded. Intervention: All subjects received psychiatric intervention and intensive rehabilitation programs during hospitalization. Main Outcome Measures: The injury pattern and psychiatric condition were described. Abilities of locomotion, management of activities of daily living, and bladder control were measured. Results: Fifteen injuries caused by a voluntary fall subsequently resulted in thoracolumbar insult. Ten incomplete paraplegics were able to ambulate with or without a device on discharge. Four subjects had poor bladder control. The outcome of self-care skills was worse in those with high level injury. Psychiatric symptoms were one of the main obstacles during rehabilitation. Conclusion: Voluntary fall that caused thoracolumbar injuries was the main cause of injuries in these patents. Psychiatric symptoms were present in the majority and might hinder the prognosis of treatment. Nevertheless rehabilitation programs were found to benefit subjects after their psychiatric problems were under control.