Introduction
A spinal cord injury happens when the spinal cord, a group of essential nerves running down a person’s back, gets hurt because of an injury or sickness. This can result in losing feeling, ability to move, and body functions below the area where the injury occurred. Spinal cord injuries can change a person's life in a big way. They cause problems with the body as well as emotional and psychological challenges.
What Is Spinal Cord Injury Rehabilitation?
Spinal cord injury rehabilitation is a joint effort where a team of different healthcare professionals works together to help patients recover. This team includes doctors, physical therapists, occupational therapists, speech-language pathologists, nurses specialized in rehabilitation, psychologists, social workers, and others.
Treating and helping people recover from the trauma caused by SCI is difficult, costly, and tiring. Treating patients with spinal cord injuries is a continuous process that lasts for many years. It begins soon after the injury with immediate medical care and surgeries. Then, there are treatments for problems with sensation, movement, and body functions that persist over time. Finally, ongoing treatment is provided throughout the patient's life, typically at home.
What Is the Acute Care Phase of Spinal Cord Injury Rehab?
This stage happens right after the injury and ensures the person's health is stable. The most important things are medical treatments, operations, and preventing complications.
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This phase begins with the patient's admission to the hospital, focusing on stabilizing their neurological state. Immediate medical interventions and surgical procedures are employed to prevent further damage to the spinal cord and surrounding structures.
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During this period, the primary goal of rehabilitation is to prevent complications that could have long-term effects. Early intervention helps reduce joint contractures, muscle atrophy, and chronic pain.
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Intensive passive range of motion (ROM) exercises are important for patients with complete injuries. These exercises target contractures, muscle wasting, and pain that can arise during acute hospitalization.
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The positioning of joints is a key consideration in preventing complications. Sandbags, pillows, or rigid orthotics protect articulary structures and maintain appropriate joint alignment.
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The most common and significant complication during this phase is joint contractures. These occur when muscles and tendons become tight and inflexible due to immobility. Passive ROM exercises are performed regularly to prevent joint contractures and maintain functional capacity.
What Is the Subacute Rehabilitation Phase for Spinal Cord Injuries?
The subacute rehabilitation phase optimizes mobility, prevents complications, and prepares individuals for greater functional independence. As patients transition from the acute phase to specialized rehabilitation facilities, the focus shifts to regaining basic functions and preventing complications. The intensity of therapy increases, and the goal is to improve mobility and functional independence.
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Passive Range of Motion - Passive ROM exercises continue to be a cornerstone of this phase. These exercises help to maintain and improve joint flexibility, prevent contractures, and ensure optimal muscle function. They are tailored to the patient's level of injury, awareness, and cooperation.
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Shifting from Flaccidity to Spasticity - During the subacute phase, flaccidity (muscle weakness) transitions to spasticity (muscle stiffness). Therapeutic interventions must adapt to this change, utilizing spasticity to aid muscle activation while managing its potential negative effects on mobility and daily activities.
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Upper Extremity Strengthening - For individuals with complete paraplegia, strengthening the upper extremities is important. This strength is needed for tasks like independent bed transfers. Active and resistance exercises are introduced to enhance muscle power, with options like dumbbells or electrical stimulation.
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Pressure Ulcer - Frequent changes in position are emphasized to prevent the development of pressure ulcers. Careful positioning and rotation every 2-3 hours help to alleviate pressure on vulnerable areas like the sacrum, ischium, and trochanter.
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Orthotics and Mobility Devices - Orthotic devices, such as corsets, provide spinal support during the transition from bed to sitting. Mobility devices like wheelchairs, walkers, or crutches are introduced for out-of-bed transfers, and appropriate fitting and usage are needed to ensure safety and comfort.
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Orthostatic Hypotension - Orthostatic hypotension (low blood pressure upon standing) is addressed using tilt tables. Gradual upright positioning helps patients adapt to sitting and standing, preparing them for wheelchair use and transfer activities.
What Is the Chronic Rehabilitation Period of Spinal Cord Injury?
The chronic rehabilitation phase focuses on helping people walk independently and using tools to assist them. It also includes adapting their homes for easier mobility and addressing their emotional well-being. Occupational therapy improves their daily life and helps them reconnect with society.
Ambulation Goals
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The primary objective during chronic rehabilitation is to enable individuals with complete and incomplete paraplegia to achieve independent mobility.
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Levels of Ambulation - The ability to walk or move about is categorized into different levels based on the individual's functional capabilities. These include social ambulation for interactions, domestic ambulation for household tasks, and exercise ambulation for physical activity.
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Ambulation Standards - Social ambulation involves walking unaided or with assistive devices for around 50 meters. Domestic ambulation may range from partial assistance to independent movement within the home environment. Exercise ambulation may require more advanced assistance for activities like walking or transferring.
Assistive Devices
To achieve ambulation goals, various assistive devices play a pivotal role.
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To facilitate walking and mobility, walkers, crutches, and orthoses are essential for individuals with spinal cord injuries.
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Orthoses are beneficial for individuals with adequate pelvic control. Crutches aid those who have the strength to support themselves while walking. These devices provide stability and confidence, allowing for safe and controlled walking.
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In cases of complete injury ranging from C8 to T12, a para walker, also known as a hip guidance orthosis, can be employed.
Technological Advancements
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Advancements in technology have introduced innovative approaches to rehabilitation. Robotic assistance and hybrid devices combine orthotic support with functional electrical stimulation (FES) to enhance ambulation capabilities.
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Robotic-assisted gait training, such as the Locomat system, has shown promise in improving functional outcomes for subacute SCI patients. Robotic devices can help restore upper extremity function and mobility through guided training.
Home Modifications
Adapting to the home environment is needed for individuals with SCI to engage in independent activities of daily living.
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Proper wheelchair access should be ensured. Doorways should be wide enough for manual or battery-assisted wheelchairs.
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Electric switches and kitchen appliances should be positioned at accessible heights for easy use.
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Carpets should be removed to create a smooth surface for wheelchair maneuverability.
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Bathrooms should feature wall-mounted tubs and handles to enhance safety and accessibility.
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Installing ramps at entrances allows for easy access for individuals using wheelchairs or other mobility devices.
Psychological Restoration
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Psychological well-being is a critical aspect of chronic rehabilitation. Depression is common post-SCI, affecting approximately one-third of patients within the first six months.
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Suicide is a significant cause of mortality among SCI patients under 55. Ensuring access to psychiatric care is vital to managing depression and psychotic behavior.
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Occupational therapy plays a pivotal role in restoring psychological and emotional well-being. Engaging in creative activities and social interactions and focusing on personal strengths help individuals regain a sense of purpose and integrate into society.
Conclusion
Through multidisciplinary teamwork, the latest technology, and determination, people with spinal cord injuries can find ways to become more independent, improve their ability to do things, and have a better life. Every time progress is made, each goal is reached, and the strength shown by patients and healthcare workers highlights how rehabilitation can change lives.
