World Physiotherapy Day 2023: How Rehabilitation Plays A Crucial Role In Spinal Cord Injury Management

Spinal cord injuries often result in partial or complete loss of motor and sensory function below the injury site, which are life-altering, affecting a person's mobility and independence.

The Role Of Rehabilitation In Spinal Cord Injury Management

Source : Getty

(By Dr Chitra Kataria, Chief of Rehabilitation, Indian Spinal Injuries Centre, New Delhi)

The spinal cord is a crucial component of the central nervous system that serves as a bridge between the brain and the rest of the body. It consists of a bundle of nerve fibers encased within the protective vertebrae of the spine. Any damage to this delicate structure can not only lead to severe impairment or loss of function in various parts of the body, but also can restrict or harm sensations, reflexes and result in lack of coordination in movement.

The Challenge:

Traumatic events like vehicle accidents, slips and falls, or sports injuries can cause spinal cord injuries, as can non-traumatic ones like tumors or infections. Spinal cord injuries often result in partial or complete loss of motor and sensory function below the injury site. These injuries are life-altering, affecting a person's mobility, independence, and overall quality of life. Traditional rehabilitation alone may not be sufficient to maximise recovery, making rehabilitation a crucial component of the recovery process.

How Rehabilitation Helps:

Rehabilitation involves a team and patient-centred approach. The overall aim of rehabilitation is to enable the person to return to a productive and satisfying life. Acute medical management of people with SCI focuses on minimising further neurological damage to the spinal cord and optimising recovery. Stability of the spine is clearly a priority. During this stage, rehabilitation is predominantly focused on treating respiratory complications and preventing secondary musculoskeletal problems related to prolonged bed rest. Rehabilitation following SCI commences as soon as the patient is medically stable after injury. This can vary from a few days to many weeks, depending on whether the patient suffered other injuries at the time of the accident or subsequently developed medical or respiratory complications. Rehabilitation phase focuses on goals related to motor tasks such as walking, pushing a wheelchair, transferring and using the upper limbs.

Early Intervention Crucial:

In SCI cases, the importance of early intervention cannot be overstated. Rehabilitation initiates as soon as the patient's condition stabilises. Early mobilisation helps prevent secondary complications such as muscle atrophy, contractures, and pressure sores.

Cutting-Edge Rehabilitation Techniques:

Functional Electrical Stimulation (FES)

FES is another innovative approach that utilises electrical stimulation to facilitate functional movements. It enables individuals with SCI to regain some degree of independence in daily activities, such as standing, walking, or grasping objects. This groundbreaking technology has transformed the lives of many patients.

Locomotor Training

Regaining the ability to walk is a common goal for most individuals following SCI. Locomotor training is to train in walking. The therapy helps to improve and recover walking movement through challenged practice and lower extremity weight bearing after incomplete SCI. The traditional training strategies focuses on weight shift in supported standing using assistive device wherever required on parallel bar and using crutches, walker outside parallel bar. The novel strategies exist to improve this function such as treadmill training with or without body weight support.

Aquatic Therapy

Water-based therapy in specially designed pools can alleviate gravity's impact on weakened muscles and joints. Aquatic therapy helps SCI patients improve mobility, muscle strength, and cardiovascular fitness in a safe and supportive environment.

Virtual Reality

VR based rehabilitation is a novel technology that allows user to interact in three dimension with computer generated setting.  The three core pillars of rehabilitation: repetition, feedback and motivation can easily be gained through use of virtual reality. Various studies have shown improvement in dynamic sitting balance, upper limb function, cognitive function and standing balance using Nintendo WII, Sony PlayStation as an intervention after spinal cord injury.

Upper Extremity Functional Restoration

This program emphasises on restoring movement needed in daily life and can be achieved using the following strategies:

- Nerve- re-education

- Muscle strengthening

- Task specific training

- ADL Training

Mat Activities 

MAT activities should be arranged in a progressive sequence, starting with simpler tasks and gradually advancing to more challenging ones. This ensures that the patient engages in activities that align with their current skill level or are slightly beyond it. Progression through this sequence of MAT activities is instrumental in enhancing strength, expanding the functional range of motion, fostering postural stability, promoting dynamic balance, and aiding in the discovery of the most effective and functional approaches for accomplishing specific tasks.

Transfer Training

Once the patient has attained a satisfactory level of sitting balance, Transfer Training is typically introduced. This skill serves as an essential foundation for numerous other functional activities, including but not limited to tub transfers, ambulation, and driving.

Exercise for Fitness 

A well-designed endurance training and resistance training program has been shown to improve function, strength, endurance, respiratory function, perceived health and quality of life. Common endurance exercise modalities include upper extremity ergometers, wheelchair propulsion, aquatic therapy and circuit resistance training.

Comprehensive Care

Comprehensive Care deals with the psychological and emotional effects of SCI. Patients with SCI frequently struggle with anxiety, sadness, and a sense of loss. Psycho-social rehabilitation offer emotional support, setting achievable rehabilitation goals to restore a sense of purpose, teaches stress-reduction techniques, and employs pain management strategies to alleviate physical discomfort. Rehabilitation, in a way, also encourages social integration by educating patients about their condition, and when necessary, also teaches adaptation and coping strategies, offering positive reinforcement, and providing long-term follow-ups, fostering a comprehensive approach.

Way Forward

Rehabilitation offers new hope and better outcomes for persons dealing with the challenges of SCI, from early intervention to the adoption of cutting-edge technologies like: Virtual Based Rehabilitation, FES, Locomotor training, Aquatic therapy. Rehabilitation programs also emphasis on restoring movement needed in daily life. This can be achieved using Assistive Technology, ADL Training and Wheelchair skills programs. The rehabilitation of people with spinal cord injuries can be revolutionised by incorporating these cutting-edge techniques, giving them a better future with newfound opportunities.

(Disclaimer: The opinions, beliefs, and views expressed by the author on this website are personal and do not reflect the opinions, beliefs, and views of ABP News Network Pvt Ltd.)