Types Of Therapies For Spinal Cord Injury Rehabilitation: Objectives

Spinal Cord Injuries (SCI) can be caused by a stressful or non-traumatic event that damages nerve cells and affects motor, sensory, respiratory, bowel, and sexual function. The disruption to the nervous system also affects the person’s blood pressure, the health of their skin, and their ability to control their temperature.

Spinal cord injury not only affects the physical and mental health of the person who has it, but it also has a big effect on families, communities, and health care systems all over the world.

Concepts that are important for physiotherapy

It’s important for all physiotherapists to understand the following ideas and how they fit into the process of management.

  1. Vertebral Injuries (acute phase, which affects how much treatment is needed)
  2. Spinal Shock (reflexes are gone for three days to three months)
  3. Autonomic dysreflexia (SCI above T6) causes the sympathetic nervous system to work harder.
  4. Orthostatic Hypotension is low blood pressure, which can cause dizziness when moving from lying down to getting up.
  5. Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) (Know the signs and symptoms of these diseases to make sure therapy is safe)
  6. Bladder- & Bowel Dysfunction
  7. Pressure ulcers (a part of healing is preventing them)
  8. Heterotopic ossification is the hardening of soft tissue, which can cause contractures.
  9. Psychological and emotional distress 

Physiotherapy Treatments for a Spinal Cord Injury

Physical exercise that has been used for a long time.

A lot of hands-on therapy, exercises, and stretching moves are used in this type of traditional treatment to help people move. The goal is to help a patient deal with pain, improve circulation, prevent or lessen muscle atrophy, contractures, and weakness, and improve their general health and wellness. This is done by helping you retrain your brain and body to try to get back some or all of the movement you’ve lost.

There are many different ways to help people with physiotherapy, such as:

  • Stretching the muscles
  • Massage therapy, 
  • Moving the joints, 
  • Acupuncture, and neurodynamic movements

Therapy based on activities

Activity-based therapy (ABT), also called activity-based restorative therapy (ABRT), is a type of therapeutic exercise that helps people with neurological conditions, spinal cord injuries, and other traumatic injuries get better and get back to their normal lives. It uses a lot of repeated muscle movements to improve neuroplasticity, strength training, and gait training.

Functional Electrical Stimulation

Functional electrical stimulation (FES) is a type of treatment that uses electrodes to send short electrical shocks to weak or paralysed muscles to help them work better or get back to normal. Even though this type of treatment isn’t used as often as it could be, some providers use it to help with movements that improve heart and lung function, bladder and bowel function, and mobility.

Acupuncture, and neurodynamic movements

The neural system is mobilised during neurodynamic manual therapy, a method of physically treating pain. The method of treatment depends on altering the tension and gliding in the neural system as well as between the nerves and other soft tissues. Numerous mechanical and physiological reactions in neural tissues are triggered by this neurodynamic mobilisation. such as alterations in intraneural microcirculation, axonal transport, and nervous impulse movements, as well as neural sliding, pressurisation, elongation, and tension.

Role of physiotherapy in Spinal Cord injury.

The role of physiotherapy in (SCI) is crucial for the rehabilitation and recovery of individuals with  this Condition

PT aims to maximise functional independence, Improve Quality of life (QOL), and promote overall well- being in  Individuals with SCI.

The crucial areas of treatment that are mainly prioritised by PT in the course of Rehabilitation are.

1.Initial assessment and management

PT plays  a vital role in the early stages of SCI by  assessing the individual’s physical ability abilities, Functional Limitations, and specific Impairments or motor  and sensory losses and plans for treatment to gain better prognosis of the Individual with  SCI.

2.Mobility and Gait training.

PT works with Individuals with SCI to improve their mobility and ability to walk, if possible.

PT, design customised exercise programs that Include strengthening , Stretching and balance exercises to enhance muscle strength and Coordination. 

Assistive devices such as Walkers, Crutches, or wheelchairs , may also be prescribed to aid mobility.

Many Customised orthotics and prosthetics  are  also advised to patients with SCI according to their neurological deficit requirements.

3.Spasticity management

As it is a common Complication after SCI, characterised by Involuntary muscle Contractions and stiffness.

PT approaches such cases with Stretching(static  and Ballistic), Stretching exercises,ROM exercises (PROM AAROM AROM) and various positioning Strategies to manage Spasticity and improve flexibility .

4.Respiratory Care

SCI Can affect respiratory function, leading to breathing difficulties.

PT helps patients with SCI, who have respiratory distress with respiratory exercises to improve Lung capacity, coughing techniques to clear secretions and breathing exercises to enhance respiratory efficiency.

Patients are trained by PT on the use of various respiratory aids  as ventilators and breathing aids.

5.Pressure sore prevention.

SCI patients are highly prone to the risk of developing Pressure Sores due to reduced mobility and sensation. 

PT  Strictly advises Nurses and other patient care attendants on proper positioning techniques, regular shifting of body weights, and the use of air balloons, air beds, water beds, etc to prevent pressure sores .

PT also teaches patient care attenders about Skin care, wound management, and the importance of maintaining good nutrition.

6.Functional training and ADLs.

PTS work with individuals with SCI to regain independence in performing daily activities such as and eating ,dressing, bathing , toileting.

PTs focus on developing Strength, Coordination and adaptive techniques to overcome physical limitations  and improve functional abilities. 

7. Pain Management

CPS (Chronic Pain Syndrome) is  a common issue  among individuals with SCI.

 PT employs various pain relieving approaches like Manual therapy, heat and cold therapy, electrical stimulation, and therapeutic exercises to alleviate pain systems and improve  (QOL).

8.Education and Psychological support.  

PTs educate patients regarding self -care techniques, adaptive equipment use and strategies for encouraging daily changes.

Overall ,PTs play a multidimensional role in management of SCI rehabilitation ,to enhance the overall well-being and functional independence of individuals with SCI.

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