Spinal cord injury

--What happens when your spinal cord is injured?

The spinal cord travels in a canal through the bones of the neck and back. It is a highly complex bundle of nerves connecting the brain with the body. Injuries to the spinal cord result in paralysis (an inability to move muscles) and loss of sensation, as well as disruption to many different bodily systems such as those associated with bladder and bowel function.

No two spinal cord injuries are the same because the effect of a spinal cord injury depends on exactly where and how severely the spinal cord is damaged. A spinal cord injury in the neck results in tetraplegia (or quadriplegia), which affects both arms and both legs. An injury high in the neck is more serious than an injury low in the neck and can seriously limit a person’s ability to breathe and cough. A spinal cord injury in the back results in paraplegia that only affects the legs and torso, but not the arms. Many people with spinal cord injury regain the ability to walk, but if you have a serious injury you may remain wheelchair dependent.

--How do I know if I require physiotherapy or other medical attention?

The signs and symptoms of spinal cord injury include loss of movement and sensation. These typically occur immediately after some type of trauma or injury. A suspected spinal cord injury is a medical emergency and people need to be transferred by ambulance to hospital with great care to minimise any further damage to the spinal cord. Spinal cord injuries are formally diagnosed by doctors using an examination of the nervous system, X-ray and scans.

People with spinal cord injuries often require surgery to stabilise the injury in their neck or back. Depending on the level and extent of paralysis, a long and comprehensive rehabilitation process may be required. Physiotherapy is an important aspect of rehabilitation as it focuses on helping you learn to move again as best as possible.

--What will my life be like after surgery?

Your outcome is largely determined by where and how seriously the spinal cord is damaged. The likelihood of walking again is best predicted by your ability to feel and control bowel motions because this indicates whether nerve messages are travelling from the brain all the way to the very end of the spinal cord. There are other predictors of the likelihood of walking such as strength in some important leg muscles.

Rehabilitation focuses on helping people with spinal cord injuries return to their homes and families, and lead a full and satisfying life regardless of the severity of the injury. Physiotherapy is just one aspect of comprehensive rehabilitation. It specifically focuses on mobility and helping people regain as much mobility and function as possible. This includes helping those with more serious injuries learn to push themselves in a wheelchair, move their paralysed body parts and be independent from a seated position. For those with less severe injuries, physiotherapy focuses on helping people learn to walk again.

--How can physiotherapy help me in my rehabilitation?

Physiotherapy for people with spinal cord injuries is very varied. It primarily focuses on helping you attain optimal mobility but also addresses many other associated issues. Consequently, there are many different treatment options. Below is a summary of some of the most common rehabilitation options, but their appropriateness depends on the type of injury you have sustained and your rehabilitation goals.

Gait (walking) training: This typically involves using a treadmill to walk. If you are unable to do this because of leg weakness, then you can be suspended in a harness over a treadmill. The suspension takes some of the weight off the legs to make it easier to walk. Sometimes therapists help move the legs if you are very weak and in the early stages of rehabilitation. Alternatively, you may be provided with leg splints and practise walking with crutches in the rehabilitation gym.

Wheelchair training: People who are reliant on wheelchairs need to learn an array of skills to enable them to move about in their wheelchairs in the community. Training typically consists of learning to push a wheelchair over different terrains and up and down a step or slope.

Seated mobility training: People who are wheelchair dependent need to learn to transfer in and out of bed and on and off toilets. Physiotherapy typically involves repeated practise of these skills.

Strength training: Weakness is a central feature of spinal cord injury and physiotherapy typically involves strengthening exercises. This can be done using gym equipment or through practising mobility skills.    

Fitness training: Physiotherapy can help you get fit and healthy after your injury by encouraging regular exercise adjusted to your ability. 

People with spinal cord injury can also periodically benefit from short courses of physiotherapy at different stages of their lives. This can be particularly important to help people adapt to their injuries and the effects of ageing.

--How effective is physiotherapy for my recovery and rehabilitation?

Physiotherapy is central to the success of rehabilitation following spinal cord injury. However, there are many different specific approaches and techniques­—some of which are new and without a good evidence base.

We know with certainty that physiotherapy interventions that address fitness, strength and mobility training are effective.

We also know that physiotherapy interventions are effective for helping people regain the ability to walk provided the spinal cord injury is not too serious. We are less certain about the relative merits of different ways to help people regain the ability to walk. There is growing evidence to suggest that walking on treadmills or with expensive robotic devices is no better than more standard physiotherapy that involves the uses of splints and walking aids.

--What can I do at home after a spinal cord injury?

It is important for people with spinal cord injuries to have a comprehensive home exercise program. This is best designed by a physiotherapist with expertise in spinal cord injuries.

Shoulder pain is common after spinal cord injury, particularly those who push themselves in a manual wheelchair and use their arms greatly in daily function. It is important to maintain good posture in the wheelchair, and build muscle strength around the shoulder joints and blades where possible, as this can reduce pain.

--How long until I’ll notice a difference?

Rehabilitation following spinal cord injury is a long and slow process. The rate of improvement is highly dependent on the severity of the injury. It is best for you to discuss expected outcomes through a formal goal-planning process with your physiotherapist before you start an exercise program. However, as a general rule, you should expect to see some benefit from a physiotherapy program in one or two months.

--Where can my family go for support?

There are many organisations within Australia that can support people with spinal cord injuries and their families. Immediately after injury the best source of support will be the specialised spinal injury units located in a few key public hospitals throughout Australia (see the Australian and New Zealand Spinal Cord Society website for these hospitals). There are two consumer organisations that can also provide support: Spinal Cord Injuries Australia and the ParaQuad Association. People can also find information through the Australasian Spinal Cord Injury Network and the International Spinal Cord Society.