Spinal Cord Injury What is it?
A spinal cord injury (SCI) it defined as damage to the spinal cord caused by an insult resulting in the transient or permanent loss of usual spinal motor, sensory, and autonomic function.
What are the causes of a spinal cord injury?
The more frequent causes are
- Trauma: Falls account for 40% and are most common in the elderly.
- Non-traumatic causes such as degenerative disease, infection, toxins, tumors, cysts, inflammation, disruption of spinal cord blood supply, and congenital abnormalities.
How can physiotherapy help with spinal cord injuries?
The management of people with SCI is therefore complex. Physiotherapists can treat different problems related to this syndrome and these involve many body systems, even though the underlying pathology is neurological.
The acute medical treatment focuses on preventing secondary injury to the spinal cord and optimising recovery. During this stage, is very important to treat respiratory complications and preventing secondary musculoskeletal problems related to prolonged bed rest. The aim of rehabilitation in this period is the prevention of long-term complications. Intensive physiotherapy sessions are completed involving stretch programmes aiming to prevent contractures, muscle atrophy, and pain during the acute period of hospitalisation.
The most common and important complication is the development of joint contractures and stiffness during this period. If the patient is paraplegic or tetraplegic, intensive passive exercises must maintain the lower extremities to be compatible with the level of the injury. These exercises should be done in a flaccid period at least once a day and at least 2-3 times a day in the presence of spasticity.
Consideration of adjuncts to physiotherapy?
The high-profile NASCIS II study recommended the use of steroids demonstrating a small reduction in the level of injury in those treated early with high dose methylprednisolone, and this has recently been ratified in a review.
– Physiotherapy interventions to treat and prevent contractures.
– Passive movements and stretch are used to treat and prevent contractures.
– Physiotherapy interventions to improve the performance of motor tasks
– Motor learning: gait training, eating, washing, dressing.
– Stretching should be done in patients without active wrist extension and fingers that are not fully stretched. Empowering exercises for shoulder rotation are proposed for using crutches, swimming, electric bicycles and walking
End of acute phase
– active and resistance exercises to strengthen the muscles of the upper extremity should be initiated at the earliest possible period. Weight and resistance exercises can be applied with dumbbells in bed depending on the patient’s muscle strength.
– Corsets are used for fixation and supporting the spine while moving on to a sitting position after the end of the bed interval. In the case of thoracic and upper lumbar region fractures are used hyperextension corsets as part of the treatment.
– Walkers, crutches, and orthoses are important to provide chronic stage ambulation. Patients with control of the pelvis can walk with an orthosis or crutches outside the parallel bars. If the muscle strength of quadriceps femoris is normal, patients can walk with elbow crutches and orthosis without needing a wheelchair. In patients with complete injury of C8-T12, ambulation can be achieved by a para walker (hip guidance orthosis), both in the house and outside.
The most important expectations in the chronic phase or phase to return home are ensuring the maximum independence related to the level of the patient’s injury, integration of the patient to society and teaching the importance of the family’s role.