title: A view of the future Model Spinal Cord Injury System through the prism of past achievements and current challenges.
abstract: OBJECTIVE
  To examine the contributions of the Model Spinal Cord Injury System (MSCIS) program to the evaluation and care of individuals with spinal cord injury (SCI) and to acknowledge today's challenges to chart the future course of the MSCIS.
  
  
  METHODS
  Retrospective review of the literature and prospective development of consensus by task force members and consultants. Integration of recent reported findings from panel presentations and publications regarding the MSCIS 2000 through 2005.
  
  
  RESULTS
  Significant strides have been made toward the improvement of care for individuals with SCI, which can be attributed to the quality of clinical investigation and education. This has been achieved through the leadership of MSCIS directors in partnership with members from national and international voluntary organizations. These efforts include more than 2,000 peer-reviewed publications from the MSCIS, which have served as a basis for practice guidelines in the field. Although much has been accomplished with regard to reducing medical and behavioral complications, mortality, and length of stay in the hospital and increasing successful return to the community, more is needed.
  
  
  CONCLUSIONS
  The MSCIS has a unique opportunity to provide solutions because of its world-renowned database and center, outcome measures, and infrastructure for trials. To maximize this opportunity, the MSCIS must continue to address the appropriate investigational and service issues by defining the best approach to data collection, rigorous clinical studies, and behavioral strategies in the next decade.
authors.affiliation: Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. John.Ditunno@mail.tju.edu
authors.forename: John F
authors.initials: JF
authors.lastname: Ditunno
authors.forename: David F
authors.initials: DF
authors.lastname: Apple
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Burns
authors.forename: William H
authors.initials: WH
authors.lastname: Donovan
authors.forename: Kristofer J
authors.initials: KJ
authors.lastname: Hagglund
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Lammertse
authors.forename: Kristjan J
authors.initials: KJ
authors.lastname: Ragnarsson
authors.forename: Robert L
authors.initials: RL
authors.lastname: Waters
authors.forename: Denise G
authors.initials: DG
authors.lastname: Tate
authors.forename: David S
authors.initials: DS
authors.lastname: Tulsky
mesh_terms: D003695:Delivery of Health Care / Q000639:trends*; D006801:Humans; D008959:Models, Neurological; D010818:Practice Patterns, Physicians' / Q000639:trends; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000628:therapy*