Camilo Castillo, MD, MBA
SCI Medical Director & Professor, University of Louisville
Abstract
What’s Next for SCI? A Clinician’s Perspective
Spinal cord injury (SCI) care is entering a period of transformation, but clinicians face significant systemic challenges that go beyond medical science. The primary issue is fragmented care delivery. SCI patients often transition from acute hospitalization to inpatient rehabilitation and then outpatient follow-up without a unified plan or access to SCI-trained providers. This lack of continuity increases complications, delays recovery, and places unnecessary burdens on patients and families.
Insurance restrictions compound these problems. Coverage for inpatient rehabilitation is shrinking, with payers pushing for shorter lengths of stay despite evidence that extended rehab improves outcomes. Advanced technologies such as neuromodulation, robotics, and virtual reality remain inaccessible for many patients because insurers classify them as experimental. Furthermore, reimbursement models rarely support interdisciplinary care teams or navigator-led programs, even though these approaches improve coordination and reduce readmissions.
Environmental and policy factors add another layer of complexity. Government initiatives promoting bundled payments and value-based care often fail to account for the high complexity of SCI management. These policies risk incentivizing premature discharge and underfunding long-term rehabilitation. Workforce shortages in rehabilitation nursing and therapy further strain inpatient and outpatient units, limiting capacity for comprehensive care.
Training gaps are also critical. The number of fellowship-trained SCI physicians is declining, and residency programs provide limited exposure to advanced neurorehabilitation techniques. Without targeted investment in education and incentives for specialization, the field risks losing expertise essential for implementing new technologies and care models.
Addressing these challenges requires a coordinated plan: advocate for integrated practice units, expand telehealth and home-based rehab, and engage payers and policymakers to recognize SCI as a high-complexity condition deserving comprehensive coverage. Clinicians must lead this effort to ensure that innovations translate into real-world outcomes, improved independence, reduced complications, and better quality of life for individuals living with SCI and other paralyses.
Bio
Dr. Camilo M. Castillo is a Full Professor of Neurosurgical Surgery at the University of Louisville and Program & Fellowship Director for the Spinal Cord Injury (SCI) Program at UofL Health Frazier Neuroscience and Rehabilitation Centers. He leads an Integrated Practice Unit (IPU) model that uses nurse navigators to optimize care for SCI patients across the acute and long-term phases. A faculty member of the Kentucky Spinal Cord Injury Research Center (KSCIRC), Dr. Castillo is the Principal Investigator for Onward Empower BP, a pioneering study targeting orthostatic hypotension in SCI. He has conducted innovative research on virtual reality for SCI rehabilitation, including collaborations with NASA’s AFTE software. Dr. Castillo founded the Americas Committee at ASIA and currently serves on ASIA’s Board of Directors, promoting global cooperation in SCI care. He has published extensively and presented internationally on SCI outcomes, health equity, and advanced rehabilitation strategies.
