Spinal Cord Injury Rehab & Treatment
Spinal cord injury is perhaps one of the most devastating forms of neurological injury that can occur from trauma. Because the spinal cord connects between the brain and the peripheral nerves, damage to the spinal cord can permanently result in paralysis of the body.
This form of paralysis usually occurs in segments in a top to bottom manner, rather than globally. It also usually affects both sides of the body. Paralysis that affects just the trunk and legs is called paraplegia, while paralysis that affects the arms, trunk and legs is called tetraplegia.
Most forms of spinal cord injury require surgery to stabilise the site of injury, as often it is the result of fractures from trauma associated with car accidents, falling from a height and violence. You can also get spinal cord injury from non-traumatic incidents such as canal narrowing or tumours that compress the spinal cord.
Classifying injury is important for predicting functional outcomes
Spinal cord injury is classified by the name of the lowest level that has full normal function. For example, when someone is considered a C5 tetraplegia, it means that the lowest level with full feeling and movement corresponds to the patch of skin and key muscle group associated with that level of nerve supply. In this case it is the bicep muscle and feeling on the outside of the elbow. The American Spinal Injury Association (ASIA) uses a detailed and standardised scale to determine this, and it helps us predict functional outcome.
Not everyone who has a spinal cord injury suffers complete paralysis below their level of injury (ASIA A). Some people have partial paralysis either in the form of preserved sensation or movement in their lower parts of their body. This means that they can be classified as an ASIA B, C or D. ASIA E is used to denote normal.
Sometimes partial paralysis follows a set of patterns, known as a syndrome:
Anterior Cord Syndrome
Anterior cord syndrome means that there has been damage to the front part of the spinal cord, usually disruption in the anterior spinal artery, the main blood supply to the spinal cord. The result of this that the tracts that lie in the front of the spinal cord become injured, resulting in a loss of movement and feeling of temperature and pain. However, the tracts that transmit information about our body position (proprioception) and light touch are preserved.
Central Cord Syndrome
The most common of spinal syndromes, central cord syndrome refers to injury to the inner part of the spinal cord, most frequently as a result of hyperextension injury of the neck especially in older people. The result is such that the arms are disproportionately affected by paralysis, whereas the lower trunk and legs progressively are spared. This is due to the anatomical organisation of the spinal tracts.
Brown Sequard Syndrome
This syndrome related to the loss of movement and sensation on one side of the body, due to the injury affecting one side of the spinal cord. It is almost like getting a stroke on one side of the spinal cord, except that on the other side there is also a loss of pain, crude touch and temperature sensation as well, usually 2-3 levels further down. This is because the tracts that transmit pain, crude touch and temperature cross at the spinal cord level.
Rehabilitation over time
There is an increasing body of scientific evidence looking at improving the rehabilitation of people with spinal cord injury, as there is currently no cure. Presently, rehabilitation is about maximising one’s physical function through regaining as much movement and functional skill as possible, regular exercise, health weight management and strengthening of key muscle groups.
Wheelchair and seating choices are also extremely important in the face of loss of movement and sensation to maintain healthy skin, posture and ability to function.
Because of our experience with the Victorian Spinal Cord Service, Klint therapists are highly skilled in treating spinal cord injury.
We can help in the following areas:
- regaining ability to walk
- assist in acquiring suitable braces and orthotics to enable standing and stepping
- functional electrical stimulation to enhance functional movement
- teaching of transfers, including getting on and off the ground and in difficult places
- optimising respiratory care (breathing)
- advice and prescription of cushions, seating and wheelchairs (manual and power)
- conservative management of shoulder pain
- teaching swimming in tetraplegia and paraplegia
- therapy following nerve or tendon transfers
- setting up of a suitable gym or home exercise program
For more information and helpful advice, contact us today!