Rehabilitation guide
A spinal cord injury is damage to the signal pathway between the brain and the body; depending on the level of the injury, it affects the legs or all four limbs. Rehabilitation covers not only movement but also the skin, breathing, the bladder and independent living. Regular exercise improves fitness and muscle strength; skin checks and pressure relief are the foundation of preventing pressure sores.
The spinal cord is the bundle of nerves that carries signals between the brain and the body. When it is damaged, sensation, movement and control of the internal organs below the level of injury are impaired. The most common causes are falls and road traffic injuries; tumours, vascular conditions and infections can also cause it.
In an incomplete injury the spinal cord still carries some signals; some sensation and movement remain. In a complete injury no signals pass. If the injury is high up, all four limbs are affected (tetraplegia); if it is lower down, the arms are spared and the lower trunk and legs are affected (paraplegia).
When sensation is reduced, pressure resting on the same spot for a long time goes unnoticed and the skin is damaged. The tailbone, sitting bones, sides of the hips, heels and ankles are most at risk. Prevention rests on three things:
Pushing yourself up on your arms can damage the tendons in the shoulder, so it is recommended only when the other methods cannot be done. If you see an area that has changed colour, keep your weight off it until the colour returns to normal. Have your cushion and seating assessed at least every two years.
The international guideline, based on a review of 211 studies, sets out two levels for adults with spinal cord injury. For fitness and muscle strength: at least 20 minutes of moderate-to-vigorous aerobic exercise twice a week, plus three sets of strengthening for each major functioning muscle group twice a week. For heart and metabolic health: at least 30 minutes of moderate-to-vigorous aerobic exercise three times a week.
An arm ergometer, brisk wheeling, swimming and strengthening with an elastic band are the most accessible options. The guideline is based on adults aged 18–64 whose injury was more than a year ago; those with a recent injury, those over 65 and those with other health conditions are advised to consult their doctor before starting.
At home
The first two are for protecting the skin and are done throughout the day. The others are for balance, shoulder health and breathing. Which movements suit you depends on the level of your injury; decide your programme with your rehabilitation team.
Turn the front castors forwards and lock the brakes. Lean forwards, bringing your chest towards your knees, and hold. To come back up, push from your knees or from the front of the armrest. Do your first attempts in front of a fixed table.
30–90 seconds, every 15–30 minutesLock the brakes and swing away one armrest. Holding the other armrest, lean towards the opposite side until the weight is completely off one buttock. Hold, come back up and repeat to the other side.
30–90 seconds to each side, every 15–30 minutesIf your trunk control allows: place a light object in front of you, a little beyond arm’s length. Lean your trunk forwards from the hips to reach the object, then sit back up. This improves sitting balance and transfer skills.
10 repsTie the elastic band to something solid at chest height and lock the brakes. Keeping your elbows close to your body, pull the band back and draw your shoulder blades together. This balances the shoulders, which always work forwards when pushing the chair.
3 sets, 2 days a weekSit upright. Without lifting your shoulders towards your ears, squeeze your shoulder blades back and together, hold for a few seconds and relax.
10 repsSit comfortably. Take a slow, deep breath in through your nose, hold for a moment, then breathe out for a long time through pursed lips. When the chest and tummy muscles are affected, this helps to ventilate the lungs.
5–10 breaths, several times a dayFor a wheelchair user, the shoulders are the “legs”; do not make light of shoulder pain. If you have pain when transferring or pushing the chair, ask your physiotherapist to assess your technique and your wheelchair set-up.
Video
From the YouTube channel of Shepherd Center, a US hospital specialising in rehabilitation after spinal cord and brain injury.
A video explaining the basics of spinal cord injury.
An exercise video made for people with spinal cord injury.
It depends on whether the injury is complete or incomplete. In an incomplete injury the spinal cord can still carry some signals, so some sensation and movement remain below the level of injury; if little nerve cell loss has occurred, marked recovery is possible. In a complete injury no signals pass. In both cases the aim of rehabilitation is to make the best use of the remaining function, increase independence and prevent complications.
With three habits: check your skin twice a day, in the morning and before bed. In a wheelchair, relieve the pressure every 15–30 minutes for 30–90 seconds. In bed, turn every 2–6 hours, depending on how well your skin tolerates pressure. If you see an area that has changed colour, keep your weight off it until the colour returns to normal.
Yes, and it is recommended. The international guideline, based on 211 studies, recommends at least 20 minutes of moderate-to-vigorous aerobic exercise twice a week for fitness and muscle strength, plus three sets of strengthening for each major functioning muscle group twice a week. If your injury is recent or you are over 65, consult your doctor before starting.
It is an emergency in which blood pressure suddenly rises to a dangerous level, and it can occur in people whose injury is at the sixth thoracic level (T6) or above. A full bladder or bowel is the most common trigger. There is a severe, pounding headache, with sweating and flushing above the level of injury. Sit the person up, loosen tight clothing, and check the catheter and bladder; if it does not settle quickly, call 112.
See a doctor without delay if you have any of the following:
Sources
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