What to Expect With Spinal Cord Injuries and How Physiotherapy Can Help

Accidents happen all the time and the severity of them depends on the situation and the people involved. An uncommon injury that can occur after an accident is a spinal cord injury. There are between 250,000 and 500,000 that happen worldwide each year. The main cause of spinal cord injuries that make up 37% of all cases are motor vehicle accidents. Falls make up 31%, violence related to a gun or knife is around 15%, sports injuries 8% and the last 9% is health-related such as a tumour. Many tests such as CT, MRI, physical exam and neurological exams are needed to diagnose a spinal cord injury. The process is usually done in a hospital setting where the tests can be analyzed and the patient can be assessed by health care professionals. Rehabilitation will be needed if the injury is defined as a spinal cord injury. At the hospital, there will be professionals ready to care for you and give you the recommended medication. Having professionals to assist you during the healing process from the initial incident is vital so no further injuries occur.

Figure 1. Spinal cord injuries are life-changing events. They reduce overall mobility and will need you to have assisted devices such as a wheelchair.

The hospital will notify you if you have a spinal cord injury. If this is the case, then there will be inpatient management that can last 8-24 weeks depending on the severity. This usually occurs in the ICU of the hospital so they can focus on the injury and monitor the patient closely. Once the patient is discharged, the next steps are taken. Figure 1 shows an example of how life can be altered by a spinal cord injury. Doctors might prescribe or recommend assisted devices during their stay at the hospital or upon leaving. An example would be a wheelchair or a parking disability permit. Rehabilitation will generally take 3-12 months, which is then followed by yearly medical and functional reviews. There are 3 phases to the injury; which are acute (hospital), sub-acute (rehabilitation) and chronic (long-term). The acute phase of an injury is often the most painful and confusing, requiring a variety of tests to be run. Sub-acute is the process of rehabilitation and the assistance of professionals to help with the prevention of further injuries and promoting neuro recovery, addressing any underlying impairments, and maximizing function as soon as possible. The second phase will require a multidisciplinary team such as surgeons, physiotherapists, occupational therapists, personal support workers, and others depending on the injury scale. The chronic stage will be able to display the maximum movement and mobility that will be achieved and how to manage life after the injury. It would be beneficial to keep in contact with the team to assist with life as you age and the body changes.

Figure 2. With the proper tools and assistance, life in a wheelchair can be managed. It takes a team to help guide the process of changing your lifestyle. A good support team will be of value during this time.

Spinal cord injuries are life-changing for the person who experiences them, but also for those around them. Seeking professional help is needed to guide the patient in the right direction. Support from close family and friends with advice from healthcare professionals is the best way to get positive results. Figure 2, displays how vehicle alterations can be done to assist with entering and exiting a vehicle. The sooner professional help is sought out, the easier it will be to create a plan on how to execute future endeavours safely. Different types of spinal cord injuries can occur after an accident. Each will have a different treatment plan to follow depending on the severity of the injury. Physiotherapy is a main contributor to the healing process after leaving the hospital. An assessment will be done, which will occur on the first appointment. Any medical documents provided during this appointment from the hospital will allow for the best practice to occur. By providing us with all the medical records we will be able to assess the situation so no more injuries occur while there is an increase in mobility through safe exercises. Physiotherapists are a great source of knowledge on how to get your body moving in the best way possible. Every accident has a different result and how people deal with the incident varies as well. Getting as much support as possible is the best approach to an overall recovery.

Figure 3. Going to a physiotherapist and listening to the recommended exercises will allow you to be able to recover in the best way possible. Strengthening exercises will enable you to get stronger and be able to try things on your own. Once a routine gets created doing activities on your own will be possible and able to be done safely.

The physiotherapist’s assessment of the patient will determine the next course of action. The focus of a physiotherapist will help the healing process for the patient. During the rehabilitation process, physiotherapy will help maximize sensory and motor function recovery, while also preventing any secondary injuries that can occur. Physiotherapists will be able to assist with the reintegration into society safely. Speaking to different clinics or asking for a clinic referral will allow the patient to be able to be comfortable with their choice. During the assessment, any questions can be asked. We are here to help and make all of our patients feel safe and comfortable in our care. It is very important to us for our patients to leave stronger and with more tools than what they came in with. Please bring in any medical documents you get from the hospital so the treatment plan can be suitable. Exercise and strength training will be difficult at first but will assist with the overall recovery process. Movement is going to be different than before the spinal cord injury but physiotherapists are here to help guide you in the right direction. Figure 3, displays the long-term adaptation to routine, which will allow for exercise to be done alone once it is established and confidence is built. Everyone’s injuries are different and vary depending on the severity of the incident and how soon after you attend physiotherapy.

There are two factors after an injury that determine if you will be able to move your arms and legs. The first factor will be where the damage is located and the second factor will be how severe the damage is. The loss of feeling and control of your body’s movement from a spinal cord injury is known as quadriplegia and paraplegia. Quadriplegia will impact your hands, arms, legs, pelvic organs and trunk. Paraplegia impacts parts of your body such as the legs, pelvic organs, and parts of your trunk but not the arms. Both injuries are life-changing and need a healthcare team to perform tests to determine the completeness of the injury and the neurological level. Completeness refers to the neurological level of the injury, which can impact feeling and sensation. Complete spinal cord injuries will lose all control of movement while incomplete spinal cord injuries will have some feeling and control of movement in the affected area and will vary for each person and their situation.

Figure 4. Electric wheelchairs are a great way to assist in the process of getting around. The ease will help reduce strain on the body. If this is something that would be suitable for your situation, it will be recommended by a doctor.

Everyone will have different goals or focuses when seeing a physiotherapist. Everyone has different styles of living, and creating a normal routine again will be hard without professional advice. It is important to seek professional assistance when discovering this to get as much information as possible and create a plan. As seen in Figure 4, there are options for how to approach this new lifestyle change. A wheelchair can be useful if there is some mobility, however, electric wheelchairs might also be taken into consideration when dealing with aging patients or the inability to use the upper body. It will take a lot of different professionals to determine what would be the best approach. Making sure your house is suitable for working, cleaning, living and

Figure 5. When a spinal cord injury occurs it is very important for your house to be able to accommodate your lifestyle. Levelling desks and tables to be able to be suitable for your work or life can be done. Custom-made can be done but also figuring out new measurements for the scale of range can be beneficial to overall quality of life.

having people over will take time but it is possible to achieve comfort. Making tables more level will allow for there to be more control and accessibility. Our team is here to assist you in any way possible. Please feel free to create a list of questions before coming into treatment as there as it sometimes is overwhelming entering the clinic and beginning. An example of a suitable table is displayed in Figure 5.

Health Bound Health Network is here to assist people who are interested in receiving treatment at any of our five locations, in Etobicoke, Toronto, Barrie, Hamilton and Markham. We are CARF certified, which means that Health Bound’s methods are elevated and evaluated by an external team that reviews our practice. If you have any questions about our services or locations please email at [email protected]. We are here to help you get through any accident or injury safely and with confidence. Below are the phone numbers for each location so you can contact each clinic directly for your booking. Please feel free to contact us and book your next appointment today!

Toronto – 909 Pape Ave – 416-548-7872

Markham – 4331 14th Ave – 416-850-8558

Etobicoke – 3250 Bloor Street West Unit #111 – 416-236-7778

Barrie – 65 Bell Farm Road – 416-519-3727

By: Maria Votsis

References:

Physical therapy after spinal cord injury: A systematic review of treatments focused on participation – PMC (nih.gov)

Physiotherapy Management of Individuals with Spinal Cord Injury – Physiopedia (physio-pedia.com)

Physiotherapy rehabilitation for people with spinal cord injuries – ScienceDirect

Spinal cord injury – Symptoms and causes – Mayo Clinic

Spinal Cord Injury: Causes, Symptoms, Treatment & Types (clevelandclinic.org)

The Role of a Physical Therapist in Spinal Cord Injury Rehabilitation