Physical therapy for spinal cord injury

Your spinal cord is a bundle of nerves placed behind your vertebral column. It performs the important task of carrying messages between the brain and the rest of the body.

Acute spinal cord injury (SCI) is regarded as one of the most debilitating neurological conditions that can affect the human body. It is caused by a traumatic injury, so severe that it bruises, partially tears, or completely tears the spinal cord.

Exercise is the key to prevent spasticity of muscle resulting from SCI. Passive range-of-motion exercises (PROM) and self range-of-motion exercises (SROM) can help improve muscle flexibility to a great extent.

A physiotherapist or physical therapist will be able to draw up an exercise plan after assessing the type and severity of SCI. The exercise plan must have realistic goals for the patient.

Causes of SCI

SCI is essentially the result of a traumatic injury. Anything that can cause the compression of the spine or neck can be a potential cause of SCI. Some of these include:

• Sports injuries
• Diving accidents
• Trampoline accidents
• Motor vehicle accidents
• Abscess on spinal cord caused by infection
• Acts of violence
• Birth injuries

Christopher Reeve, the actor who is best known for playing the role of Superman, was paralysed due to SCI resulting from a horse-riding accent.

In the book, Me Before You written by Jojo Moyes the protagonist is hit by a car while he is crossing which leads to him being paralysed from the neck down.

Types of SCI

The severity of damage to the spinal cord determines whether the injury is complete or incomplete. The location of the injury also determines how severe the symptoms are.

A complete injury results in absolutely no movement and feeling below the level of the injury.

An incomplete injury will still have some degree of movement and/or feeling below the level of the injury.

Based on the above, there are two medical terms used to describe the condition:

1. Quadriplegia/Tetraplegia: Loss of movement and feeling in arms, legs trunk, pelvic organs
2. Paraplegia: Loss of function and feeling from the waist-down (trunk, legs, and pelvic organs)

Acute phase of SCI

The acute phase of SCI occurs immediately following the injury and is conducted at a hospital that has an appropriate trauma centre. During this phase, the patient is immobilised so as to ensure there is no further damage to the spinal cord, to minimise existing damage, and treat any other injuries that may have been sustained.

Depending on the severity of the trauma and pathophysiological changes, the early acute phase may be from 2 hours to 48 hours after the injury. The subacute phase lasts from 2 days to 2 weeks after the injury. The immediate phase lasts from 2 weeks to 6 months after the injury.

Signs and symptoms of SCI

In case you or a loved one has suffered a traumatic accident or injury, these are some of the signs you need to look for (in order to diagnose or rule out SCI):

• Respiratory issues
• Muscle weakness
• Loss of feeling in arms, legs, or chest
• Loss of voluntary movement of muscles in chest, arms, or legs
• Loss of bowel and/or bladder control and function

Some of the above symptoms may be common to other ailments as well. However, individuals who have recently suffered any kind of trauma or injury need to definitely keep an eye out on these. The time between the injury and treatment plays a critical role in determining the severity and extent of damage (complications).

Adverse signs and red alerts

SCI typically results in long-term effects. Patients and their caregivers need to be on the lookout for these serious warning signs:

• Impaired breathing after the injury
• Chronic headaches
• Incontinence, irregular urination, diarrhoea, constipation
• Increasing pain
• Skin sores, abscess, or infections
• Severe muscle spasms or cramps
• Fever, cough, or other types of infection

Diagnosis and treatment

Acute SCI is a medical emergency and requires a full medical examination, which includes a physical examination and a battery of tests. Some of these tests are:

• CT scan
• MRI
• X-ray
• Blood tests

SCI is also known to cause other neurological issues. This is why any head and/or neck injury needs to be examined by a doctor, especially if the individual has a concussion, has vomited, is delirious, or even loses consciousness.

Treatment for SCI is determined by:

• The patient’s age
• Medical history
• Type of SCI and its severity
• Initial response and treatment offered immediately at the site of the accident

The treatment plan for SCI may include:

• Medicines like corticosteroids – to help reduce the swelling in the spinal cord
• Feeding tube – placed through the nostril or directly through the abdomen into the stomach)
• Bladder catheter
• Ventilator
• Observation and after-care in the ICU
• Exercise – to help with recovery and possibly regain some motor function.

SCI recovery involves long-term hospitalisation and rehabilitation. A team of doctors, nurses, therapists (speech, physical, and occupational), and other specialists work in tandem to manage your pain, better your heart function, monitor bladder and bowel control, and attempt to control muscle spasticity (involuntary shaking).

In many cases, surgery is required to evaluate the degree of injury of the spinal cord, to stabilise the fractured vertebrae, release pressure from the injured area, as well as to address any other injuries that may have occurred at the time or after the accident.

Benefits of physical therapy

Damage to the central nervous system can lead to devastating consequences. However, through physical exercise and rehabilitation, many patients have been able to regain some motor function. They are a little more independent and a lot more confident.

Physiotherapy for spinal cord rehabilitation promotes neuroplasticity. This is an incredible phenomenon which refers to the brain and spinal cord’s ability to recover from injury and regain functions affected by the injury. Repetitive practice of purposeful activities can go a long way in promoting neuroplasticity.

Physical therapy exercises

A physical therapist, occupational therapist, or a rehabilitation nurse will assist you with PROM by helping you move your muscles and joints through their full motion. SROM are exercises that you can do without any support from others. SROM exercises can only be done by patients who have an incomplete injury.

Some examples of PROM are:

• Shoulder abduction
• Shoulder flexion and extension
• Elbow flexion and extension
• Wrist and hand flexion and extension
• Hip and knee flexion
• Hip abduction
• Ankle rotation
• Toe flexion and extension

Some examples of SROM are:

• Neck flexion
• Supine shoulder stretch
• Hip and knee bend
• Seated hamstring stretch
• Ankle and toe stretch
• Seated back stretch
• Lying on stomach

Apart from these, the physical therapist may also advise aerobic exercises, strength-training, exercises, yoga, and gait-training to the exercise regime.

Remember, physical therapy for SCI rehabilitation can be a great way to optimise mobility and improve the patient’s quality of life.

How can one avoid SCI?

Truth be told, there is no way to avoid an SCI. Naturally, we cannot lead a life of measured steps and walking on the line. However, we can definitely be careful, responsible and attentive to our surroundings.

• Do not drink and drive
• When seated in moving vehicle, always wear a seat belt
• Wear a helmet when riding a motorcycle (even if you’re the pillion rider)
• Wear a helmet and other protective gear when participating in any sports, particularly adventure sports
• Be careful at home and try to avoid falls
• Do not keep firearms within reach; unload and lock them away

Living with SCI

An SCI can be physically and emotionally debilitating for the patient. It can also emotionally impact caregivers and family members, especially children and the elderly.

Focusing on your strengths, spending time with family, talking about your injury and its implications, and being a part of the community can go a long way in helping you and those around come to terms with SCI.

The Plexus Regenerative Rehabilitation Program for SCI includes stem cell therapy, stem cell nutritive therapy, and other oral and intravenous medications. Intrinsic to this program is physiotherapy, occupational therapy, speech therapy, acupuncture, therapeutic massages, and more. All of these help the patient adapt and adjust to the changes in their lifestyle owing to the injury.

To know more about this program, and to book an appointment, please call us on:

+91 89048 42087 | 080-2546 0886

080-2547 0886 | 080-2549 0886

A highly regarded neurologist and stem cell specialist, Dr Na’eem Sadiq studied neurology and clinical neurophysiology in London before working with some of England’s and the Middle East’s most prestigious medical institutions. He completed his MBBS