What is Spinal Cord Injury Rehabilitation?
If you or a loved one has suffered a spinal cord injury (SCI) you may have questions about what spinal cord injury rehab is and how it differs from traditional inpatient or outpatient physical therapy. SCI rehab, sometimes called activity based therapy, is specialized physical training that helps individuals build strength and improve their functional fitness after they have completed traditional physical therapy. The goals of this type of rehab vary depending on the individual's lifestyle and the location of their injury. For example, someone with a cervical level SCI is more likely to have difficulty controlling their chest and abdominal muscles. Therefore, seated balance and posture exercises are important in order to build strength and improve their functional ability to sit up with little to no assistance. Someone with a thoracic level SCI is more likely to have voluntary control over their core muscles, but not their hip and leg muscles.
After being discharged from the hospital and from traditional physical therapy, every SCI client that I have had the opportunity to work with still had physical and functional limitations that were difficult address on their own. Some wanted to increase their upper body and core strength in order to transfer in and out of their wheelchairs independently. Some wanted to begin an exercise program to improve their mental health, minimize chronic pain, and reduce the risk of osteoporosis. Because no two injuries are the same, planning exercise programs for SCI rehab requires creativity, consideration of client's desires, and extensive knowledge of the human body. At NeuMotion Rehab (NMR), we consider 4 main elements as we develop each exercise plan: Range of Motion (ROM), Core Strengthening and Engagement, Weight Bearing, & Strength and Conditioning.
Range of Motion
Range of motion refers to a limb or joint's ability to go through it's complete spectrum of movements. Each joint in the human body has different expected ranges in each direction. After a SCI, limitations in ROM are common in both the affected and unaffected body parts. At NMR, we combine active (client led) and passive (trainer led) ROM techniques to increase mobility and reduce unwanted stiffness in the body. Many of our SCI clients also live with increased tone and spasticity which results in involuntary muscle contractions that can be disruptive. Regular stretching and joint mobilization techniques have reduced that spasticity and improve the quality of our client's movements.
Core Strengthening
In SCI rehab, core strengthening is very different than a typical gym regimen of sit ups and crunches. For those who have voluntary control of their abdominal muscles, core exercises are geared toward correcting any imbalances that may be present as a result of compensatory patterns of movement following their injury. For those who cannot voluntarily engage all or portions of their core, exercises that increase their ability to maintain seated posture, sit up, roll over, and change positions in and out of their wheelchairs are important.
Weight Bearing
Individuals who have had an SCI are at higher risk for developing osteoporosis, a condition where bones become weak and brittle. Typically, mechanically loading bones during exercises like standing, kneeling, or walking stimulates the process of bone remodeling which keeps bones strong and healthy. Studies on the effect of weight bearing exercises in SCI rehab are inconsistent. Some studies show that it has little effect while some maintain that it increases bone density. At NMR we incorporate weight bearing exercises in an effort to decrease the risk of osteoporosis and to challenge our client's muscular and nervous systems in ways outside of what they can achieve seated in a wheelchair.
Strength and Conditioning
To meet our client's individual strength and conditioning needs NMR has a variety of adaptive equipment including: hand grip aids that enable anyone to use cable machine and dumbbells, medicine balls with accessible handles, a recumbent bicycle, and a harness system for increased safety while using a treadmill or other cardio equipment. Strength and conditioning exercises help our clients improve their quality of life and ability to complete daily tasks on their own.
SCI rehabilitation is often a long, unpredictable journey without guarantees. The journey, however, is also filled with important milestones and victories. Clients work closely with their therapist or trainer to create and work toward goals that will help them increase their fitness and self esteem. One of the most exciting things about working with SCI clients is seeing them develop and rediscover patterns of movement in ways that they did not know was possible. At NMR we think that life and fitness after a spinal cord injury has the potential to be full, engaging, and worthwhile. Our goal is to partner with our clients and to be a resource to help in any way that we can.
References:
SpinalCord.comTeam. “Spinal Cord Injury: Types of Spinal Cord Injuries.” Spinal Cord Injury | Types of Spinal Cord Injuries | SpinalCord.com, 2 Dec. 2020, https://www.spinalcord.com/types-of-spinal-cord-injuries.
Svircev, Jelena. “SCI Forum Report & Video.” Osteoporosis and Spinal Cord Injury - Northwest Regional Spinal Cord Injury System, 13 Nov. 2012, https://sci.washington.edu/info/forums/reports/osteoporosis.asp.
“Spinal Cord Injury.” Reeve Foundation, https://www.christopherreeve.org/living-with-paralysis/health/causes-of-paralysis/spinal-cord-injury.