Possibility Of Physiotherapy Intervention For Full Recovery After Spinal Cord Injury

Spinal Cord Injury (SCI) is a devastating condition, not only for the injured person but for their families and loved ones. Injury to the spinal cord causes loss of signals between the brain and the body leading to loss of sensation and motor control below the injured site. It may also be associated with abnormal activities of the spinal cord, above and below the injured site, such as spasticity, neuropathic pain, and autonomic dysreflexia.

Management of spinal cord injuries can be divided into Acute and Rehabilitation stages. The Acute stage requires all life threatening and co-existing injuries be evaluated, managed and stabilized, after which Rehabilitation follows. This involves a team and patient-centered approach. An individualized treatment plan is developed as injury manifestation may occur differently in patients. The typical goals of SCI rehabilitation are to strengthen available muscles under voluntary control, to support and compensate for paresis or paralysis using braces and assistive devices, to teach new movement strategies to accomplish activities of daily living, including dressing, transfers, and bed mobility, to teach new strategies for upright mobility that incorporate braces and assistive devices, and to teach wheelchair mobility skills.

Often times, patients and their families are being told that full recovery is unlikely after a spinal cord injury (SCI) and this is based on the premise that the nervous system is hard-wired and irreparable.This perspective has provided the foundation that has buttressed and guided decision making for rehabilitation after SCI. Clinicians have selected compensation for irremediable sensorimotor deficits using braces, assistive devices, and wheelchairs to achieve upright and seated mobility. The patient learns to compensate, using other abilities to complete a task, or to modify the task or the environment to accomplish the goal. Neuroscientists, however, speculate that the central nervous system, in particular the spinal cord is malleable and can learn after injury by Locomotor Training, a physiologically based therapy which involves intense practice and repetition of the task of walking which capitalizes on the intrinsic mechanisms of the spinal cord to generate rhythmic movements via sensorimotor pathways.

Hugues Barbeau a physiotherapist and neuroscientist proposes development of rehabilitative strategies for locomotive activity after SCI which is based on an understanding of activity-dependent plasticity and of the neurological control of walking. He explores the use of Body Weight Support over a treadmill  for providing the sensory experience of walking in order to generate walking after SCI.

 

FURTHER READING

http://ptjournal.apta.org/content/86/10/1406

Please share your personal encounter in the management of SCI patients.

REFERENCES

Guide to Physical Therapist Practice. 2nd ed. Phys Ther. 2001: 81:9– 746.

Behrman AL, Harkema SJ. Locomotor training after human spinal cord injury: a series of case studies. Pays. Ther. 2000;80(7): 688-700 [PubMed]

Rossignol S, Chau C, Brustein E, et al. Locomotor capacities after complete and partial lesions of the spinal cord. Acta Neurobiol Exp. 1996; 56:449–463

Michael LJ. Eric H et al. Activity-based Therapies in Spinal Cord Injury: clinical focus and empirical evidence in three independent programs. http://www.ncbi.nlm.nih.gov/articles/PMC3584743

Van de Crommert HW, Mulder T, Duysens J. Neural control of locomotion: sensory control of the central pattern generator and its relation to treadmill training. Gait Posture. 1998; 7:251–263.

    Barbeau H. Locomotor training in neurorehabilitation: emerging rehabilitation concepts. Neurorehabil Neural Repair. 2003;17 :3-11.

Dietz V, Duysens J. Significance of load receptor input during locomotion: a review. Gait Posture. 2000; 11:102–110.

Barbeau H, Wainberg M, Finch L. Description and application of a system for locomotor rehabilitation. Med Biol Eng Comput. 1987; 25:341–344.

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