Spinal Cord Injury (SCI)
Physiologist
Why our Neuro Surgeons are Best?
Our Neuro Surgeons excel with over 20 years expertise and vast knowledge in neurosurgery. Renowned for precise diagnoses and innovative treatments, they ensure optimal patient care and outcomes, making them leaders in their field.
Introduction
- Traumatic spinal cord injury
- Ischemic spinal cord injury
- Tumors and metastasis to the spinal cord
- Vascular malformations such as arteriovenous malformation, aneurysm
- Spinal cord infections
- Auto-immune conditions such as multiple sclerosis, transverse myelitis
- Spondylitic myelopathy (degeneration of the vertebral column)
- Toxic/metabolic causes such as sub-acute combined degeneration of the spinal cord, radiation-induced spinal cord damage, chemotherapy-induced spinal cord damage
Common Symptoms
Individuals affected by these conditions often experience
- Weakness and numbness of the arms and/or legs
- Bladder and bowel dysfunction
- Swallowing difficulties
- Breathing difficulties
Treatment Process
The treatment of patients with spinal cord injuries is an ongoing process that starts shortly after the injury with acute care and early surgical interventions. This continues with sensory, motor, and autonomic dysfunction treatment in the chronic phase and finally involves lifelong treatment in the home environment.
Acute and Subacute Rehabilitation
This period begins with hospital admission and stabilization of the patient’s neurological state, lasting for a 6-12 week bed period. The aim of rehabilitation during this period is to prevent long-term complications. Key aspects include:
- Passive Exercises : Intensive exercises to prevent contractures, muscle atrophy, and pain.
- Joint Positioning : Using sandbags, pillows, plaster splints, or rigid orthotics to protect the articulary structure and maintain optimal muscle tone.
- Upper Extremity Strengthening : Empowering exercises for shoulder rotation to prepare for using crutches, swimming, electric bicycles, and walking. Strong upper extremities are crucial for independent transfer from the bed.
- Corsets : Used for spinal support and fixation during the transition to sitting positions. Various types are used based on the injury location.
- Orthostatic Hypotension Management : Using a tilt table to gradually increase upright position tolerance and stimulate blood pressure reflexes.
- Functional Goals : Preparing patients for bed and wheelchair movements, dressing, and transfers. Exercises focus on sitting, balance, and upper extremity strengthening.
Wheelchair and Mobility Aids
Wheelchairs are essential for SCI patients to be mobile and participate in social life. The choice of wheelchair depends on the level of injury
- Battery-assisted Wheelchairs : Suitable for upper segment injuries.
- Manual Wheelchairs : Preferred for lower-level injuries.
Proper dimensions for wheelchairs are crucial for optimal mobility, skin integrity, and maintaining normal anatomical posture.
Functional Ambulation
The potential for functional ambulation depends on whether the injury is complete or incomplete and its level. Key factors affecting ambulation potential include:
- Injury Level : Patients with T11-L2 injuries can ambulate at home, while those with more distal injuries can ambulate socially.
- Assistive Devices : Walkers, crutches, and orthoses aid ambulation.
- Technological Advancements : Devices like RGO (Reciprocating Gait Orthosis) and hybrid walking devices with Functional Electrical Stimulation (FES) enhance walking capabilities. Robotic-assisted gait training shows promise in improving functional outcomes.
Chronic Rehabilitation
The goal during the chronic period is to achieve maximum independence for both complete and incomplete paraplegic patients. This involves:
- Independent Mobilization : Ensuring the patient can walk unaided or with assistive devices.
- Ambulation Goals : Social, domestic, and exercise-oriented ambulation, based on the patient’s injury level, age, weight, general health status, motivation, and spasticity.
- Assistive Devices : Utilizing lightweight and advanced technological devices for walking.
Home Modifications
Modifications to the home environment are essential for SCI patients to achieve independent daily living activities. Key modifications include:
- Door Width : 81.5 cm for manual wheelchairs, 86.5 cm for battery-assisted wheelchairs.
- Electric Switch Height : 91.5 cm.
- Accessibility : Ensuring easy access to door handles, eliminating carpets, and providing hard surfaces for wheelchair maneuverability.
- Bathroom and Kitchen Adaptations : Installing handles in bathtubs and ensuring the height of kitchen apparatuses is accessible.
Psychological and Emotional Support
Restoring the patient’s psychological and emotional state is crucial due to the high incidence of depression in SCI patients. Key aspects include:
- Depression Management : Treating depression and preventing suicide, which is a leading cause of death in SCI patients under 55.
- Occupational Therapy : Helping patients integrate into society and find their role, which is vital for psychological well-being.
- Social and Psychological Support : Addressing social and psychological problems through creative and occupational activities.
Our comprehensive rehabilitation program for spinal cord injury patients aims to restore maximum independence and quality of life. Through a multidisciplinary approach, we address both physical and psychological challenges, ensuring patients can reintegrate into society and lead fulfilling lives.