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The Rehabilitation Stage: begins as soon as the SCI survivor is medically stable and cleared for therapy
The world of spinal cord injury rehabilitation and recovery is evolving. Traditionally, someone diagnosed with a SCI was basically considered a lost cause and sent to rehab to learn how to live life from the wheelchair. Now, the medical field is slowly realizing more must be done to achieve maximum recovery potential and maintain a healthy lifestyle post-injury.
Traditional rehabilitation is still an important tool to re-learn daily living skills such as eating, dressing and personal care and to receive education about proper wheelchair use, how to safely transfer and to strengthen functioning muscles.
For the survivors who decide they want more, there are now specialized SCI recovery centers across the country that use activity-based therapy in combination with load bearing exercise and functional electrical stimulation (FES) to achieve goals that were once unthinkable. While no center promises a client will definitely walk again, they do give hope and the opportunity to fight for more recovery, greater independence and an increased quality of life.
For more information on the benefits of this type of therapy,
please visit www.coreflorida.com.
For most families, the rehabilitation process is a mystery. However, a physiatrist led team approach is the most effective. At the very least, three hours per day should include some of the following:
Physical Therapy (PT): Physical therapy includes exercise programs geared toward muscle strengthening and endurance, maintaining range of motion, improving coordination and regaining as much mobility as possible, often with the use of assistive devices.
Occupational Therapy (OT): Occupational therapy helps redevelop fine motor skills. Patients also learn techniques for dressing, bathing, self-grooming, preparing food, etc. Families are often taught strategies for safe and effective caregiving.
Recreational Therapy (RT): Recreational therapy encourages patients to build on their abilities so that they can participate in recreational or athletic activities at their level of mobility. Engaging in recreational outlets and athletics helps those with spinal cord injuries achieve a more balanced and normal lifestyle and also provides opportunities for socialization and self-expression.
Respiratory Therapy: For quadriplegics and possibly even higher thoracic injuries respiratory therapy may be needed to teach ventilator care, if needed; breathing treatments and exercises to promote lung function.
Aquatic Therapy: Defined as the use of water and specifically designed activity by qualified personnel to aid in the restoration, extension, maintenance and quality of function for persons with acute, transient, or chronic disabilities, syndromes or diseases. Aquatic therapy may focus on skills including pool entry and exit and swimming skill development.
Vocational Rehabilitation: Vocational rehabilitation begins with an assessment of basic work skills, current dexterity, and physical and cognitive capabilities to determine the likelihood for employment. A vocational rehabilitation specialist then identifies potential work places, determines the type of assistive equipment that will be needed and helps arrange for a user-friendly workplace. For those whose disabilities prevent them from returning to the workplace, therapists focus on encouraging productivity through participation in activities that provide a sense of satisfaction and self-esteem. This could include educational classes, hobbies, memberships in special interest groups and participation in family and community events.
The idea that SCI rehabilitation is only taking place while in a rehabilitation facility is inaccurate. While the first six months to two years is the window of recovery that the medical world tends to give, more and more research is showing that recovery is an ongoing process where SCI survivors have made huge strides five, seven or even ten years post injury! Christopher Reeve’s recovery, which was heavily followed and documented, allowed him to voluntarily move an index five years after his horse riding accident that left him a quadriplegic.
Many people opt to go home and begin some form of outpatient rehab, but like Christopher Reeve, many are taking a more aggressive approach and finding specialized spinal cord injury programs that incorporate FES, load-bearing exercise and gait training. It is important to take care of the overall body, not just the parts with mobility, to ensure physical and mental health, prevent complications and optimize recovery.
Continuing an exercise program once at home is an integral part of living with a SCI, just as it is for those without a SCI.
Please visit www.coreflorida.com for more information on exercise recovery programs for SCI.
Defining the difference between what is a muscle spasm and what is actual controlled movement is important. Toes can twitch and move because of stimuli or because of small muscle spasms, but if an injured person can control the movement and do it on command consistently this is different than a spasm. The ability to control something at such a fine motor level is a positive sign.
Quote from trainers at Project Walk in regards to a quadriplegic client named Natalie who started out wiggling a toe and is now taking steps:
"In our experiences, the ability to wiggle a toe changes everything. Those who have participated in our program and were able to wiggle a toe all improved enough to take steps and most have gone on to functional walking."
Functional Electrical Stimulation (FES) emits small electrical pulses to peripheral nerves that connect the spinal cord to muscles. This is how FES enables muscles to perform even though there is limited or no voluntary control of the muscles. Research has shown FES provides real aerobic exercise in people who otherwise can't move on their own; it boosts heart and lung function, improves strength and circulation and builds muscle mass, even in people with high quadriplegia. Studies also indicate it reduces the frequency of pressure sores.
Commercially FES is available in the form of a stationary bicycle designed to induce patterned movement of the legs or the arms. In addition to the bicycle, a device called Parastep is FDA approved for some paraplegics (T4 to T12 ) for "ambulation." Parastep, which has been approved by Medicare for reimbursement, facilitates gait by firing leg muscles; a front-wheeled walker fitted with a control pad is used.
A doctor’s prescription is required to begin a FES program and it is important to note there are some risks associated with FES. Fracture of leg bones is possible due to loss of bone mineral density. Also, FES can trigger autonomic dysreflexia in upper-level injuries. People with severe spasticity, contractures, or osteoporosis are typically not good candidates.
The answer to this question varies because every spinal cord injury is different, therefore so are the accessibility needs. In a world that is often not designed with the wheelchair user in mind, it is important to try and make the survivor’s home comfortable while also promoting as much independence as possible. Not all modifications have to be extensive and expensive.
For example, an appropriately built ramp or well placed grab bar can make the biggest difference in the safety and sense of independence for a wheelchair user. Also, before spending a lot of money on modifications, remember function can continue to return and what someone requires in rehab may not be what they end up needing a year or two post-injury. The basics, like ramps and an accessible bathroom, usually top the list of immediate needs after discharge from rehab.
Just like cars, wheelchairs come in a variety of makes and models. There are a lot of options to consider from the basics like manual chair or power chair to the meticulous like back angles and degrees of dump needed. Ordering a wheelchair for the first time can be confusing and it is strongly recommended novices use the expertise of the occupational therapist or seating specialist at the rehab center prior to discharge.
When going through the ordering process, it is important to remember recovery is ongoing and the needs of the survivor are changing. Picking a wheelchair that is easily adaptable may be a wise choice because as the SCI survivor gets stronger and becomes more acclimated to the wheelchair they may not want a tall back or seatbelt and chest strap. A chair with options for adaption will last longer and avoid unnecessary expense.
The thought of going home is what gets most people through the vigorous therapy sessions during rehabilitation, but when the time comes it can be scary for a number of reasons. Losing the security of round the clock medical supervision, ease of accessibility and the constant support of fellow survivors is daunting. But, YOU CAN DO IT!
Many rehabilitation centers recognize this fear and operate programs to help patients and families with the transition between the rehab center and home. These programs often allow a caregiver and patient to stay close to the rehab center in a home-like setting. The caregiver and patient go through a daily routine of getting up, getting dressed and completing normal tasks to simulate what it will be like at home, all with the comfort of knowing medical support is a phone call away should any problems arise. This trial run is aimed at reducing the anxiety of both the SCI survivor and caregivers.
Life has been on ‘pause’ and this is the time to push ‘play’ and utilize all you’ve learned in rehab to achieve the goals you have for your life.