Spinal Injury Rehabilitat...

Spinal cord injury (SCI) is a traumatic or non-traumatic event that leads to neural damage that affects motor, sensory, and respiratory function, also bladder, bowel, and sexual function. Neurological interruption also affects the individual's blood pressure, ability to regulate temperature and skin integrity. Rehabilitation is the fundamental process of recovery, physiotherapy is one of the diverse approaches used in rehabilitation to restore or improve patient's capability. Recovering from a spinal cord injury is usually a long and challenging process. The recovery depends on the level of the spinal cord injury and whether it is classed as complete or incomplete.

Complete Spinal Cord Injuries
This type of injury is the most serious and occurs when the spinal cord is injured. This injury eliminates the brain’s ability to send signals below the injury site. An injury at the level of the lumbar spinal cord can lead to paralysis below the waist while preserving the motor functions in the upper body and arms. Complete injury at the level of the cervical spine can lead to a loss of motor function in the lower and upper body.

Incomplete Spinal Cord Injuries
An incomplete spinal injury can occur due to compression or damage to the spinal cord that reduces the brain’s ability to send signals below the injury site. Because of incomplete injuries, the symptoms may vary from person to person. Some sensory and motor functions may be compromised slightly in some patients or nearly eliminated in others.

The main aim of Spinal Injury treatment is:

• To focus on maximizing the recovery of an individual’s motor and sensory function.
• Help prevent secondary health issues and complications related to the individual injury.
• To enhance motor functional activities with early intervention and management to prevent further complications
• To improve an individual’s independence in activities of daily living, such as eating, bathing, grooming, dressing, and mobility.
• To work towards a stage where the individual can live as fully as possible.

The rehabilitation of SCI depends on the level and type of injury to the spinal cord. The patients often require initial treatment in an intensive care unit with the rehabilitation process that starts in the acute phase. Inpatient management can last from 8 - 24 weeks, with follow-up outpatient rehabilitation from 3 - 12 months, usually followed by yearly medical and functional reviews. The physiotherapist follows the five steps to decide on goals with the individual and develop a plan of discharge that is appropriate for the individual’s level of injury.

The five key steps are:

• Assessment of the patient to check his impairments and activity limitations.
• Set goals.
• Identifying the key impairments that limit the achievement of goals.
• Design a physiotherapy treatment plan including pain management, motor skill development, strengthening, joint mobility, cardiovascular fitness, and respiratory functioning.
• Measurement of the outcome of treatments.
• The management can be divided into 3 Phases:

• Acute,
• Sub-acute (Rehabilitation), and
• Chronic (Long Term).

During the acute and subacute phases of treatment, rehabilitation strategies focus more on the prevention of secondary complications, addressing underlying impairments, promoting neuro recovery, and maximizing function. In the chronic phase, assistive or compensatory approaches are often used.

One of the key roles of the physiotherapist is to help someone recover from a spinal cord injury. The benefits of physiotherapy are:
Pain Control: The physiotherapist helps to reduce or eliminate pain after an injury or surgery, also strengthens the surrounding muscles, and improves mobility. Recommends rest that can help provide pain relief, but active rehabilitation is often better.

Movement awareness: Improves the levels of movement and strength as well as overall well-being. Enhances movement awareness by teaching the importance of posture awareness and how to reduce the stress on the back while sitting or standing.

Increase functional Strength: In case of lost sensation and strength in certain parts of the body. A physiotherapist can recommend exercises that can strengthen weak areas.

Balance and coordination: Spinal injuries can sometimes affect balance and coordination but rehabilitation can help to relearn and adjust. Especially for older individuals who may be more prone to fall injuries after an operation, but it’s also important for athletes who want to return to their pre-injury level of fitness.

Cardiovascular Strength: Helps keep the heart healthy by engaging in aerobic exercises that help maintain good circulation and cardiovascular health following an injury to the spine. They might assist with changes to the home or in choosing the appropriate treatment plan to keep the heart healthy by engaging in aerobic exercises that promote better recovery.

Respiratory muscle Strength: Help with trouble breathing that occurs when the damage has been sustained in the cervical and thoracic areas of the spine. The therapist teaches the patient to breathe again and improve respiratory muscle strength.

Improve Mobility: Help is improving mobility by alternative ways to move, by strengthening muscles, or by teaching the patient to operate an assistive device like a wheelchair, walking frame, or crutches. Also helps to prevent the onset of scar tissue that can limit mobility, this helps to increase flexibility in a recovering area.

Physiotherapy is the foundation of spinal cord injury rehabilitation. It focuses on improving mobility through exercises and electrical modalities. A physiotherapist evaluates the functional abilities and creates a personalized exercise regimen designed to maximize the range of motion, improve the movement patterns and strengthen the muscles, by using the following interventions and exercises:

• Thermotherapy.
• TENS.
• Functional Electrical Stimulation (FES).
• Acupuncture.
• Breathing exercises.
• Massage therapy.
• Strengthening exercises.
• Stretching exercises, etc.

Spinal rehabilitation focuses on patients regaining control of their body functions through various exercises, interventions, and adaptive techniques. The patient with the following conditions can benefit from spinal rehabilitation.

• Spinal cord injury, traumatic and non-traumatic.
• Central nervous system or Neuromuscular disorders.
• The disease process of the spinal cord.
• Dual diagnosis of spinal cord and brain injury.
• Post Spinal surgery.