Cryotherapy lowers the temperature and promotes healing and recovery by reducing pain and inflammation. FES:
Functional electrical stimulation uses electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, grip, and reach. Respiratory training:
After spinal cord injury respiration is affected. Levels of innervations are:
- C3-5 Diaphragm,
- C3-8 Scalene,
- C5-T1 Pectoralis,
- T1-11 Intercostals and
- T6-12 Abdominals.
Physiotherapy interventions like secretion clearance and increased ventilatory techniques. Secretion clearance techniques include percussions, vibrations, shaking, postural drainage, and suctioning. Increased ventilation techniques include positioning, abdominal binders, deep breathing exercises, incentive spirometry, and inspiratory muscle training. Other types of equipment used are continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP). Range of movement exercises:
Decreased range of motion may lead to contractures due to immobilization, spasticity, increased muscle tone, and poor positioning. Stretching exercises:
The physiotherapist positions the part in the lengthened position and uses passive stretching and other techniques such as compression, sustained deep pressure, and heat. Prevention of Pressure Ulcers:
The occiput, sacrum, scapulas, and heels are areas prone to pressure when lying supine. While the greater trochanter and malleoli are more prone to side-lying.
The physiotherapist gives passive pressure care, such as frequent rolling regimes and mobilizing, and skin moisturizing. Strengthening exercises:
Progressive strengthening exercises or resistance training and functional strength training are given to achieve favorable results in maintaining and strengthening the muscles. 1-3 sets with 8-12 repetitions and 1-3mins of rest between the sets can be done thrice a week. Bed mobility and transfers:
The patient is taught bed mobility like rolling, mobilizing from supine to long-sitting, unsupported sitting, lifting vertically, and transfers. Wheelchair (WC) mobility:
Patients with C1-4 tetraplegia require powered wheelchairs controlled by chin movements, sip, puff, or head array. Patients with C5 tetraplegia most commonly use powered wheelchairs controlled by hand movement.
Most individuals with C6-8 tetraplegia can independently mobilize with manual wheelchairs and might use a hand-controlled wheelchair.
Individuals with SCI lower than C8 will be able to independently mobilise with a manual wheelchair.
Patients are taught turning, opening and closing doors, going around and over obstacles, going up and down inclines, as well as mobilizing indoors and outdoors are important activities to practice to ensure safe and independent mobility. Gait and standing:
Gait training, strengthening, and balance exercises are the most common physiotherapy activities. The ability to stand or walk is dependent on several factors such as spasticity, bone mineral density, orthostatic hypotension, emotional well-being, and bladder and bowel function. Standing can be attained by using assistive devices such as standing frames, tilt tables, and standing wheelchairs. Patients with paraplegia might be able to stand in parallel bars using orthoses or knee-extension splints. Orthoses and walking aids such as knee-ankle-foot and hip-knee-ankle-foot orthoses can be used for the gait training of patients with complete paraplegia to partially paralyzed lower extremities.