Spinal Cord Injury Rehabilitation

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Can You Define Spinal Cord Injury?

  • As a result of traumatic damage that causes a permanent or temporary change in the motor, sensory and autonomic functions of the spinal cord, different clinical conditions may occur in the person depending on the level of the injured spinal cord.
  • As a result of injury to the spinal cord in the cervical region, tetraplegia clinic occurs in the case of loss of muscle strength in all four extremities. .
  • Injury to the spinal cord in the thoracic, lumbar or sacral segments, including the conus medullaris and cauda equina, results in paraplegia.

At What Age Does Spinal Cord Injury Occur Most Frequently And What Are The Most Common Causes?

  • The most common age of injury is 19 years (16-30). It is more common in males (78.2%). The majority of the affected people are single and working. The frequency varies seasonally.
  • The most common causes are falls in the elderly, motor vehicle accidents in women, firearm injuries, diving and motorcycle accidents in men.
  • The causes of spinal cord injury can be divided into two groups as traumatic and non-traumatic. Non-traumatic causes include neoplastic, infectious and inflammatory causes, vascular causes and other causes (nutritional myelopathy, radiation myelopathy).

What Is The Purpose Of Rehabilitation In A Patient With Spinal Cord Injury?

  • The aim of the rehabilitation clinic is to improve physical and functional capacity and prevent complications in individuals with spinal cord injury. For this purpose, an appropriate rehabilitation programme is designed for the patient.
  • The rehabilitation programme planned for the patient is arranged according to the patient’s current functions.
    • In-bed activities are planned for a patient who cannot yet perform out-of-bed activities. Respiratory exercises are performed to improve the patient’s respiratory capacity, range of motion exercises to prevent joint movement limitation, strengthening exercises to maintain muscle strength, correction of the patient’s in-bed posture, in-bed mobility exercises (in-bed turning, gradual standing up, supported and unsupported sitting positions).
    • To maintain range of motion, range of motion exercises should be performed at least two to three times a day for each joint. To prevent flexion contractures of the hip and knee, prone positioning for at least 30 minutes every day is recommended. Since flexion contracture develops frequently in the ankle, it may be necessary to position the feet at a 90-degree angle while lying and sitting, and to use a device for this if necessary.
    • Electrical stimulation, PNF exercises, progressive resistive exercise programme, biofeedback applications can be used for strengthening.
    • In patients who have been in a lying position for a long time, it is recommended to plan to gradually bring them to an upright position using an angle-adjustable tilt table in order to prevent low blood pressure that may develop during the transition to standing and to monitor them closely.
    • In patients who can tolerate standing upright, the patient can be lifted to standing position by using a standing table. The patient can be kept standing on a parallel bar with the use of a posterior shell.
    • In the bed-dependent period, patients should be closely monitored for the development of pressure sores and measures should be taken accordingly. Changing position regularly (every 2 hours when lying down, every half hour when sitting), paying attention to hygiene, careful placement of the areas where pressure sores may develop in the lying position, supporting with pillows, skin control twice a day are some of these measures.
    • In patients who can sit in a wheelchair, transfer activities from bed to wheelchair and from wheelchair to bed are developed. Push-up exercises (lifting oneself with one’s arms), conditioning exercises, turning and crawling exercises are practised. Passive range of motion exercises and stretching exercises are continued for muscles that have not yet developed activity.
    • If the person is now able to stand, exercises on the parallel bar are started. Stabilisation of the trunk and pelvis is important in this case. The patient is first taught weight transfer, balance exercises are practised and improved, and walking training is performed.
    • The aim of the treatment is to walk independently. However, depending on the level of spinal cord injury, whether walking can be achieved or not is reviewed and discussed with the patient and his/her family. The patient and his/her family are guided within this framework.
    • Ambulation in the community, at home or for exercise purposes can be targeted. In community ambulation, the person is independent in transfers, can stand up from a sitting position, can walk at least 50 metres inside or outside the home with or without a device. In home ambulation, the person may need assistance in transfers, they can ambulate independently or with partial assistance in the home. In exercise ambulation, they need serious assistance.
    • Community ambulation can be achieved with the use of a short leg orthosis if the muscle strength of at least one of both hip flexors and knee extensors is sufficient to complete the movement against gravity.
    • Various devices are available to assist ambulation. Such as parallel bar, walker, canedian cane.
    • Wheelchair is an important means of mobility and participation in social life. The wheelchair is prescribed individually. Measurements such as pelvis width, seat length, backrest height, arm support height, seat height should be calculated individually for each patient.

What Are Other Problems That May Occur In People With Spinal Cord Injury?

Precautions should be taken for other system problems that may occur in people with spinal cord injury other than ambulation. Bone resorption, urinary tract infection and kidney stone formation, constipation, pressure sores, limitation of movement in bones, excessive spasm in muscles, respiratory problems, heart and circulatory problems, nutritional problems, chronic pain, neuropathic pain, psychological problems are included in the rehabilitation programme.

Is There A Place For Traditional And Complementary Medicine Practices In Patients With Spinal Cord Injury?

In patients with spinal cord injury, traditional and complementary medicine applications (such as acupuncture, ozone, homeopathy, phytotherapy) can be included in the treatment when appropriate according to the current findings of the person.

Are Stem Cell Applications In Patients With Spinal Cord Injury Routinely Performed Today?

Currently, research on stem cell therapies in the treatment of spinal cord injury is still ongoing, but has not yet entered routine practice. Hopefully, in the near future, it can be included in routine treatment.

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