Spinal Cord Injuries and Disorders System of Care

The VA Palo Alto Health Care System Spinal Cord Injury and Disorders (SCI/D) Center opened in 1974 and quickly established a reputation of excellence in clinical care, education of staff, training of future health care professionals, and clinical research. The Center is affiliated with Stanford University School of Medicine and has been a pioneer in providing comprehensive lifelong care for individuals with spinal cord injury.

We serve eligible Active-Duty Members and Veterans with traumatic and non-traumatic spinal cord injuries and disorders (SCI/D) including Multiple Sclerosis.

The SCI/D Center was designed and dedicated specifically to serve the health care needs of people with SCI/D.

Our inpatient unit and outpatient clinics are in Bldg. 7 at the VA Palo Alto Medical Center. Internet access is available throughout the center and the inpatient unit beds have individual TVs and electronic aids for daily living.

The outpatient clinic has 7 rooms including a full urodynamic suite.

Parking, specifically for patients at the SCI/D Center, is located at the front entrance of the SCI/D Center.

An assistive technology lab and driving simulator are in the SCI/D center and a wellness center with accessible exercise equipment, and an accessible aquatic therapy center are available for use by our patients. The center is staffed by interdisciplinary teams of experts who utilize a rehabilitation model of healthcare with a primary care focus. The staff takes pride in providing lifelong, comprehensive, personalized care that extends from the hospital into the home and community.

In addition, we have a strong relationship with the Bay Area and Western Chapter Paralyzed Veterans of America (PVA). This allows us to work collaboratively in effectively caring for our patients.

The VA Palo Alto SCI/D Center serves as a Hub Site for several affiliated VA health care systems (Spoke Sites) that do not have SCI/D Centers.

Coordinated and integrated primary and specialty services are coordinated through the VA Palo Alto Hub to the Spoke sites located in Fresno, CA, Honolulu, HI, Sacramento, CA, San Francisco, CA, and Reno, NV.

Our Interdisciplinary team is dedicated to excellence in providing comprehensive, integrated rehabilitation and state of the art health care and treatment for Veterans with SCI/D.

We promote mobilization, maximal independence, health promotion, prevention of secondary conditions, activity, productivity, attainment of vocational pursuits, and the highest quality of life.

Our program uses the rehabilitation model of health care with an emphasis on patient and family education, self-reliance, independence, and optimism about the future. The unique qualities, determinants of health, needs, and choices of each Veteran and their family are embraced and addressed within a supportive community atmosphere.

Our high-quality staff have achieved high levels of expertise in SCI/D care. We care for Veterans through their entire lives including:
- acute injury and rehabilitation
- ventilatory management and weaning
- return to the community and participation, including help getting back to work
- primary care
- medical and surgical management
- comprehensive wound care
- respite
- support through the journey through peer mentoring programs


We actively participate in clinically relevant research including areas our Veteran patients have identified as important.

The VA Palo Alto SCI/D Center is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).

If you have questions about care at the Palo Alto SCI/D Center or you want to find out about transferring a patient into the Center, please call us at Contact us by phone at (650) 493-5000, ext. 65871.

An interdisciplinary team is important for successful outcomes. At the center of the team and the most important member is you and your family. Working alongside and supporting you will be a team that includes:
Primary care physicians and Nurse Practitioners who will provide ongoing care throughout the rehabilitation process. They will communicate regularly with you, your family, and the rest of the rehabilitation team to ensure that you have the most comprehensive care plan possible. As a result, your care team will grow and or become smaller as you progress through your care plan. Some of your other teammates will include the following:

Rehabilitation Nurses combine traditional patient care skills with expertise in rehabilitation by managing complex medical issues, collaborating with other specialties, providing ongoing patient/caregiver education, setting goals for maximal independence, and establishing plans of care to maintain optimal wellness.

Physical Therapists provide services to help restore your maximum function through increasing mobility and strength and decreasing pain. Treatment may include: muscle re-education, mobility training, gait training; wheelchair skills; therapeutic exercise; pain relief practice; and other appropriate treatment techniques.

Occupational Therapists help you regain the ability to do normal everyday tasks. This may be achieved by restoring old skills or helping you learn new skills, or by helping with a variety of adaptive equipment, wheelchairs including seating options, orthotics, and home modifications.

Recreational Therapists meet with you to assess your skills and abilities while addressing your interests and needs, paying special attention to the different kinds of things you like to do for leisure and productivity activities. Personalized treatment plans are developed to address physical, social, and emotional needs and to help you return to familiar, or develop new, leisure activities while integrating back into the community.

A Social Worker will help you with many aspects of care, such as preparing and implementing your discharge plan, arranging meetings with you and your family, arranging a schedule for family training days and working with other interdisciplinary team members.

A Psychologist trained to assess and treat the many challenges facing spinal cord injured patients and their families. Psychologists provide clinical and counseling services for coping and adjustment problems related to traumatic injury/illness. Psychologists work with you and your family to identify and address specific issues (e.g.: mood/emotions, stress management, body image, quality of life, etc.) that may prevent you and your family from achieving the highest level of functioning after injury.

If you’re a Veteran with a new spinal cord injury or disorder, or an existing spinal cord injury or disorder, the Palo Alto SCI/D Center can provide all your rehabilitation needs.

The SCI/D Center at the VA Palo Alto Health Care System is a CARF accredited rehabilitation center. We provide acute and sub-acute rehabilitation for Veterans and Active-Duty Military with injury or disorders of the spinal cord in many of the western states and Pacific Island territories of the USA.

We promote early mobilization, functional independence, community participation, and prevention of complications. Your acute rehabilitation care will be under the direction of board-certified Spinal Cord Injury Medicine physicians and will include a comprehensive and intensive interdisciplinary team approach incorporating your goals and utilizing the skills of multiple disciplines, e.g., physical therapy, occupational therapy, speech language pathology, rehabilitation nursing, psychology, respiratory therapy, recreation therapy, other medical specialties, etc. This care is coordinated so that a 24/7 therapeutic environment is created and implemented.

The focus of care for the patients admitted for rehabilitation is to facilitate achievement of each patient’s goals of care while maximizing medical, functional, psychological, and social functioning as a result of his/her participation in the program.

Our SCI/D inpatient service provides state-of-the-art services including comprehensive rehabilitation, annual evaluations for health maintenance and prevention of secondary complications, medical care for acute and chronic needs, surgical services, and a comprehensive wound care management program.

A majority of SCI/D related care may be provided on the inpatient unit at the Center. Based on the needs of individual, we also collaborate with subspecialty services including urology, plastic surgery, neurosurgery, general surgery, internal medicine, podiatry, and palliative care, as some examples. If other specialized diagnostic, surgical, medical, or emergent care is needed, this is readily available and accessed onsite in the adjacent buildings on the VA Palo Alto Health Care System campus.

If you live a distance away and want to be accompanied by your family and/or caregivers during your stay here, arrangements can be made to stay at the VA Palo Alto Fisher House

Our SCI/D Outpatient Primary Care Team uses an integrated approach to provide comprehensive, coordinated, and individualized health care. The team focuses on SCI/D issues as well as primary health care throughout the life span. The emphasis is on wellness, prevention of complications, achievement of maximum function, and quality of life. Physical, social, and mental health care is provided by our team that includes SCI/D physicians and nurse practitioners, nurses, social workers, psychologists, physical, occupational and recreational therapists, a pharmacist, and a vocational rehabilitation specialist.

You will be seen by the same team. A team that knows you and your health history. We provide comprehensive annual health care check-ups as well as appointments for follow-up of specific needs. We also provide:
- Education regarding SCI/D and general health care issues
- Medication
- Medical supplies and equipment needs
- Telephone consultation
- Consultation with other providers


Our SCI/D clinics also have specialty clinics to focus on specific areas important to people with an SCI/D. These clinics are conducted in the SCI/D Center outpatient clinic. This provides continuity of care and coordination of care with the specialist and the SCI/D Patient Centered Medical Home Team.

Additional appointments can be scheduled based on the individual's needs and centered around the specialty clinic visit. The specialty clinics consist of:
- Psychology
- Sexuality
- Telehealth
- Upper Extremity/Hand
- Advance Seating Clinic
- Urology and Urodynamics/Procedures Clinic
- Functional Extremity Clinic
- Bowel and Bladder Clinic
- Wound Clinic
- Plastic Surgical Clinic
- Therapy Clinics-Physical Therapy, Occupational Therapy and Recreational Therapy
- Chiropractic and Acupuncture Clinic

Our SCI/D Home Care Program helps with transition from the rehabilitation setting to the home environment while striving to optimize independence for each individual. The SCI/D Home Care team is under the direction of the SCI/D Outpatient Medical Director and consists of a registered nurse, nurse practitioners, an occupational therapist, a social worker and a recreational therapist. The team directs their care toward promotion, maintenance, and restoration of optimal function and independence in the home and community. Individuals who live within 100 miles of the VA Palo Alto Health Care System and are seen regularly at the SCI/D Center may be eligible for services provided by the Home Care Program.

After an initial assessment by Home Care staff, Veterans work closely with the team to identify problems and formulate goals. Visit frequency varies, depending on the nature of the issues addressed. Home Care staff members are available to conduct educational sessions when relevant for the individuals and their caregivers needs. When the goals are achieved or are no longer relevant, individuals will be discharged from the Home Care Program and continue their care through the SCI/D Outpatient Clinic.

Whole Health is VA’s approach to care that supports your health and well-being. Whole Health centers around what matters to you, not what is the matter with you. This means your health team will get to know you as a person, before working with you to develop a personalized health plan based on your values, needs, and goals.

At the VA Palo Alto SCI/D Center, we embrace Whole Heath through your journey. Your Personal Health Plan is built around your immediate and long-term goals from acute rehabilitation to annual wellness checks and through life’s transitions.

Our interprofessional, team-based approach encompasses medical, physical, behavioral, and social drivers that influence individual and community health. We support the Circle of Health including Personal Development through Vocational Rehabilitation, Power of the Mind with Tai Chi and Qi Gong Wellness Education Classes, and Relationships through our Psychology Services.

We include Complementary Medicine including Dry needling, Acupuncture and Chiropractic Clinics. Our Recreation Therapists assist your health and wellbeing through community reintegration. Their support of your goals, involving engagement in meaningful activities, will encompass your surroundings including where you live and work, as well as environments both inside and outside the home, to improve your physical, social, mental health and overall wellbeing.

Learn more about how Whole Health can support your VA care.
- Find a local Whole Health point of contact to learn more about Whole Health where you get your care.
- Learn more about starting your Whole health journey
- Get inspiration from stories of other Veterans.

Referrals are received via consultation with VA or Non-VA facilities and may be refer by fax or phone call to the Admissions Coordinator to discuss. Patients and family may also contact the Admissions Coordinator to inquire about eligibility to the inpatient program. Our team will review and notify you of the decision and recommendations.

Preparing for a visit and what to expect
Patients will be contacted near their date of admission for preadmission screening and review of the process. Special mode transportation may be arranged for patients who qualify. On-site accommodations (Fisher House) to support family and caregivers may be available. Defender’s Lodge may also be available to Veterans and their support members for outpatient appointments. All patients, family, and visitors are required to comply with current VA Palo Alto HCS and SCI/D policies. Children under 18 who are visiting are required to be accompanied by an adult who is not the patient. Instruction regarding visiting will be provided during the preadmission screening.

For questions or to leave a message for a patient, please contact the inpatient unit at (650) 493-5000, ext. 65872

A list of the current medications you take, including vitamins and supplements
A copy of your Advance Directive
Necessary personal equipment, such as:
- Battery chargers, for power wheelchairs, cell phones, electric razors, etc.
- Transfer board, if you use one
- CPAP or BiPAP machine, if you use them
- Adaptive devices that aid in your daily routine, e.g., splints, braces, eating utensils
- Toiletries, e.g., toothbrush, toothpaste, shampoo, lotions, Chapstick, shaving razor
- A two-week supply of urinary catheters, colostomy supplies, etc. in the event the hospital generic supplies, that will be used and may not work as well, until special order items arrive.
- Personal earphones, earplugs

Comfortable clothing, such as sweatpants, shirts, sweater, socks. Washer and dryer are available for your use. *Please be sure to label your laundry/tags with your name.

Please note: There is a 2 bags maximum allowance per veteran. Please pack accordingly.


Please do NOT bring:
- Smoking materials. VA Palo Alto is a Smoke Free facility.
- Valuables (i.e. money, credit cards, etc), alcohol, or other drugs
- Weapons, knives, or firearms
- Medications and supplements-these will be provided during your admission

As an SCI/D Center, we provide annual comprehensive preventative health evaluations. It is strongly recommended that Veterans with SCI/D get their annual evaluations from an SCI/D Center.

Services are provided on an inpatient or outpatient basis depending on your needs.

This yearly evaluation addresses spinal cord injury and disorder issues including, mobility, self-management with daily living activities, bowel and bladder management and wellness health care areas such as cardiovascular, skin, respiratory, and sexual health, as well as other medical, therapy and psychosocial needs.

Equipment needs to improve function are evaluated by physical and occupational therapists.

Activity and participation including community integration are evaluated by recreational therapists.

SCI/D annual evaluations emphasize prevention of complications, early identification of problems, and continuance of optimal health. Both inpatient and outpatient annual evaluations are prescheduled in advance to ensure the check-up is efficient, effective and comprehensive.

Inclusion Criteria
The SCI/D Center provides rehabilitation for eligible persons with SCI/D age 18 and over, when there is a reasonable expectation that rehabilitation will result in increased function, reduced secondary conditions, or improved quality of life for the person served and the family.

Persons eligible for admission to the Spinal Cord Injury/Disorder include:
- Active Military Duty Members
- Service-Connected Veterans
- Non-Service-Connected Veterans

Persons with the following conditions may be served:
- Traumatic spinal cord injuries
- Vascular insults to the spinal cord
- Degenerative spine disease resulting in neurologic deficit
- Cauda equina syndrome producing neurologic deficits
- Inflammatory or infectious diseases of the spine or spinal cord resulting in neurologic deficits
- Demyelinating diseases of the spinal cord
- Intra-spinal neoplasms resulting in neurologic deficits

Exclusion Criteria The following etiologies are not treated in the SCI/D System of Care:
- Intracranial Etiologies. Quadriparesis or other paralytic conditions due to intracranial processes such as traumatic brain injury, brainstem, or cerebrovascular accident.
- Peripheral Neuromuscular Processes. Sensory and motor impairments due to peripheral nerve pathologies such as diabetic neuropathy or other peripheral neuropathies, Guillain-Barre, plexopathies, muscular dystrophies, myasthenia gravis or myopathies.
- No Spinal Cord Involvement. Etiologies and diseases that do not involve the spinal cord.

We offer patient education classes on SCI/D topics. Classes are offered virtually every Thursday from 12 PM to 1 PM or in person in the SCI/D multipurpose room. Topics covered include but are not limited to:

- Autonomic Dysreflexia
- What is an SCI/D
- Bowel Care
- Bladder Management
- Safety in the Home and Community
- Emergency Preparedness
- Medication Management
- Coping after an SCI/D
- Nutrition and Fitness
- Recreation and Sports


If you are interested in participating, please notify the 7F/7H nursing staff at (650) 493-5000, ext 65872 or the telehealth coordinator at extension (650) 493-5000, ext 66304.

We support a broad spectrum of clinical research conducted by investigators both within and outside of the Center, to address significant problems related to SCI/D, in line with our Mission to maximize functional independence, promote health throughout the lifespan and enhance quality of life. Our clinical research program is supported by two dedicated staff, the Director of SCI/D Clinical Research and the SCI/D Research Manager.

The SCI/D clinical research team works closely with clinicians, patients and other stakeholders to identify important topics for exploration that will improve quality of life and translate directly into patient care. Our clinical research portfolio has encompassed studies of musculoskeletal and cardiometabolic health after SCI/D, upper limb function, and community-based recreation and wellness.

Current funded research projects include the following:
- Role of Aberrant Gut Immune Response in Neurogenic Bowel
- Identifying Perspectives and Healthcare Needs of Persons with Spinal Cord Injury Who Identify as Sexual and Gender Minorities
- Clinical Care Needs and Experiences for Patients with Spinal Cord Injury Identifying as LGBT
- Assessing Bone Health after SCI: Establishing Evidence for a Clinical Protocol
- Impact of Mobile Manual Standing Wheelchair on Standing Dosage and Utility


There are numerous opportunities for persons with spinal cord injury and dysfunction, both VA patients and others, to participate in clinical research. Call the SCI/D Research Manager, (650) 493-5000, extension 62286, for more information about the SCI/D clinical research program and for opportunities to participate.

Our Hub and Spokes system provides quality care for approximately 1000 individuals.

87% of our patients return home after initial rehab over the past three years.
98% of patients had a positive Overall Satisfaction with services received over the past 3 years