Spinal Cord Injury Rehabilitation: What to Expect

Rehab after a spinal cord injury can be challenging, but you are not alone—several specialists will help reduce your pain and improve your function.

Written by Michael G. Fehlings, MD, PhD, FRCSC, FACS

Rehabilitation after spinal cord injury (SCI) can be a frustrating process—and the severity of your injury may dictate how long the rehab process will be for you. Fortunately, a team of multidisciplinary medical specialists will support you and your recovery. Doctors, nurses, occupational therapists, physical therapists, psychologists, speech therapists, orthotists, and recreational therapists are among the health care professionals who will help reduce your pain and regain function.

SCI rehabilitation is a wide-reaching process. Of course, it includes a physical conditioning program (eg, strengthening muscles and relearning how to do basic tasks). But there’s also a mental and emotional component that helps you come to terms with the extent of your spinal damage, loss of independence, and financial impact.
Physical Therapy’s Role in Spinal Cord Injury Rehab
A physical therapist is a key member of your SCI rehab team. He or she will help you regain function, improve mobility, and prevent complications that may arise years after the initial traumatic injury.

A physical therapy (PT) program after SCI likely includes the following:

While PT can help people move better and easier after SCI, barriers such as ventilator dependence, neuropathic and somatic pain, and psychosocial challenges can prevent PT from making meaningful gains in recovery. If you’re struggling to start or maintain a physical therapy program, talk to your physical therapist or other member of your health care team.

Read more about overarching goals of physical therapy.

Weight-Supported Locomotor Training: Another Tool to Boost Mobility After Spinal Cord Injury
Weight-supported locomotor training (WSLT) may be part of an intensive SCI rehab program, and it has been shown to improve mobility.

WSLT uses both assisted devices and therapists to support your weight while you walk on a treadmill or on the ground. The goal of WSLT is to promote the remaining nerve connectivity between regions above the traumatic injury and the locomotor central pat­tern generator with the spinal cord. The locomotor central pattern generator is a region of neurons that can trigger movement without any sensory input or input from the brain.

In addition to improving assisted mobility, WSLT supports cardiorespiratory health, and may prevent pressure sores and joint-related complications of SCI.

Functional Electrical Stimulation: A Possible Breakthrough for Severe Spinal Cord Injury
Functional electrical stimulation (FES) is an exciting area of SCI rehabilitation that shows great promise, particularly for people who have endured a severe spinal cord injury.

The FES device is basically a stimulator (generator) that connects to electrodes; both are surgically implanted near the spinal cord. FES sends pulses of low-level electricity down the spine that mimic the brain signals that activate muscular movement.

The goal of FES is to activate the nerves that have been damaged by the traumatic injury, which may allow you to regain motor control, walk, move your upper body, and have normal bowel/bladder function.

Additionally, FES can lower your chances of developing systemic complications of chronic SCI, including pressure sores and respiratory problems.

FES is an actively researched field, and advanced stimulators are being created to offer even more promise for this treatment. Read more about how FES has helped people with severe SCI.

Occupational Therapy After Spinal Cord Injury
An occupational therapist addresses the social, emotional, and functional aspects of life after SCI.

An occupational therapist’s goal is to help you gain as much independence as possible after your injury. To that end, occupational therapy focuses on integrating adaptive devices into your daily life to support your independence at home and at work.

The devices your occupational therapist may recommend include wheelchairs, lifts, spinal braces and orthoses, controls for home (for lights, television, or phones), bathroom equipment, and tools to make driving easier.

Healing the Mind and the Spine: Psychological Aspects of Spinal Cord Rehab
Recovering from a significant spine injury is much more than physical: There are major mental and emotional hurdles to clear. In addition to an occupational therapist, you may work with a psychologist and recreational therapist to support your total well-being.

These health care professionals will help you, and your family adjust to the changes that come with living with a SCI. They may use talk therapy, music therapy, and other techniques and activities to help you manage depression and anxiety while building confidence and coping skills.

Spinal Cord Injury Rehabilitation: The Road May Be Long, But You’re Not Alone
After suffering a traumatic spinal cord injury, you may feel like your whole world has been taken from you. Recovering from SCI is not easy: It’s long, challenging, and can wear on even the strongest person. Rely on your health care team: These professionals will give you the best chance of regaining function, enhancing the function you have, and preserving a good quality of life. Also, know that the medical community is continually learning more about how to improve the lives of people affected by SCI. You can read more about the current clinical landscape in Spinal Cord Injury Clinical Trials and Therapies.

Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

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