Physiotherapy Management of Individuals with Spinal Cord Injury: Difference between revisions
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== Introduction == | == Introduction == | ||
The acute management and rehabilitation of spinal cord injury depends on the level and type of injury to the spinal cord. Individuals with a spinal cord injury often require initial treatment in an intensive care unit with the rehabilitation process typically starting in the acute care setting, followed by extended treatment in a specialised Spinal Injury Unit. Inpatient management can last from 8 - 24 weeks, with follow up outpatient rehabilitation from 3 - 12 months, generally followed by yearly medical and functional reviews. <ref name=":0">Lu X, Battistuzzo CR, Zoghi M, Galea MP. Effects of Training on Upper Limb Function after Cervical Spinal Cord Injury: A Systematic Review. Clinical Rehabilitation. 2015 Jan;29(1):3-13.</ref><ref name="Mehrholz et al.">Mehrholz J, Kugler J, Pohl M. Locomotor Training for Walking after Spinal Cord Injury. Cochrane Database of Systematic Reviews. 2012 (11).</ref> | The acute management and rehabilitation of spinal cord injury depends on the level and type of injury to the spinal cord. Individuals with a spinal cord injury often require initial treatment in an intensive care unit with the rehabilitation process typically starting in the acute care setting, followed by extended treatment in a specialised Spinal Injury Unit. Inpatient management can last from 8 - 24 weeks, with follow up outpatient rehabilitation from 3 - 12 months, generally followed by yearly medical and functional reviews. <ref name=":1">Stack E, Stokes M, editors. Physical Management for Neurological Conditions. Elsevier Churchill Livingstone; 2012.</ref><ref name=":0">Lu X, Battistuzzo CR, Zoghi M, Galea MP. Effects of Training on Upper Limb Function after Cervical Spinal Cord Injury: A Systematic Review. Clinical Rehabilitation. 2015 Jan;29(1):3-13.</ref><ref name="Mehrholz et al.">Mehrholz J, Kugler J, Pohl M. Locomotor Training for Walking after Spinal Cord Injury. Cochrane Database of Systematic Reviews. 2012 (11).</ref> | ||
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. 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 individual and develop a plan of discharge that is appropriate for the individuals level of injury and circumstances. <ref name=":0" /><ref name="Mehrholz et al." /> | 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. 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 individual and develop a plan of discharge that is appropriate for the individuals level of injury and circumstances. <ref name=":0" /><ref name="Mehrholz et al." /><ref name=":2">Harvey L. Management of Spinal Cord Injuries: A Guide for Physiotherapists. Elsevier Health Sciences; 2008 Jan 10.</ref> | ||
The management of individuals with a spinal cord injury can be divided into 3 Phases: Acute, Subacute (Rehabilitation), and Chronic (Long Term). During the acute and subacute phases of treatment, rehabilitation strategies focus more on prevention of secondary complications, promoting neurorecovery and maximizing function. In the chronic phase, compensatory or assistive approaches are often used, whereas in the acute and subacute phases, there is a greater emphasis on techniques that address underlying impairments. | The management of individuals with a spinal cord injury can be divided into 3 Phases: Acute, Subacute (Rehabilitation), and Chronic (Long Term). During the acute and subacute phases of treatment, rehabilitation strategies focus more on prevention of secondary complications, promoting neurorecovery and maximizing function. In the chronic phase, compensatory or assistive approaches are often used, whereas in the acute and subacute phases, there is a greater emphasis on techniques that address underlying impairments. <ref name=":1" /><ref name=":2" /> | ||
== Acute Phase == | == Acute Phase == | ||
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=== Objectives === | === Objectives === | ||
<div align="justify"> | <div align="justify"> | ||
Treatment objectives in the acute phase include: | Treatment objectives in the acute phase include: <ref name=":1" /> | ||
* to institute a prophylactic respiratory regimen to manage respiratory conditions and any complications as a result of the spinal crod injury or associated conditions e.g. Decrease incidence
atelectasis and enhance clearance of
secretions
| * to institute a prophylactic respiratory regimen to manage respiratory conditions and any complications as a result of the spinal crod injury or associated conditions e.g. Decrease incidence
atelectasis and enhance clearance of
secretions
| ||
* to achieve independent respiratory status where possible | * to achieve independent respiratory status where possible | ||
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== Rehabilitation Phase == | == Rehabilitation Phase == | ||
<div align="justify"> | The rehabilitation needs of individuals with a spinal cord injured people are best at a specialised Spinal Cord Injury Unit, but often rehabilitation begins in the Acute or Trauma Hospital while the individual is awaiting transfer to a Spinal Injuries Unit. Rehabilitation requires consideration of the whole person, their physical, psychological, vocational and social background. The rehabilitation process is a goal directed, and time limited process aimed at facilitating maximal independenceand optimal reintegration back into the individual’s chosen community role and lifestyle. <ref name=":1" /><ref name=":2" /> | ||
Physiotherapy is a key component during the rehabilitation process following spinal cord injury, and includes a variety of interventions that address multiple domains in the International Classification of Functioning, Disability and Health (ICF) including body function and structure, activity limitation, and participation, with many interventions directed at preventing, rather than treating, impairments, activity limitation and participation restrictions.
Quality of Life including community participation, gainful employment, interpersonal relationships, and leisure activities have become the overriding focus of management. <ref name=":1" /><ref name=":2" /><div align="justify"> | |||
<div align="justify"> | <div align="justify"> | ||
=== Objectives === | === Objectives === | ||
<div align="justify"> | <div align="justify"> | ||
Treatment objectives of the rehabilitation phase include: | Treatment objectives of the rehabilitation phase include: | ||
*to establish an interdisciplinary process which is patient-focused, comprehensive and co-ordinated | * to establish an interdisciplinary process which is patient-focused, comprehensive and co-ordinated | ||
*physical motor functional activities with early intervention and | * to address physical motor functional activities with early intervention and management to prevent further
complications | ||
*to | * to improve an individual’s independence in activities of daily living, such as bathing, eating, dressing, grooming, and wheelchair use; | ||
*to achieve functional independence, whether physical or verbal, and equipment provision in order to
facilitate this 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. | * to achieve and maintain successful reintegration
into the community. | ||
== Long Term Phase == | == Long Term Phase == | ||
=== Objectives === | === Objectives === | ||
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Introduction[edit | edit source]
The acute management and rehabilitation of spinal cord injury depends on the level and type of injury to the spinal cord. Individuals with a spinal cord injury often require initial treatment in an intensive care unit with the rehabilitation process typically starting in the acute care setting, followed by extended treatment in a specialised Spinal Injury Unit. Inpatient management can last from 8 - 24 weeks, with follow up outpatient rehabilitation from 3 - 12 months, generally followed by yearly medical and functional reviews. [1][2][3]
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. 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 individual and develop a plan of discharge that is appropriate for the individuals level of injury and circumstances. [2][3][4]
The management of individuals with a spinal cord injury can be divided into 3 Phases: Acute, Subacute (Rehabilitation), and Chronic (Long Term). During the acute and subacute phases of treatment, rehabilitation strategies focus more on prevention of secondary complications, promoting neurorecovery and maximizing function. In the chronic phase, compensatory or assistive approaches are often used, whereas in the acute and subacute phases, there is a greater emphasis on techniques that address underlying impairments. [1][4]
Acute Phase[edit | edit source]
The prevention of complications arising from spinal instability or neurological compromise involves all members of the multi-disciplinary team.In this early phase post injury, physiotherapy management is predominantly involved in the prevention and management of respiratory and circulatory complications, and in minimising the impact of immobilization on the individual e.g. pressure area development and contracture development. [2][3]
Objectives[edit | edit source]
Treatment objectives in the acute phase include: [1]
- to institute a prophylactic respiratory regimen to manage respiratory conditions and any complications as a result of the spinal crod injury or associated conditions e.g. Decrease incidence atelectasis and enhance clearance of secretions
- to achieve independent respiratory status where possible
- to maintain full range of movement of all joints within the limitations determined by the stability of the fracture
- to monitor and manage neurological status
- to maintain and strengthen all innervated muscle groups
- to facilitate functional patterns of activity
- to support and educate the patient, carer’s, family and staff
Rehabilitation Phase[edit | edit source]
The rehabilitation needs of individuals with a spinal cord injured people are best at a specialised Spinal Cord Injury Unit, but often rehabilitation begins in the Acute or Trauma Hospital while the individual is awaiting transfer to a Spinal Injuries Unit. Rehabilitation requires consideration of the whole person, their physical, psychological, vocational and social background. The rehabilitation process is a goal directed, and time limited process aimed at facilitating maximal independenceand optimal reintegration back into the individual’s chosen community role and lifestyle. [1][4]
Physiotherapy is a key component during the rehabilitation process following spinal cord injury, and includes a variety of interventions that address multiple domains in the International Classification of Functioning, Disability and Health (ICF) including body function and structure, activity limitation, and participation, with many interventions directed at preventing, rather than treating, impairments, activity limitation and participation restrictions. Quality of Life including community participation, gainful employment, interpersonal relationships, and leisure activities have become the overriding focus of management. [1][4]Objectives[edit | edit source]
Treatment objectives of the rehabilitation phase include:
- to establish an interdisciplinary process which is patient-focused, comprehensive and co-ordinated
- to address physical 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 bathing, eating, dressing, grooming, and wheelchair use;
- 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.
Long Term Phase[edit | edit source]
Objectives[edit | edit source]
Resources[edit | edit source]
Add text here...
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Stack E, Stokes M, editors. Physical Management for Neurological Conditions. Elsevier Churchill Livingstone; 2012.
- ↑ 2.0 2.1 2.2 Lu X, Battistuzzo CR, Zoghi M, Galea MP. Effects of Training on Upper Limb Function after Cervical Spinal Cord Injury: A Systematic Review. Clinical Rehabilitation. 2015 Jan;29(1):3-13.
- ↑ 3.0 3.1 3.2 Mehrholz J, Kugler J, Pohl M. Locomotor Training for Walking after Spinal Cord Injury. Cochrane Database of Systematic Reviews. 2012 (11).
- ↑ 4.0 4.1 4.2 4.3 Harvey L. Management of Spinal Cord Injuries: A Guide for Physiotherapists. Elsevier Health Sciences; 2008 Jan 10.
