Facilitating the

Self-Managementof Spinal Cord Injury

Michelle A. Meade, Ph.D.

University of Michigan

Department of Physical Medicine & Rehabilitation

Center for Managing Chronic Disease

mameade@umich.edu

Shawn Floyd, B.S.

Spinal Cord Injury Association of Virginia

Disclosures

• The Faculty have no commercial or financial

interests in this presentations.

•CME Staff Disclosures

Professional Education Services Group staff

have no financial interest or relationships to

disclose.

Acknowledgements

This presentation was adapted from the

Facilitating Health Mechanics manual, written

by and copyrighted to the author as a part of

the project Self-Management of SCI/D funded

by grant #576 from the PVA Education

Foundation.

PVA Research Foundation grant #2751

“Evaluating the Effectiveness of Health

Mechanics: A Self-Management Program for

Individuals with Spinal Cord Injury” which is

currently in progress

Learning Objectives

Audience members will

be able to discuss the importance of a

self-management perspective for

individuals with SCI

be able to identify three self-management

skills and how they may be applied by

individuals with SCI

become aware of how to incorporate the

development of self-management skills

into their patient teaching and clinical

practice

Self-Management

An evidence-based approach to managing chronic illness

Provides education and skill-building related to self-

monitoring, communication, problem-solving and relaxation.

The ability of an individual with a chronic condition to manage

their health and its physical and psychosocial consequences

Requires

Learning about and understanding their injury & care

Prioritizing health concerns

Active participation in the health care partnership

Accepting responsibility for performing specific health behaviors

Existing evidence and programs

Peer led

Chronic Disease Self-Management Program / Arthritis

Lorig and Stanford Patient Education Research Center/

Living well with a disability

Provider based / professionally facilitated

Lifestyle Redesign (Florence Clark and colleagues)

OT intervention for various populations

From Asthma

Clark and colleagues

Problem Solving Training (Nezu & D’Zurilla)

Spinal Cord Injury

Kennedy & Colleagues coping effectiveness training

Self-Management Goals

Manage health and emotions

Prevent and deal with secondary conditions

Improve communications with others

Optimize Environment

Improve Community Integration

SCI-Specific Management

Skin

Circulation / blood pressure

Respiratory

Bowel management

Bladder management

Range of Motion

Additional Challenges with

General Health Management

Nutrition / Diet

Regular Exercise

Not Smoking / Smoking Cessation

Taking Medication Appropriately

Address Bone Health

Optimize Emotional / mental health

Preventative health care

Managing Secondary Conditions

Urinary Tract Infections

Spasticity

Pain

Autonomic Dysreflexia

Sexual Dysfunction

Depression / anxiety

Pressure sores / skin breakdown

Managing the Social Environment

Getting social support

Communication

Confronting Stereotypes

Educating others

Attendant management

Managing the Physical

Environment

Home accessibility

Transportation

Ramps, steps and elevators

Advocacy

Americans with Disability Act

Managing the Healthcare System

Communication with health care

professionals

Pain management

Insurance and what is covered

Ordering supplies

Durable medical equipment

Facilitating Health Mechanics

An evidence based program

http://www.med.umich.edu/pmr/research/interests

Developed as results of

• Needs Assessment

• Review of Existing theories, research and programs

• Input from both consumer and

professional advisory boards

• Evaluated by focus groups

Components

Attitude

Self-monitoring

Problem-Solving

Communication

Organization

Stress Management

Attitude

Importance of accepting responsibility for

your health and your future and becoming

positive and proactive

Expectations

Assumptions

Outlooks

Responsibility

Actions

Self-Monitoring

To Monitor is to regularly observe or record

information about what is happening

Identifying signs and symptoms

Collecting Information

Processing Information

Evaluating the effectiveness of changes

Problem-Solving

New situations or emotions

Steps

State problem

Outline Problem with all relevant details

List possible solutions

Consider possible consequences of possible

solutions

Rank / combine solutions

Implement one possibility

Evaluate effectiveness

Communication

Ways of communicating

Basics of communicating

Determine what the goal of the conversation is

Determine the most effective way of achieving

that goal (be strategic)

Accept responsibility for your own feelings

Give and accept feedback with an open mind

and non-defensive manner

Communicating in the health care environment

Organization

Steps

Decide on a goal

Plan

Take Action

Maintenance

To organize is to put something in an orderly system to make it easier to use or negotiate

Stress Management

Primary methods

Relaxing the body

Calming the mind

Refocusing attention

Soothing the soul

Building on strengths and supports

Things to avoid

Example: Bladder management

Attitude

Self-monitoring

Problem solving

Communication

Organization

Stress management

Peer Mentoring and

Self-Management

Why Self Management in the

“Real World” is Critical

THE MANY ROLES OF A

MENTOR

Guide Supporter

Helper Advisor

Listener Confidant

Role-model Self-esteem booster

Sounding board Big brother/sister

Teacher Coach

Information provider Companion

Friend Motivator

Mentors facilitate a positive attitude while

promoting problem solving techniques

Factors

Factors influencing level of self-management skills and

competency:

Attitude

Age

Education

Cognitive capacity

Pre-existing experience in using the skills in other

contexts

Level of adjustment and mental health status

influence both ability and motivation to take on the

responsibility of actively managing health

“Takes One to Know One”

Provides Support Across the Spectrum

New Injury

Injury education, explanation of common terminology

Sort out relevant information

Assess patient understanding

Answers questions and provides emotional support

Demonstrates firsthand that life isn’t over because of the injury

Discharge to 1st year

Assists in teaching concrete problem solving techniques (i.e.

returning to an apartment or house that is highly inaccessible)

Provides information on community resources

Helps make connections as they rebuild their lives and become

interested in things “beyond the basics”

Beyond the Basics

Resuming work/education

Family life

Adaptive sports/recreation

Advocacy

Research

Mentoring

Partnering with Health Care

Professionals

Help individuals with SCI

Understand what is going on

What can be done to address challenges

Explain what they are recommending and why

Relate info to long or short-term goals

Discuss specific behaviors

Assess understanding

Address questions individuals with SCI have about

information they have received from other sources

As We Age

Compare Aches and Pains

“Expert” Patients have insight that are not

to be discredited.

Summary

Both theories and research are readily available to

help understand health behavior changes

Health care providers can and should use these to

support their own treatment and interventions

Facilitating Health Mechanics is a manualized

program that is available to assist providers in

collaborating with patients to support their self-

management skills

Peer mentoring can provide important supports and

role modeling for the self-management process

Obtaining CME Credit

• If you would like to receive CME credit

for this activity, please visit:

http://www.pesgce.com/PVAsummit2011/

• This information can also be found in the Summit

2011 Program on page 8.