Rehabilitation and Therapy after Spinal Cord Injuries

Spinal cord injuries are life-altering and permanent, but that doesn’t mean they can’t be improved.

It takes a great degree of determination and stick-to-itiveness to get the spine back to a semblance of normalcy. Really, a whole village of physical therapists, doctors and cheerleaders are necessary to carry your spirits through the valley of rehab to a place where you can get your footing.

The difference between spinal column injuries and spinal cord injuries

After a spinal cord injury, you’d think the main course of action would be not moving, right? 

Wrong! As soon as the injury is stabilized, doctors want you on the road to rehabilitation. The sooner you begin to strengthen muscles and ligaments, the better. However, depending on exactly what you injured and how badly, the type of rehab will vary drastically.

For instance, a spinal column injury is very different from a spinal cord injury. The spinal column is the actual stack of vertebrae in your back that houses the spinal cord, which is a thin bundle of nerves that controls almost every movement of your body.

When the column is injured, that means you actually broke a bone or blew out a disc. This is when you get to say, “I broke my back.”

Injuring your spinal cord, on the other hand, is among the worst injuries a person can sustain.

Like the cream in a Twinkie, the spinal cord is delicate and vulnerable. If the column is compromised, the cord can be damaged, torn or even cut in half. Surgeons can try to fix these grievous wounds, but we only understand nerves to a certain degree and have never been able to replicate their original placement entirely.

This means that the patient can become one of a few things: if injured near the neck (cervical), then he could be entirely paralyzed. If injured near the mid-back (thoracic), he is likely a paraplegic who is having trouble breathing. If injured near the low-back (lumbar), he is probably a paraplegic who can’t control his bowels.

What does rehabilitation mean for a spinal cord injury?

It depends on the area of the spine that was injured.

For instance, if the higher area of the spine was injured (anywhere from C1-C4), the first priority will be controlling swelling and stabilizing the area. Rehabilitation will be focused on compensating for that injury by using other non-paralyzed areas of the body to gain some measure of autonomy, but since those are the most encompassing of spinal injuries, it is likely that rehab will be focused on learning to use mechanized wheelchairs and figuring out assisted devices created to help quadriplegics.

For lower areas of the spine, the prognosis is far brighter.

It also matters if the injury is complete or incomplete, i.e., if there is any feeling beneath the injury itself. If the patient injured the cord at C4 but can move his left foot, it’s an incomplete injury with a good prognosis.

As for other areas of the spine, a thoracic spinal cord injury patient might need to learn how to wean off a breathing apparatus, but she could learn to drive a manually adaptive car.

A lumbar spinal cord injury patient might be a paraplegic, but he can live independently and is able to use a mechanized wheelchair.

There is the acute phase and then rehabilitation follows immediately thereafter. Acute is done while in the hospital or while still being seen by doctors on a consistent basis. The patient is actively treating, wearing braces, taking medication and looking only to stabilize.

Rehab comes afterward, when the patient already has a prognosis and a plan of action. That plan for rehabilitation simply means, “What must we do to get this patient back to as normal a life as possible?”

Step-by-step rehab

Rehabilitation can take any number of forms. The physiotherapist or physical therapist on staff will want to assess how mobile the patient is to start and how much range of motion they have.

These sessions usually last at least three hours a day, because when they aren’t in rehab, they are motionless in bed or in a wheelchair. This leads to muscle atrophy, so the therapists do what they can to prevent that.

The goal is to help the patient become as independent as possible within the new limits of their injuries.

For a cervical injury patient, this might be just learning to manipulate things with their mouth or tongue. For a thoracic patient, this could be learning to dress while sitting down.

In terms of specific rehabilitation, patients will go through a number of different regimens and have a dedicated team for their varied needs:

• Physical therapy: They will focus on lower extremities and mobility. They will also likely use electrostimulation to keep muscles from atrophying and help patients to use assistive devices. They might also provide some variation of Body Weight Supported Locomotor Training, in which the patient is supported by a harness and walks on a treadmill with most of her bodyweight carried by the straps. This improves stability, gait, speed, and decreases reliance on assistive devices. This might also be done in some kind of shallow pool as well.
• Occupational therapy: These therapists focus on upper extremities and the routines of daily living, such as dressing, cleaning, eating and so on.
• Rehabilitation nurses: These angels address bowel and bladder dysfunction, as well as any pressure ulcers or bedsores that occur.
• Psychologists: They deal with the emotional and behavioral fallout from the accident. If there is any cognitive dysfunction, they will identify and address it.
• Speech-language pathologists: Cervical and thoracic patients will need help with communication and swallowing, which these experts can provide.
• Case managers and social workers: These are the touchstones for the rehab team and go between the doctors and the family.

While rehabilitation is very much a team effort, the goal is to help the patient become independent once again. Even if that is on a much smaller scale than the patient is hoping for, the team can help him or her come to terms with what the injury means. Spinal cord injuries are big, life-changing and sometimes world-shattering. A great rehabilitation team can help put those pieces back together.

If you have suffered a spinal cord injury, look through our resources to see if there are groups that can help. Please know that everyone is on your side and that we will do whatever we can to help you feel better.