When treating a person who has a spinal cord injury, the ultimate goal is repairing the damage created by the injury. Treatment should not be limited to one method as greater improvements are achieved with a variety of methods. Furthermore, increasing activity will increase recovery. The rehabilitation process after a spinal cord injury begins in the acute care setting. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals work as a team to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition.
The amount of time a patient is immobilized may depend on the level of the spinal cord injury. Physical therapists work with the patient to prevent any complications that may arise .Other complications that arise from immobilization are muscle atrophy and Osteoporosis, especially to the lower limb, increasing the risk of fractures to the femur and tibia. While passive weight bearing of paralyzed lower extremities appears to be ineffective, stressing the bones through muscular contractions initiated by functional electrical stimulation (FES) have yielded positive results in some cases. Generally, the frequency is effective with three or more weekly exercise sessions. Studies of duration suggest that several months to one or more years of FES are necessary. Improvement of locomotor function is one of the primary goals for people with a spinal cord injury. SCI treatments may focus on specific goals such as to restore walking or locomotion to an optimal level for the individual. The most effective way to restore locomotion is by complete repair, but techniques have not yet been developed for regeneration. Treadmill training, over groundtraining, and functional electrical stimulation can all be used to improve walking or locomotor activity. These activities work if neurons of the central pattern generator (CPG) circuits, which generate rhythmic movements of the body, are still functioning. With inactivity, the neurons of CPG can degenerate. Therefore, the above activities are important for keeping neurons active until appropriate regeneration activities are developed. As a team, health-care professionals help to re-orient the patient, provide support for the patient and family, and begin to develop goals with the patient.
Occupational therapy plays an important role in the management of SCI. Recent studies emphasize the importance of early occupational therapy that is begun immediately after the client is stable. This process includes teaching of coping skills, and physical therapy. In the first step, acute recovery, the focus is on support and prevention. Interventions aim to give the individual a sense of control over a situation in which the patient probably feels little independence. As the patient becomes more stable, they may move to a rehabilitation facility or remain in the acute care setting. The patient begins to take more of an active role in their rehabilitation at this stage and works with the team to develop reasonable functional goals. Though rehabilitation interventions are performed during the acute phase, recent literature suggests that 44% of the total hours spent on rehabilitation during the first year after spinal cord injury, occur after discharge from inpatient rehabilitation. Participants in this study received 56% of their total physical therapy hours and 52% of their total occupational therapy hours after discharge. This suggests that inpatient rehabilitation lengths of stay are reduced and that post-discharge therapy may replace some of the inpatient treatment.
One of the newest physical therapy products to achieve the above goals is the TUTOR system. This set of devices (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) has been developed to achieve renewed mobility to affected limbs which have been disabled due to spinal cord or brain injury, Parkinson’s disease, CP, MS,stroke, head injuries Radial/Ulnar nerve injuries, Brachial Plexus injuries and other upper or lower surgery disabilities. The HANDTUTOR is an ergonomic glove and the ARMTUTOR, LEGTUTOR and 3DTUTOR are comfortable braces that are attached to the specific limb and then connected to customized software where th epatient conducts intensive exercises with exclusively created games. These games are challenging and allow the patient to develop usage of his affected limb. Through the use of telerehabilitation the patient can even accomplish this exercise program at home if he is located too far from a rehabilitation facility. Physical/occupational therapists respond and record the patient’s progress in order to create a customized exercise program appropriate to that particular patient.