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Sister Kenny Rehabilitation Institute

Spinal Cord Injury System of Care

Spinal Cord Injury System of Care

Spinal cord injury and disorders

Through comprehensive rehabilitation, patients and their families can learn how to cope with the complex difficulties they face after a spinal cord injury.

The Spinal Cord Injury System of Care at Sister Kenny Rehabilitation Institute serves individuals who have received a traumatic or non-traumatic injury to their spinal cord.

We provide services for all stages of recovery: inpatient rehabilitation, outpatient and lifelong follow-up.

Nationally recognized spinal cord care

For more about inpatient care, call
612-863-4457.

For more about outpatient care, call 612-863-4446.

The Institute's inpatient and outpatient rehabilitation facility at Abbott Northwestern Hospital is the only such program in the Twin Cities area accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF), an independent national organization that certifies facilities which meet the highest patient care standards.

This means that we follow rigorous guidelines for best practice quality and nationally and internationally recognized service standards.

See statistics about inpatient outcomes

Spinal cord injury rehabilitation team

Our spinal cord injury rehabilitation team works with patients and their families to develop a plan of care to help each patient regain as much independence as possible. Team members include specialists in the treatment of spinal cord injury:

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Spinal cord injury

Your spinal cord sends the messages to and from your brain and body that make it possible for you to feel and move. A spinal cord injury can cause loss of feeling, paralysis, breathing problems, and difficulty with bowel and bladder control.

Learn more about spinal cord injury and disorders.

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Care navigators

Sister Kenny Rehabilitation Institute care navigators are licensed registered nurses who help patients navigate their way through an increasingly complex health care system.

Rehabilitation care navigators guide care to achieve high levels of patient safety, excellent coordination of care along a health care continuum, improved patient satisfaction, compliance with regulatory standards, and efficient use of resources, all in pursuit of exemplary outcomes.


Source: Sister Kenny Rehabilitation Institute
Reviewed by: Jennifer Theis, MSOTR/C, program coordinator, Sister Kenny Spinal Cord System of Care
First Published: 03/22/2011
Last Reviewed: 03/03/2011

Program features

The Spinal Cord System of Care provided at Sister Kenny Rehabilitation Institute offers many unique features:

  • evaluation by physiatrists and nurse practitioners
  • plan of care: inpatient and outpatient
  • rehab nursing
  • therapies and education (Kenny Grad School)
  • environment of care
  • specialty services
  • lifelong follow-up and re-evaluation (outpatient medical visits)
  • Sister Kenny Rehab Associates – physiatrists' clinic

Specialty services

The following services may also be offered, depending on an individual's needs, and are available to both inpatients and outpatients:

Spinal Cord Injury System of Care

Therapies and education

Inpatients at Sister Kenny Rehabilitation Institute receive a minimum of three hours of therapy a day.

Patients with their family and the rehabilitation team establish core outcome goals for their rehabilitation stay.

Comprehensive therapy and education programs help patients and their families prepare for the physical, emotional and social needs they may experience after discharge into the community.

Therapies and education include:

  • activities of daily living – such as learning how to get dressed and how to prepare meals
  • transfers and mobility – learning to use a wheelchair and to move yourself from your wheelchair to your bed, car, and other situations
  • emotional adjustment – support group and individual counseling
  • self care – learning to manage your bowel and bladder, care for your skin and to understand your medications
  • community outings – patient and family practice rehabilitation skills in the community with the help of their therapists
  • therapeutic swimming pool – allows you to move in a warm, non-weight bearing environment with a therapist
  • family involvement and education – you and your family are the most important part of the rehab team and will be included in setting and achieving your rehabilitation goals, family conferences, and discharge plans.

Specific education topics may include adaptive driving and vehicles, bladder, bowel, circulatory system, musculoskeletal care, wellness and nutrition, skin, adjustment and coping, and sexuality.

Inpatient care

For more about inpatient care, call
612-863-4457.

Upon admission to Sister Kenny Rehabilitation Institute, an individual is evaluated by an transdisciplinary rehab team that includes a physiatrist and/or nurse practitioner, occupational and physical therapists, therapeutic recreation specialist, a psychologist and possibly a speech-language pathologist.

The rehab team determines the patient's level of independence and level of need for assistance.

After the initial evaluation is completed, the team meets within four to five days of the patient's admission to review results of the evaluations and formulate a plan of care that details the patient's anticipated length of stay, goals to be achieved (short- and long-term), discharge location and needs after discharge.

Patient/family conference

Review of these findings and plan of care is discussed in a patient/family conference. During this conference, the physician, care navigator and social worker discuss the results and recommendations with the person with spinal cord injury and his/her family.

This meeting is also held to fine tune and establish goals for the inpatient rehabilitation stay that are in accordance with core goals and objectives.

Within one week of this family conference, the family is encouraged to participate in family day to observe current abilities and start family training.

The rehab team regularly meets with individuals with spinal cord injury and their family members to discuss emotional responses to the onset of a spinal cord injury and progress (both physical and emotional) during the rehab program.

These discussions occur during one-to-one, couples, family and peer group support.

During daily rounds, the rehab team reviews issues related to each person with spinal cord injury to evaluate progress, and determine appropriate interventions and specialty services.

Once a week, the rehab team discusses the plan of care and whether the individual is on track for anticipated length of stay, discharge location and core goals. Interventions and goals are modified — with input from the person with spinal cord injury — as needed.

An individual is ready for discharge when core goals are met or the individual's condition meets discharge criteria.

Goals may be modified during an individual's stay or met in a different setting that is better for the individual's overall rehabilitation program.

The rehab team works with the individual with spinal cord injury and family members to decide the best discharge setting to help meet ongoing rehabilitation needs, with the emphasis on empowering discharge to the community rather than another facility. This may include special support service, equipment or follow-up appointments.

Spinal Cord System of Care Continuity Clinic

Spinal Cord System of Care Continuity Clinic

Sister Kenny Rehabilitation Associates doctors and therapists work with patients and their families to decide the best follow-up plan and home program to meet continuing, life-long needs.

For more about outpatient care, call 612-863-4446.

Outpatient care

Once referral for outpatient services is received, the potential outpatient is contacted by Sister Kenny Rehabilitation Institute scheduling and registration staff.

Based on an individual's diagnosis and functional limitations, the outpatient rehab team:

  • addresses the individual's needs using a variety of coordinated therapy services
  • designs a plan of care based on physician's orders, therapist's recommendations, and the individual's needs and goals
  • determines an anticipated frequency and duration for services.

The rehab team re-evaluates each outpatient's plan of care at monthly team meetings.

Therapy services are discontinued when individuals meet their personal goals and the goals of the rehab team.

The rehab team works with the individual with spinal cord injury and family members to decide the best follow-up plan and home program to meet continuing, life-long needs.

Admission information

The Spinal Cord System of Care at Sister Kenny Rehabilitation Institute accepts referrals to both the inpatient and outpatient programs from physicians, social workers, nurses, therapists, discharge planners, insurers, case managers, patients and family members.

When a referral is received from an Abbott Northwestern or United Hospital unit, one of the staff pysiatrists will see and assess the patient's ability to participate in everyday activities, identify their rehabilitation needs and determine if appropriate for an inpatient stay.

Inpatient program

Referrals from other local, out of state and greater Minnesota hospitals or facilities are assessed, using the same criteria, by a member of the admitting department's clinical liason team.

If you have questions or wish to make a referral,
please call the Admissions Department at
612-863-4457.

These assessments are done by phone or onsite. If an inpatient stay is recommended, the admission staff will work with the insurance company, referring facility, patient and family to arrange for the admission.

If an inpatient stay is not deemed appropriate, then recommendations are provided by the assessing physician or nurse practitioner.

Outpatient program

Referrals for persons with a spinal cord injury can be made to the Sister Kenny Rehabilitation Associates Clinic and to the outpatient therapy department at Abbott Northwestern: