Principles of Rehabilitation Strategies in Spinal Cord Injury (original) (raw)

Rehabilitation of spinal cord injuries

World Journal of Orthopedics, 2015

Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.

Spinal cord injury: rehabilitation

Acta Fisiátrica, 2012

Spinal cord injury: rehabilitation LEVEL OF RECOMMENDATION AND EVIDENCE: A: Strong consistency experimental or observational studies. B: Fair consistency experimental or observational studies. C: Case reports (uncontrolled studies). D: Opinion lacking critical evaluation, based on consensus, physiological studies or animal models. OBJECTIVES: Offering information about the treatment and rehabilitation for patients with spinal cord injuries.

Effect of Various Treatment Modalities After Spinal Cord Injury

Acta Scientific Orthopaedics

Spinal cord injury (SCI) is a devasting neurological condition producing physical dependency, morbidity, psychological stress and financial burden, Spinal cord injury is characterized by the degradation of motor, sensory and autonomic functions either because of wholly or partially damage in the spinal cord because of trauma. Its a debilitating neurological condition with socio economic impact on affected individuals and the health care system, It completely changed subjects life because it's a life long treatment and loss of income and patient completely depend on others. According to Ara Z., et al. 2022 SCI is a life threatning process and it greatly effects subjects' quality of life and families, In 1700 BC in an Egyptian surgical papyrus, they describe the frustration of health care professionals in treating a severe spinal cord injury, the Papyrus reported spinal fractures as a ''disease that should not be treated''. Most of these studies approach a patient with acute spinal cord injury (ASCI) in one of four manners: corrective surgery or a physical, biological or pharmacological treatment method. clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration.

Restoring function after spinal cord injury

The neurologist, 2003

By affecting young people during the most productive period of their lives, spinal cord injury is a devastating problem for modern society. A decade ago, treating SCI seemed frustrating and hopeless because of the tremendous morbidity and mortality, life-shattering impact, and limited therapeutic options associated with the condition. Today, however, an understanding of the underlying pathophysiological mechanisms, the development of neuroprotective interventions, and progress toward regenerative interventions are increasing hope for functional restoration. This study addresses the present understanding of SCI, including the etiology, pathophysiology, treatment, and scientific advances. The discussion of treatment options includes a critical review of high-dose methylprednisolone and GM-1 ganglioside therapy. The concept that limited rebuilding can provide a disproportionate improvement in quality of life is emphasized throughout. New surgical procedures, pharmacologic treatments, a...

Spinal cord injury and its treatment: current management and experimental perspectives

Advances and technical standards in neurosurgery, 2012

Clinical management of spinal cord injury (SCI) has significantly improved its general prognosis. However, to date, traumatic paraplegia and tetraplegia remain incurable, despite massive research efforts. Current management focuses on surgical stabilisation of the spine, intensive neurological rehabilitation, and the prevention and treatment of acute and chronic complications. Prevention remains the most efficient strategy and should be the main focus of public health efforts. Nevertheless, major advances in the understanding of the pathophysiological mechanisms of SCI open promising new therapeutic perspectives. Even if complete recovery remains elusive due to the complexity of spinal cord repair, a strategy combining different approaches may result in some degree of neurological improvement after SCI. Even slight neurological recovery can have high impact on the daily functioning of severely handicapped patients and, thus, result in significant improvements in quality of life.The ...

Spinal cord injury – there is not just one way of treating it

F1000Prime Reports, 2014

In the last century, research in the field of spinal cord trauma has brought insightful knowledge which has led to a detailed understanding of mechanisms that are involved in injury-and recovery-related processes. The quest for a cure for the yet generally incurable condition as well as the exponential rise in gained information has brought about the development of numerous treatment approaches while at the same time the abundance of data has become quite unmanageable. Owing to an enormous amount of preclinical therapeutic approaches, this report highlights important trends rather than specific treatment strategies. We focus on current advances in the treatment of spinal cord injury and want to further draw attention to arising problems in spinal cord injury (SCI) research and discuss possible solutions.

From basics to clinical: A comprehensive review on spinal cord injury

Progress in Neurobiology, 2014

Spinal cord injury (SCI) is a devastating neurological disorder that affects thousands of individuals each year. Over the past decades an enormous progress has been made in our understanding of the molecular and cellular events generated by SCI, providing insights into crucial mechanisms that contribute to tissue damage and regenerative failure of injured neurons. Current treatment options for SCI include the use of high dose methylprednisolone, surgical interventions to stabilize and decompress the spinal cord, and rehabilitative care. Nonetheless, SCI is still a harmful condition for which there is yet no cure. Cellular, molecular, rehabilitative training and combinatorial therapies have shown promising results in animal models. Nevertheless, work remains to be done to ascertain whether any of these therapies can safely improve patient's condition after human SCI. This review provides an extensive overview of SCI research, as well as its clinical component. It starts covering areas from physiology and anatomy of the spinal cord, neuropathology of the SCI, current clinical options, neuronal plasticity after SCI, animal models and techniques to assess recovery, focusing the subsequent discussion on a variety of promising neuroprotective, cell-based and combinatorial therapeutic approaches that have recently moved, or are close, to clinical testing.

Spinal Cord Injury Prevalence and Treatment Modalities

IntechOpen eBooks, 2023

Spinal cord injury (SCI) is a devasting neurological condition producing physical dependency, morbidity, psychological stress, and financial burden. During the last 30 years, its global prevalence has increased from 236 to 1298 cases per million populations. Two types of spinal cord injury are primary and secondary injury. Primary injury is mechanical damage to the cord itself whereas secondary injury results from one or more biochemical and cellular processes that are triggered by the primary lesion. In 1700 BC, in an Egyptian surgical papyrus, they describe the frustration of health care professionals in treating a severe spinal cord injury, the Papyrus reported spinal fractures as a "disease that should not be treated". Most of these studies approach a patient with acute spinal cord injury (ASCI) in one of four manners: corrective surgery or a physical, biological, or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at a minimum, allow for partial functional recoveries for these patients, which could improve their quality of life. More studies were done on spinalized animals that indicate that most of these pharmacological agents may act on receptors present in the spinal cord, thus facilitate to produce coordinated locomotor movement, whereas some other drugs used to improve the neuropathological changes caused because of spinal cord injury (SCI), such as spasticity or demyelination, to improve walking.

Rehabilitation of Spinal Cord Injury: WFNS Spine Committee Recommendations

Neurospine, 2020

Spinal cord injury (SCI) is accompanied by a significant number of complications associated with damage to the spinal cord, gross functional impairments leading to limited self-care and movement, leading to a high level of disability, social and psychological maladaptation of the patients. Besides, pain and spasticity negatively affect rehabilitation programs. This search was conducted in PubMed/MEDLINE database. All studies published in English language (n = 16,297) were considered for inclusion. Of all studies evaluating rehabilitation in SCI patients (n = 80) were included. Based on the literature review the faculty of the WFNS Spine Committee created statements covering different aspects of the contemporary rehabilitation process of the SCI patients. The prepared statements were subjected to discussions, followed by anonymous voting process by the members of the WFNS Spine Committee. As result of the diccussions and the voting process the statements were modified and published as recommendations of the WFNS Spine Committee. The care for the SCI has gone a long way from the times after the World War II when these patients were considered hopeless in terms of any functional recovery, to the contemporary comprehensive rehabilitation programs. The rehabilitation is important part of the modern comprehencive treatment of SCI patients nowadays. The current manuscript reflects different aspects of the contemporary rehabilitaton process and decision makings, which were discussed by the faculty of the WFNS Spine Committee resulting in issuing of the following recommendations.