Physiotherapy Management of Individuals with Spinal Cord Injury

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Introduction

The rehabilitation of patients who had a spinal cord injury depends on the level of the spine injured, and whether it is a complete or an incomplete spinal cord injury. In case of an incomplete spinal cord injury approximatley 25% will not become independent ambulators. Individuals with a spinal cord injury often require extended treatment in specialized spinal unit or an intensive care unit with the rehabilitation process typically starting in the acute care setting. Inpatient management can last from 8 - 24 weeks, with follow up outpatient rehabilitation from 3 - 12 months after that, generally followed by yearly medical and functional reviews. Physiotherapy, occupational therapy, speech and language therapy, rehabilitation nurses, social workers, psychologists and other health and social care professionals work as a team under the coordination of a physiatrist or rehabilitation physician to decide on goals with the patient and develop a plan of discharge that is appropriate for the individuals level of injury and circumstances. The type of therapies differ according to the type of lesion and level of injury.

The management of an individual with spinal cord injury is complex and lifelong requiring a multidisciplinary approach. A functional, goal-oriented, interdisciplinary, rehabilitation programme should enable the individual with a spinal cord injury to live as full and independent a life as possible. In the early post injury phase, physical management will mainly involve prevention and management of respiratory and circulatory complications, care of pressure areas and minimize the impact of immobilization such as contractures.

Objectives

Acute Phase

Treatment objectives in the acute phase include:

• to institute a prophylactic respiratory regimen and treat any complications
• to achieve independent respiratory status where possible
• to maintain full range of movement of all joints within the limitations determined by fracture stability
• to monitor and manage neurological status as appropriate
• to maintain/strengthen all innervated muscle groups and facilitate functional patterns of activity
• to support/educate the patient, carers, family and staff.

Rehabilitation Phase

Treatment objectives of the rehabilitation phase include:

• to establish an interdisciplinary process which is patient-focused, comprehensive and co-ordinated
• physical motor functional activities with early intervention and prophylaxis to prevent further 
complications
• to learn new information to equip the individual 
with knowledge to achieve independence
• to achieve functional independence, whether physical or verbal, and equipment provision in order to 
facilitate this independence
• to achieve and maintain successful reintegration 
into the community.

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