{"id":3316,"date":"2022-10-17T08:26:22","date_gmt":"2022-10-17T08:26:22","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/?page_id=3316"},"modified":"2026-06-18T05:42:02","modified_gmt":"2026-06-18T05:42:02","slug":"spinal-cord-injury-physiotherapy-treatment-principles-3-it","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/it\/spinal-cord-injury-physiotherapy-treatment-principles-3-it\/","title":{"rendered":"Principi di trattamento fisioterapico delle lesioni al midollo spinale"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\">\n<p><b>Original Editor <\/b>&#8211; <a title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\">Ewa Jaraczewska<\/a> based on the course by <a class=\"external text\" href=\"https:\/\/members.physio-pedia.com\/instructor\/melanie-skeen-harding\/\" rel=\"nofollow\">Melanie Harding<\/a><\/p>\n<p><b>Top Contributors<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\"><bdi>Ewa Jaraczewska<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a> and <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a><\/p>\n<\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\" \/><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contents<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduction<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-2\"><a href=\"#SCI_Physiotherapy_Treatment_Basic_Principles\"><span class=\"tocnumber\">1.1<\/span> <span class=\"toctext\">SCI Physiotherapy Treatment Basic Principles<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-3\"><a href=\"#Early_Management\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Early Management<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-4\"><a href=\"#Neurological_Recovery\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">Neurological Recovery<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Prevention_of_Complications\"><span class=\"tocnumber\">2.2<\/span> <span class=\"toctext\">Prevention of Complications<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-6\"><a href=\"#Respiratory_Complications\"><span class=\"tocnumber\">2.2.1<\/span> <span class=\"toctext\">Respiratory Complications<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-7\"><a href=\"#Integumentary_.28Skin.29_Complications\"><span class=\"tocnumber\">2.2.2<\/span> <span class=\"toctext\">Integumentary (Skin) Complications<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-8\"><a href=\"#Cardiovascular_Complications\"><span class=\"tocnumber\">2.2.3<\/span> <span class=\"toctext\">Cardiovascular Complications<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-9\"><a href=\"#Musculoskeletal_Complications\"><span class=\"tocnumber\">2.2.4<\/span> <span class=\"toctext\">Musculoskeletal Complications<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-10\"><a href=\"#Urologic_Complications\"><span class=\"tocnumber\">2.2.5<\/span> <span class=\"toctext\">Urologic Complications<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-11\"><a href=\"#Gastrointestinal\"><span class=\"tocnumber\">2.2.6<\/span> <span class=\"toctext\">Gastrointestinal<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-12\"><a href=\"#Preparing_for_Function\"><span class=\"tocnumber\">2.3<\/span> <span class=\"toctext\">Preparing for Function<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-13\"><a href=\"#Rehabilitation_Phase\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">Rehabilitation Phase<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-14\"><a href=\"#Seating_and_Mobility\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">Seating and Mobility<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Outcomes\"><span class=\"tocnumber\">3.2<\/span> <span class=\"toctext\">Outcomes<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-16\"><a href=\"#Functional_Approach\"><span class=\"tocnumber\">3.3<\/span> <span class=\"toctext\">Functional Approach<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-17\"><a href=\"#New_Technologies\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">New Technologies<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-18\"><a href=\"#Later_Stage\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">Later Stage<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-19\"><a href=\"#Health_Status\"><span class=\"tocnumber\">5.1<\/span> <span class=\"toctext\">Health Status<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-20\"><a href=\"#Participation\"><span class=\"tocnumber\">5.2<\/span> <span class=\"toctext\">Participation<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-21\"><a href=\"#Resources\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">Resources<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-22\"><a href=\"#References\"><span class=\"tocnumber\">7<\/span> <span class=\"toctext\">References<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduction<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Spinal cord injury (SCI) physiotherapy treatment is a very complex, and it must take into account not only paralysis, but also much wider consequences of impaired body functions. These include functions of the bladder, bowel, respiratory, and cardiovascular systems. As well as this, social and personal factors, participation and the environment all influence the recovery of persons with a spinal cord injury.<sup id=\"cite_ref-:0_1-0\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup> This course aims to introduce basic treatment ideas during various stages of rehabilitation after a spinal cord injury.<\/p>\n<h3><span id=\"SCI_Physiotherapy_Treatment_Basic_Principles\" class=\"mw-headline\">SCI Physiotherapy Treatment Basic Principles<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: SCI Physiotherapy Treatment Basic Principles\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=2\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: SCI Physiotherapy Treatment Basic Principles\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=2\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>Initial medical care and rehabilitation are focused on minimising additional neurological damage to the spinal cord and enhancing recovery<sup id=\"cite_ref-:0_1-1\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/li>\n<li>The multidisciplinary team should be involved and a patient-centered approach should be developed<sup id=\"cite_ref-:0_1-2\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/li>\n<li>The patient should have ongoing access to follow-up specialised care, equipment, and advanced technology<\/li>\n<li>The goals of treatment should be linked to the patient\u2019s likes, goals, and passions, the drivers in their life and to the expected outcomes for different levels of injury<sup id=\"cite_ref-:1_2-0\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>Treatment of neurological and musculoskeletal injuries should focus on the presence of weakness, contracture and poor motor control<sup id=\"cite_ref-:0_1-3\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/li>\n<li>Outcome measures should be used to measure treatment progression<sup id=\"cite_ref-:1_2-1\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<h2><span id=\"Early_Management\" class=\"mw-headline\">Early Management<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Early Management\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Early Management\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=3\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>The early management of a spinal cord injury begins as soon as the patient is medically stable. This could be days or weeks after the injury depending on the primary cause of the injury and subsequent medical and\/or respiratory complications.<sup id=\"cite_ref-:0_1-4\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup> Paramedic assessment documentation can serve as a valid source of information for the physiotherapist regarding the mechanism of the patient&#8217;s injury when physiotherapy care is being planned in this stage.<sup id=\"cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\">(3)<\/a><\/sup><\/p>\n<h3><span id=\"Neurological_Recovery\" class=\"mw-headline\">Neurological Recovery<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Neurological Recovery\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Neurological Recovery\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=4\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Neurological recovery after traumatic spinal cord injury depends on the severity, level and mechanism of the injury.<sup id=\"cite_ref-:2_4-0\" class=\"reference\"><a href=\"#cite_note-:2-4\">(4)<\/a><\/sup> Neurological recovery is not, however, associated with the treatment a patient receives or the country where the treatment is delivered.<sup id=\"cite_ref-:2_4-1\" class=\"reference\"><a href=\"#cite_note-:2-4\">(4)<\/a><\/sup> The first three months after the spinal cord injury are crucial for the recovery of individuals with a complete ASIA A spinal cord injury when their level of injury can change to ASIA B, C, D, or E; the highest number of conversions are from ASIA A to ASIA B (5.6.%).<sup id=\"cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\">(5)<\/a><\/sup><sup id=\"cite_ref-:3_6-0\" class=\"reference\"><a href=\"#cite_note-:3-6\">(6)<\/a><\/sup> These conversions are more frequently observed for patients with tetraplegia as compared to those with paraplegia.<sup id=\"cite_ref-:3_6-1\" class=\"reference\"><a href=\"#cite_note-:3-6\">(6)<\/a><\/sup> Even though most of the recovery occurs during the first three months, it can continue up to one year after the injury.<sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup><\/p>\n<p>The following <i>initial<\/i> <i>assessment results<\/i> are considered predictors for neurological recovery:<\/p>\n<ul>\n<li>The lower the level of cervical injury, the higher percentage of recovery: 85% of patients with C6 SCI will convert to C7<sup id=\"cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\">(8)<\/a><\/sup><\/li>\n<li>Biceps strength greater or equal to 3\/5 predicts motor recovery for wrist extensors<sup id=\"cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\">(9)<\/a><\/sup><\/li>\n<li>Muscles with a 1\u20132.5\/5 grade initially will reach a recovery plateau within one year. Muscles with 0\/5 grades during the initial assessment will continue their motor recovery for up to 24 months.<sup id=\"cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\">(10)<\/a><\/sup><\/li>\n<\/ul>\n<p>More information on the ASIA scale is available <a title=\"International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)\" href=\"\/International_Standards_for_Neurological_Classification_of_Spinal_Cord_Injury_(ISNCSCI)\">here<\/a>.<\/p>\n<h3><span id=\"Prevention_of_Complications\" class=\"mw-headline\">Prevention of Complications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Prevention of Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=5\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Prevention of Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=5\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Respiratory_System.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/d\/dd\/Respiratory_System.png\/300px-Respiratory_System.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/d\/dd\/Respiratory_System.png\/450px-Respiratory_System.png 1.5x, https:\/\/www.physio-pedia.com\/images\/d\/dd\/Respiratory_System.png 2x\" alt=\"\" width=\"300\" height=\"347\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Respiratory system<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h4><span id=\"Respiratory_Complications\" class=\"mw-headline\">Respiratory Complications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Respiratory Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=6\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Respiratory Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=6\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Respiratory and ventilatory functions are impaired in over 50% of individuals with a spinal cord injury.<sup id=\"cite_ref-:7_11-0\" class=\"reference\"><a href=\"#cite_note-:7-11\">(11)<\/a><\/sup> As a result, patients can experience difficulties with breathing or an inability to breathe. Pneumonia can impact a patient&#8217;s length of hospital stay and neurological outcome.<sup id=\"cite_ref-:7_11-1\" class=\"reference\"><a href=\"#cite_note-:7-11\">(11)<\/a><\/sup> It is also considered a major cause of morbidity and mortality in SCI patients.<sup id=\"cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\">(12)<\/a><\/sup> Other respiratory complications include: <a title=\"Atelectasis\" href=\"\/Atelectasis\">atelectasis<\/a>, sputum retention, and <a title=\"Respiratory Failure\" href=\"\/Respiratory_Failure\">respiratory failure<\/a>.<\/p>\n<p><i>Physiotherapy role in preventing respiratory complications<\/i>:<\/p>\n<ul>\n<li>Initiating <a title=\"Respiratory Muscle Training\" href=\"\/Respiratory_Muscle_Training\">respiratory muscle training<\/a><sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup><\/li>\n<li>Instruction on <a title=\"Assisted Coughing\" href=\"\/Assisted_Coughing\">assisted coughing<\/a> and nose blowing<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup><\/li>\n<li>Providing active <a title=\"Respiratory Physiotherapy\" href=\"\/Respiratory_Physiotherapy\">chest physiotherapy<\/a><\/li>\n<\/ul>\n<blockquote>\n<p><a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557793\/\" rel=\"nofollow\">Diaphragm pacing<\/a> is a new method to help patients with SCI reduce their dependence on a mechanical ventilator. Other benefits include promoting neuromuscular plasticity, improvements in spontaneous diaphragm activation and respiratory function, and improvement in breathing, speech and quality of life for people with spinal cord injuries.<sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup> You can find more information on diaphragm pacing <a class=\"external text\" href=\"https:\/\/journals.lww.com\/jnpt\/fulltext\/2021\/07000\/diaphragm_pacing_and_a_model_for_respiratory.6.aspx\" rel=\"nofollow\">here.<\/a><\/p>\n<\/blockquote>\n<blockquote>\n<p>You can find more information on respiratory management in a spinal cord injury <a title=\"Respiratory Management in Spinal Cord Injury\" href=\"\/Respiratory_Management_in_Spinal_Cord_Injury\">here.<\/a><\/p>\n<\/blockquote>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Common_Pressure_Areas.jpeg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/c\/cc\/Common_Pressure_Areas.jpeg\/300px-Common_Pressure_Areas.jpeg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/c\/cc\/Common_Pressure_Areas.jpeg\/450px-Common_Pressure_Areas.jpeg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/c\/cc\/Common_Pressure_Areas.jpeg\/600px-Common_Pressure_Areas.jpeg 2x\" alt=\"\" width=\"300\" height=\"175\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Common pressure areas<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h4><span id=\"Integumentary_(Skin)_Complications\"><\/span><span id=\"Integumentary_.28Skin.29_Complications\" class=\"mw-headline\">Integumentary (Skin) Complications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Integumentary (Skin) Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=7\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Integumentary (Skin) Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=7\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Decubitus ulcers can develop within 6 hours or less from an injury.<sup id=\"cite_ref-:1_2-2\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> Prevention of decubitus ulcers becomes the responsibility of the entire healthcare team.<\/p>\n<p><i>Multidisciplinary team role in preventing <a title=\"Pressure Ulcers\" href=\"\/Pressure_Ulcers\">pressure ulcers<\/a>:<\/i><\/p>\n<ul>\n<li>Patient education on pressure relief<\/li>\n<li>Encouraging the patient to follow a pressure relief regime. All team members can be involved in this. For example, speech-language therapists must know how to assist the patient with pressure relief during their therapy sessions<\/li>\n<li>Teaching the patient the steps for pressure relief. Patients must learn how to instruct others on pressure relief<\/li>\n<li><a title=\"Spasticity\" href=\"\/Spasticity\">Spasticity<\/a> management is important because spasticity can lead to pressure ulcers<sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup><\/li>\n<\/ul>\n<h4><span id=\"Cardiovascular_Complications\" class=\"mw-headline\">Cardiovascular Complications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Cardiovascular Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=8\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Cardiovascular Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=8\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Cardiovascular complications among individuals with a spinal cord injury include orthostatic hypotension and autonomic dysreflexia.<sup id=\"cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\">(17)<\/a><\/sup><\/p>\n<p><a title=\"Autonomic Dysreflexia\" href=\"\/Autonomic_Dysreflexia\">Autonomic dysreflexia<\/a> is sudden and extreme hypertension in response to afferent stimuli from below the level of injury. It can occur in up to 90% of individuals with tetraplegia or high paraplegia, and may result in vascular dysfunction, seizures, cardiac arrest, cerebral vascular accidents, and death.<sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/p>\n<p><a title=\"Orthostatic Hypotension\" href=\"\/Orthostatic_Hypotension\">Orthostatic hypotension<\/a> occurs when a patient transitions to an upright position and there is a drop of at least 20mmHg in their systolic blood pressure or 10mmHg in their diastolic blood pressure.<sup id=\"cite_ref-:4_19-0\" class=\"reference\"><a href=\"#cite_note-:4-19\">(19)<\/a><\/sup> Wang et al.<sup id=\"cite_ref-:5_20-0\" class=\"reference\"><a href=\"#cite_note-:5-20\">(20)<\/a><\/sup> have found, however, that a decrease in blood pressure is not sufficient to define orthostatic hypotension. To confirm autonomic dysfunction after a spinal cord injury, both blood pressure and heart rate responses need to be quantified.<sup id=\"cite_ref-:5_20-1\" class=\"reference\"><a href=\"#cite_note-:5-20\">(20)<\/a><\/sup> Alterations in systolic and diastolic function which manifest as fluctuations in blood pressure (hyper and hypotension) can lead to vascular cognitive impairment in individuals with SCI.<sup id=\"cite_ref-:4_19-1\" class=\"reference\"><a href=\"#cite_note-:4-19\">(19)<\/a><\/sup><\/p>\n<p>Individuals with SCI are also at an increased risk for deep vein thrombosis (DVT).<sup id=\"cite_ref-:11_21-0\" class=\"reference\"><a href=\"#cite_note-:11-21\">(21)<\/a><\/sup> Multiple factors are responsible for this increased risk,<sup id=\"cite_ref-:11_21-1\" class=\"reference\"><a href=\"#cite_note-:11-21\">(21)<\/a><\/sup> including:<\/p>\n<ul>\n<li>Venous stasis after injury<\/li>\n<li>Endothelial vessel wall injury from surgery<\/li>\n<li>An increased tendency to develop blood clots associated with trauma<\/li>\n<\/ul>\n<p><i>Physiotherapy role in preventing cardiovascular complications:<\/i><\/p>\n<ul>\n<li><a title=\"Deep Vein Thrombosis\" href=\"\/Deep_Vein_Thrombosis\">Deep vein thrombosis<\/a> (DVT) prophylaxis: early limb mobilisation, intermittent compression<sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup><\/li>\n<li>Management of postural hypotension, <a title=\"Bradycardia\" href=\"\/Bradycardia\">bradycardia<\/a> and autonomic dysreflexia<\/li>\n<\/ul>\n<blockquote>\n<p>You can read more about cardiovascular complications associated with spinal cord injury <a class=\"external text\" href=\"https:\/\/www.jadweb.org\/article.asp?issn=2221-6189;year=2018;volume=7;issue=4;spage=139;epage=144;aulast=Calvo-Infante\" rel=\"nofollow\">here.<\/a><\/p>\n<\/blockquote>\n<h4><span id=\"Musculoskeletal_Complications\" class=\"mw-headline\">Musculoskeletal Complications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Musculoskeletal Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=9\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Musculoskeletal Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=9\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Musculoskeletal problems are frequent in individuals with spinal cord injury. Activities performed with poor biomechanics will lead to shoulder and neck pain. Patients who remain in one position for a prolonged period of time will develop contracture. Spasticity can decrease flexibility and cause shortening of the soft tissue.<sup id=\"cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\">(23)<\/a><\/sup><sup id=\"cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\">(24)<\/a><\/sup> The consequences of these complications are severe. For example, when a patient develops shoulder pain, he or she will not be able to propel a wheelchair or perform transfers.<\/p>\n<p><i>Physiotherapy role in preventing musculoskeletal complications:<\/i><sup id=\"cite_ref-:1_2-3\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<ul>\n<li>Prevent lower and upper extremities contracture &#8211; consider ankle, knee, hip, shoulder joints to allow for: wheelchair positioning (ankles, knees), bed mobility, transfers, and dressing (shoulders, hips)<\/li>\n<li>Facilitate elbow extension in patients with a C5\/6 SCI and wrist extension in patients with a C6 SCI<\/li>\n<li>Educate on positions in bed and\/or wheelchair that can reduce spasticity<\/li>\n<li>Reinforce good posture &#8211; use only one or no pillow\/s under the neck in supine, early assessment for wheelchair seating and positioning<\/li>\n<li>Position for functional shortening of the long finger flexors to facilitate tenodesis grip (patients to be in pronation with finger flexion and wrist extension)<\/li>\n<\/ul>\n<h4><span id=\"Urologic_Complications\" class=\"mw-headline\">Urologic Complications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Urologic Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=10\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Urologic Complications\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=10\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Patients with a spinal cord injury are at greater risk for developing urologic complications. At higher risk are males, individuals with cervical SCI, and patients using a condom catheter.<sup id=\"cite_ref-:6_25-0\" class=\"reference\"><a href=\"#cite_note-:6-25\">(25)<\/a><\/sup> Upper urinary tract complications (UTI) affect 20\u2009\u2013\u200930% of patients with a spinal cord injury, 49% develop bladder stones, 47% will experience from hydronephrosis (i.e. urine build-up causing the kidneys to stretch and swell), and 33% will be diagnosed with vesicoureteral reflux causing the urine to flow backwards from the bladder to one or both ureters and sometimes to the kidneys.<sup id=\"cite_ref-:6_25-1\" class=\"reference\"><a href=\"#cite_note-:6-25\">(25)<\/a><\/sup> The following issues can increase the risk of UTI:<\/p>\n<ul>\n<li>Incomplete voiding<\/li>\n<li>Catheter use<\/li>\n<li>Increased tension of the bladder muscle<sup id=\"cite_ref-:6_25-2\" class=\"reference\"><a href=\"#cite_note-:6-25\">(25)<\/a><\/sup><\/li>\n<\/ul>\n<p>Physiotherapists can help prevent UTIs and bladder overfilling in patients with a spinal cord injury by:<sup id=\"cite_ref-:1_2-4\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<ul>\n<li>Encouraging the patient to drink enough water<\/li>\n<li>Working with an occupational therapist on the proper equipment to facilitate independent hydration (wheelchair cup holder with a cup and a long drinking straw)<\/li>\n<li>Following aseptic procedures with catheter care, keeping the catheter off the floor during therapy<\/li>\n<li>Maintaining the schedule for timely catheterisation<\/li>\n<\/ul>\n<h4><span id=\"Gastrointestinal\" class=\"mw-headline\">Gastrointestinal<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Gastrointestinal\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=11\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Gastrointestinal\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=11\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Spinal cord injury may lead to significant gastrointestinal and bladder dysfunction,<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup> which have a serious impact on general health, quality of life, and the social participation of individuals with a spinal cord injury. A number of patients experience constipation, abdominal pain, nausea, or bloating. Colorectal dysfunction is the most common gastrointestinal complication.<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\">(27)<\/a><\/sup> Individuals with a spinal cord injury need to be educated and instructed on an appropriate bowel programme &#8211; one that allows for continence and prevents faecal impaction.<sup id=\"cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\">(28)<\/a><\/sup><\/p>\n<p>The following are additional activities to help prevent gastrointestinal comorbidities that the <i>physiotherapist can be a part of:<\/i><\/p>\n<ul>\n<li>Assist with bowel regime to prevent constipation and to prevent distension of the abdomen<\/li>\n<li>Educate on balancing activity level and intake<\/li>\n<li>Educate patients on obesity prevention<\/li>\n<li>Follow up on calorie counts<\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/0e\/Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg\/300px-Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/0e\/Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg\/450px-Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/0\/0e\/Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg\/600px-Bigstock_Image_-_SCI_Floor_Exercises_-ID_338509606.jpg 2x\" alt=\"\" width=\"300\" height=\"200\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>SCI floor exercises<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Preparing_for_Function\" class=\"mw-headline\">Preparing for Function<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Preparing for Function\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=12\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Preparing for Function\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=12\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Early introduction of physiotherapy interventions during the acute phase of rehabilitation after a spinal cord injury should focus on:<\/p>\n<ul>\n<li>Teaching trick movements for individuals with a C5\/6\/7 spinal cord injury, including elbow extension without triceps, and tenodesis grip<\/li>\n<li>Strengthening innervated and partially innervated muscles for function<\/li>\n<li>Facilitation of weak or paralysed muscles<\/li>\n<li>Maintaining full joint range of motion\n<ul>\n<li>Educate patient on how to do functional activities and why stretches, muscle strengthening, positioning and skills training are important &#8211; give them the vision.<\/li>\n<li>Educate patient about their condition, complications, possible outcomes and length of stay and goals. This needs constant repeating, as patients are not always ready to hear the information given.<\/li>\n<li>Make sure the patient has the cognitive ability for the level of education being given. Pictures should be provided for those who cannot read, consider language (mother tongue or competent translator) and education should match a patient&#8217;s educational level.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Assisting with spasticity management<\/li>\n<\/ul>\n<p>You can read more on physical techniques in the management of spasticity <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/3101757\/tables\/1\" rel=\"nofollow\">here<\/a>.<\/p>\n<h2><span id=\"Rehabilitation_Phase\" class=\"mw-headline\">Rehabilitation Phase<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Rehabilitation Phase\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=13\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Rehabilitation Phase\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=13\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>A person-centred approach to spinal cord injury rehabilitation is well known and well advocated in healthcare systems, although the choice of rehabilitation goals may vary depending on the country and its system. This type of approach to rehabilitation focuses not only on the physical functioning of a person with a spinal cord injury, but their financial, vocational and social needs and challenges following the injury as well. However, patients and health professionals report that the goal-setting in SCI rehabilitation too often addresses only physical functioning, without considering the psychosocial component, e.g., family issues, a change of roles etc.<sup id=\"cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\">(29)<\/a><\/sup> When goal-setting during the rehabilitation phase, it is important to address issues related to a patient&#8217;s everyday life while they are still in hospital.<sup id=\"cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\">(30)<\/a><\/sup> During the spinal cord injury rehabilitation phase, emphasis should be placed on: &#8220;having definite goals as to where you are headed, what is possible for the neurological level and make it patient-specific&#8221;.<sup id=\"cite_ref-:1_2-5\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> In addition, it is important to:<\/p>\n<ul>\n<li>Mobilise the patient as soon as possible<\/li>\n<li>Assess the need for an abdominal binder for postural hypotension<\/li>\n<li>Design a graded progressive sitting programme to build patient&#8217;s sitting endurance<\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Manual_wheelchair_fro_SCI.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/61\/Manual_wheelchair_fro_SCI.png\/300px-Manual_wheelchair_fro_SCI.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/61\/Manual_wheelchair_fro_SCI.png\/450px-Manual_wheelchair_fro_SCI.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/6\/61\/Manual_wheelchair_fro_SCI.png\/600px-Manual_wheelchair_fro_SCI.png 2x\" alt=\"\" width=\"300\" height=\"200\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Manual wheelchair with cushion<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Seating_and_Mobility\" class=\"mw-headline\">Seating and Mobility<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Seating and Mobility\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=14\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Seating and Mobility\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=14\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>An appropriate <a title=\"Wheelchair Accessories\" href=\"\/Wheelchair_Accessories\">wheelchair and seating system<\/a> is a basic human right for a person with a spinal cord injury.<sup id=\"cite_ref-:8_31-0\" class=\"reference\"><a href=\"#cite_note-:8-31\">(31)<\/a><\/sup> It allows independence, health, function, and social participation.<sup id=\"cite_ref-:9_32-0\" class=\"reference\"><a href=\"#cite_note-:9-32\">(32)<\/a><\/sup> It is an essential tool to maximise the quality of life of an individual with a spinal cord injury. When choosing the seating and mobility system, the patient and healthcare provider must consider what barriers there are when entering the patient&#8217;s home \/ community facilities, a patient&#8217;s primary mode of transportation (own car vs community transportation), the patient&#8217;s current health status (which can decline or improve during the course of rehabilitation), as well as pain and difficulties while using a current seating and mobility system. In addition, the user&#8217;s age, level of injury, body size, gender, motivation, way of life, family and social roles, and cognitive abilities must be considered.<sup id=\"cite_ref-:1_2-6\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<p>Each seating and mobility system includes a wheelchair base (manual or power) and seating components (cushion, backrest, head and arm support).<sup id=\"cite_ref-:8_31-1\" class=\"reference\"><a href=\"#cite_note-:8-31\">(31)<\/a><\/sup> For an individual with a spinal cord injury, equitable and long-term access to adequate wheelchair services and assistive technology should be a priority when preparing this person for discharge from rehabilitation. It includes seating assistive technology assessment, delivery, training, maintenance, and follow-up.<sup id=\"cite_ref-:9_32-1\" class=\"reference\"><a href=\"#cite_note-:9-32\">(32)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 202px;\"><a class=\"image\" href=\"\/File:Functional_Independence_Measure.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/c\/c4\/Functional_Independence_Measure.jpg\/300px-Functional_Independence_Measure.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/c\/c4\/Functional_Independence_Measure.jpg 1.5x\" alt=\"\" width=\"150\" height=\"275\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Functional Independence Measure<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Outcomes\" class=\"mw-headline\">Outcomes<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Outcomes\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Outcomes\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=15\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p><a title=\"Functional Independence Measure (FIM)\" href=\"\/Functional_Independence_Measure_(FIM)\">Functional Independence Measure<\/a> (FIM): allows for quantification of the amount of assistance the patient requires for:<\/p>\n<ul>\n<li>Respiratory function, bladder and bowel<\/li>\n<li><a title=\"Bed Mobility and Transfers in Spinal Cord Injury\" href=\"\/Bed_Mobility_and_Transfers_in_Spinal_Cord_Injury\">Bed mobility<\/a> and transfers<\/li>\n<li>Eating, dressing, grooming, bathing<\/li>\n<li><a title=\"Wheelchair Biomechanics\" href=\"\/Wheelchair_Biomechanics\">Wheelchair propulsion<\/a> or ambulation\/transportation<\/li>\n<li>Communication and home making<sup id=\"cite_ref-:1_2-7\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<p><a title=\"Spinal Cord Independence Measure (SCIM)\" href=\"\/Spinal_Cord_Independence_Measure_(SCIM)\">Spinal Cord Independence Measure<\/a> (SCIM) addresses:<\/p>\n<ul>\n<li>Self-care (feeding, grooming, bathing, and dressing)<\/li>\n<li>Respiration and sphincter management<\/li>\n<li>Patient\u2019s mobility abilities (bed and transfers and indoors\/outdoors).<\/li>\n<\/ul>\n<p>The SCIM is used to guide clinicians in determining treatment goals and objectives for patients with an SCI.<sup id=\"cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\">(33)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage alignnone\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/7\/75\/Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg\/300px-Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/7\/75\/Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg\/450px-Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/7\/75\/Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg\/600px-Bigstock_Image_-_SCI_Walking_on_Treadmill_Using_Robotics_-_ID_157242317.jpg 2x\" alt=\"\" width=\"300\" height=\"200\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Lokomat<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Functional_Approach\" class=\"mw-headline\">Functional Approach<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Functional Approach\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=16\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Functional Approach\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=16\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>When addressing a patient&#8217;s functional ability, the clinician should consider the following principles:<\/p>\n<ul>\n<li>Treat the impairments<\/li>\n<li>Don\u2019t stick to normal functional levels (i.e. rolling before sitting up), but focus on the patient&#8217;s current abilities<\/li>\n<li>Use activities as an exercise<\/li>\n<li>Understand all the components of an activity you need for a specific function<\/li>\n<li>Break activities into smaller components and work on them<\/li>\n<li>Stretching, strengthening and maintaining range of motion are crucial for good function<\/li>\n<li>Use peer supporters to inspire the patient<\/li>\n<li>Make patients feel they have achieved something in a session, end with something they do well or enjoy<\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Patient_in_a_Standing_Frame.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage alignnone\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/8\/8e\/Patient_in_a_Standing_Frame.jpg\/300px-Patient_in_a_Standing_Frame.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/8\/8e\/Patient_in_a_Standing_Frame.jpg\/450px-Patient_in_a_Standing_Frame.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/8\/8e\/Patient_in_a_Standing_Frame.jpg\/600px-Patient_in_a_Standing_Frame.jpg 2x\" alt=\"\" width=\"300\" height=\"400\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Patient in a standing frame<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>The following tools can be used to facilitate function:<\/p>\n<ul>\n<li>Tilt table, standing frame, parallel bars standing with a long leg <a title=\"Orthoses for Management of Neuromuscular Impairment\" href=\"\/Orthoses_for_Management_of_Neuromuscular_Impairment\">orthoses<\/a>, treadmill, Lokomat to facilitate ambulation<\/li>\n<li><a title=\"Functional Electrical Stimulation Cycling for Spinal Cord Injury\" href=\"\/Functional_Electrical_Stimulation_Cycling_for_Spinal_Cord_Injury\">Functional Electrical Stimulation<\/a> (FES) to facilitate the return of muscle function <sup id=\"cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\">(34)<\/a><\/sup><\/li>\n<\/ul>\n<h2><span id=\"New_Technologies\" class=\"mw-headline\">New Technologies<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: New Technologies\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=17\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: New Technologies\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=17\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>New technologies available in the management of SCI are still in their early stages of development. Large scale clinical trials need to be done for these technologies to be proven successful.<sup id=\"cite_ref-:1_2-8\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<p>The following are examples of various technologies used in recovery after a spinal cord injury:<\/p>\n<ul>\n<li>Neuromodulation: i.e. modulation of neuronal activity.<sup id=\"cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\">(35)<\/a><\/sup> This can be done via pharmacological modulation, electrical modulation, and optogenetics modulation. Examples of electrical modulations include:<sup id=\"cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\">(36)<\/a><\/sup>\n<ul>\n<li>Brain stimulation: transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), direct motor cortex stimulation (MCS), <a title=\"Deep Brain Stimulation\" href=\"\/Deep_Brain_Stimulation\">deep brain stimulation<\/a> (DBS)<\/li>\n<li>Spinal cord stimulation: epidural electrical stimulation (EES) and transcutaneous spinal cord stimulation (tcSCS)<\/li>\n<li>Peripheral stimulation: <a title=\"Functional Electrical Stimulation Cycling for Spinal Cord Injury\" href=\"\/Functional_Electrical_Stimulation_Cycling_for_Spinal_Cord_Injury\">functional electrical stimulation<\/a> (FES)<\/li>\n<li>Brain-machine interface (BMI)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"row\">\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/K8uijjp6hfc?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\">(37)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/5EWJhBJq0tw?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\">(38)<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<ul>\n<li>Stem cell-based therapies<sup id=\"cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\">(39)<\/a><\/sup> &#8211; you can read more about cell-based therapies for spinal cord injury <a class=\"external text\" href=\"https:\/\/academic.oup.com\/stcltm\/article\/9\/12\/1509\/6407020?login=true\" rel=\"nofollow\">here<\/a>.<\/li>\n<\/ul>\n<ul>\n<li>Soft robotic glove<sup id=\"cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\">(40)<\/a><\/sup><\/li>\n<li>Exoskeleton<sup id=\"cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\">(41)<\/a><\/sup><sup id=\"cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\">(42)<\/a><\/sup><\/li>\n<li>Virtual reality<sup id=\"cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\">(43)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:SCI-exercise.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/b\/b0\/SCI-exercise.jpg\/300px-SCI-exercise.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/b\/b0\/SCI-exercise.jpg\/450px-SCI-exercise.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/b\/b0\/SCI-exercise.jpg\/600px-SCI-exercise.jpg 2x\" alt=\"\" width=\"300\" height=\"415\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>SCI exercise guidelines<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2><span id=\"Later_Stage\" class=\"mw-headline\">Later Stage<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Later Stage\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Later Stage\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=18\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>The changing needs of individuals with a spinal cord injury include changes in health status, changes in the level of participation, and changes in socio-economic status as a result of the financial burden following a spinal cord injury.<sup id=\"cite_ref-:10_44-0\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup><\/p>\n<h3><span id=\"Health_Status\" class=\"mw-headline\">Health Status<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Health Status\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=19\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Health Status\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=19\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Changes in health status include, but are not limited to:<\/p>\n<ul>\n<li>Normal ageing complications: overuse injuries, <a title=\"Osteoarthritis\" href=\"https:\/\/langs.physio-pedia.com\/it\/osteoarthritis-it\/\">osteoarthritis<\/a>, <a title=\"Osteoporosis\" href=\"https:\/\/langs.physio-pedia.com\/it\/osteoporosis-it\/\">osteoporotic fractures<\/a>, cardiovascular problems, <a title=\"Diabetes\" href=\"\/Diabetes\">diabetes<\/a>, <a title=\"Scoliosis\" href=\"\/Scoliosis\">scoliosis<\/a><sup id=\"cite_ref-:1_2-9\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><sup id=\"cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\">(45)<\/a><\/sup><\/li>\n<li>Diminished energy levels<sup id=\"cite_ref-:10_44-1\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup><\/li>\n<li>Changes in skin integrity with an increased risk for pressure ulcers<sup id=\"cite_ref-:10_44-2\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup><\/li>\n<li>Altered sleep patterns<sup id=\"cite_ref-:10_44-3\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup><\/li>\n<li>Increased risk for <a title=\"Falls\" href=\"https:\/\/langs.physio-pedia.com\/it\/falls-it\/\">falls<\/a><sup id=\"cite_ref-:10_44-4\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Participation_and_SCI.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/32\/Participation_and_SCI.jpg\/300px-Participation_and_SCI.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/32\/Participation_and_SCI.jpg\/450px-Participation_and_SCI.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/3\/32\/Participation_and_SCI.jpg\/600px-Participation_and_SCI.jpg 2x\" alt=\"\" width=\"300\" height=\"452\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Leisure activities in SCI<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Participation\" class=\"mw-headline\">Participation<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Participation\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=20\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Participation\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=20\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>When considering participation \/ changes in participation over time, it may be necessary to modify current leisure activities or explore new ones.<sup id=\"cite_ref-:10_44-5\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup> A study by Charlifue and Gerhart<sup id=\"cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\">(46)<\/a><\/sup> shows that the availability of resources, social support, and continued involvement in leisure activities as a person with a spinal cord injury ages correlate well with a higher quality of life.<\/p>\n<p>The healthcare provider&#8217;s role in increasing participation for ageing persons with a spinal cord injury includes:<sup id=\"cite_ref-:10_44-6\" class=\"reference\"><a href=\"#cite_note-:10-44\">(44)<\/a><\/sup><\/p>\n<ul>\n<li>Helping to modify leisure activities<\/li>\n<li>Providing strategies to overcome environmental barriers<\/li>\n<li>Promoting and prescribing <a title=\"Physical Activity Guidelines for Spinal Cord Injury\" href=\"\/Physical_Activity_Guidelines_for_Spinal_Cord_Injury\">physical activity<\/a> to this population<\/li>\n<li>Long-term involvement of health care professionals in the form of <a title=\"Introduction to Telehealth\" href=\"\/Introduction_to_Telehealth\">telerehabilitation<\/a> and outreach group programmes<\/li>\n<\/ul>\n<h2><span id=\"Resources\" class=\"mw-headline\">Resources<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Resources\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=21\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Resources\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=21\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li>Khamnon N, Amatachaya S, Wattanapan P, Musika N, Jitmongkolsri P, Kongngoen N, Haisirikul M, Jaikarsen K, Thaweewannakij T, Namwong W. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/s41393-022-00807-9\" rel=\"nofollow\">Reliability and concurrent validity of the Spinal Cord Independence Measure III among rehabilitation professionals<\/a>. Spinal Cord. 2022 Apr 27:1\u20137.<\/li>\n<li><a title=\"Physiotherapy Management of Individuals with Spinal Cord Injury\" href=\"\/Physiotherapy_Management_of_Individuals_with_Spinal_Cord_Injury\">Physiotherapy Management of Individuals with Spinal Cord Injury<\/a><\/li>\n<li><a title=\"Therapeutic Interventions for Spinal Cord Injury\" href=\"\/Therapeutic_Interventions_for_Spinal_Cord_Injury\">Therapeutic Interventions for Spinal Cord Injury<\/a><\/li>\n<\/ul>\n<h2><span id=\"References\" class=\"mw-headline\">References<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;veaction=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Spinal_Cord_Injury_Physiotherapy_Treatment_Principles&amp;action=edit&amp;section=22\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-:0-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_1-0\">1.0<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-1\">1.1<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-2\">1.2<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-3\">1.3<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-4\">1.4<\/a><\/sup><\/span> <span class=\"reference-text\">Harvey LA. <a class=\"external text\" href=\"https:\/\/reader.elsevier.com\/reader\/sd\/pii\/S1836955315001307?token=80C1C5DC27773772CE198258FAC141F58C1172F93F3E370FC83AF02A42B941C1F891A35D6DE43B4F2D8A9DD28C9FD28A&amp;originRegion=eu-west-1&amp;originCreation=20220526192404\" rel=\"nofollow\">Physiotherapy rehabilitation for people with spinal cord injuries<\/a>. Journal of physiotherapy. 2016 Jan 1;62(1):4-11.<\/span><\/li>\n<li id=\"cite_note-:1-2\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_2-0\">2.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-1\">2.1<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-2\">2.2<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-3\">2.3<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-4\">2.4<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-5\">2.5<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-6\">2.6<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-7\">2.7<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-8\">2.8<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-9\">2.9<\/a><\/sup><\/span> <span class=\"reference-text\">Harding M. Spinal Cord Injury Physiotherapy Treatment Principles Course. Physioplus 2022<\/span><\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-3\">\u2191<\/a><\/span> <span class=\"reference-text\">Reznik J, Simmons J. <a class=\"external text\" href=\"https:\/\/books.google.pl\/books?hl=en&amp;lr=&amp;id=xbXrDwAAQBAJ&amp;oi=fnd&amp;pg=PP1&amp;dq=physiotherapy+treatment+principles+spinal+cord+injury&amp;ots=2nkgy3IwmS&amp;sig=mNGU-Iu1DiNnGeF2W1IG02d5ZrI&amp;redir_esc=y#v=onepage&amp;q=physiotherapy%20treatment%20principles%20spinal%20cord%20injury&amp;f=false\" rel=\"nofollow\">Rehabilitation in Spinal Cord Injuries<\/a>. Elsevier Health Sciences; 2020 Jul 15.<\/span><\/li>\n<li id=\"cite_note-:2-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:2_4-0\">4.0<\/a><\/sup> <sup><a href=\"#cite_ref-:2_4-1\">4.1<\/a><\/sup><\/span> <span class=\"reference-text\">Khorasanizadeh M, Yousefifard M, Eskian M, Lu Y, Chalangari M, Harrop JS, Jazayeri SB, Seyedpour S, Khodaei B, Hosseini M, Rahimi-Movaghar V. Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis. J Neurosurg Spine. 2019 Feb 15:1-17.<\/span><\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-5\">\u2191<\/a><\/span> <span class=\"reference-text\">Steeves J, Kramer J, Fawcett J, Cragg J, Lammertse DP, Blight AR, Marino RJ, Ditunno Jr JF, Coleman WP, Geisler FH, Guest J, Jones L, Burns S, Schubert M, van Hedel HJA, Curt A. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/sc201099#citeas\" rel=\"nofollow\">Extent of spontaneous motor recovery after traumatic cervical sensorimotor complete spinal cord injury<\/a>. Spinal Cord 2011; 49: 257\u2013265. <\/span><\/li>\n<li id=\"cite_note-:3-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:3_6-0\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-:3_6-1\">6.1<\/a><\/sup><\/span> <span class=\"reference-text\">Kirshblum S, Snider B, Eren F, Guest J. <a class=\"external text\" href=\"https:\/\/www.liebertpub.com\/doi\/10.1089\/neu.2020.7473?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed\" rel=\"nofollow\">Characterizing Natural Recovery after Traumatic Spinal Cord Injury<\/a>. J Neurotrauma. 2021 May 1;38(9):1267-1284<\/span><\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-7\">\u2191<\/a><\/span> <span class=\"reference-text\">Kirshblum S, Botticello A, Lammertse DP, Marino RJ, Chiodo AE, Jha A. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3698852\/\" rel=\"nofollow\">The impact of sacral sensory sparing in motor complete spinal cord injury<\/a>. Arch Phys Med Rehabil. 2011 Mar;92(3):376-83.<\/span><\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-8\">\u2191<\/a><\/span> <span class=\"reference-text\">Ditunno JF Jr, Cohen ME, Hauck WW, Jackson AB, Sipski ML. Recovery of upper-extremity strength in complete and incomplete tetraplegia: a multicenter study. Arch Phys Med Rehabil. 2000 Apr;81(4):389-93<\/span><\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-9\">\u2191<\/a><\/span> <span class=\"reference-text\">Ditunno JF Jr, Sipski ML, Posuniak EA, Chen YT, Staas WE Jr, Herbison GJ. Wrist extensor recovery in traumatic quadriplegia. Arch Phys Med Rehabil. 1987 May;68(5 Pt 1):287-90. <\/span><\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-10\">\u2191<\/a><\/span> <span class=\"reference-text\">Ditunno JF Jr, Stover SL, Freed MM, Ahn JH. Motor recovery of the upper extremities in traumatic quadriplegia: a multicenter study. Arch Phys Med Rehabil. 1992 May;73(5):431-6.<\/span><\/li>\n<li id=\"cite_note-:7-11\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:7_11-0\">11.0<\/a><\/sup> <sup><a href=\"#cite_ref-:7_11-1\">11.1<\/a><\/sup><\/span> <span class=\"reference-text\">Agostinello J, Battistuzzo CR, Batchelor PE. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/s41393-018-0196-6\" rel=\"nofollow\">Early clinical predictors of pneumonia in critically ill spinal cord injured individuals: a retrospective cohort study<\/a>. Spinal cord. 2019 Jan;57(1):41-8.<\/span><\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-12\">\u2191<\/a><\/span> <span class=\"reference-text\">Warren PM, Steiger SC, Dick TE, MacFarlane PM, Alilain WJ, Silver J. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/s41467-018-06937-0\" rel=\"nofollow\">Rapid and robust restoration of breathing long after spinal cord injury.<\/a> Nature communications. 2018 Nov 27;9(1):1-4.<\/span><\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-13\">\u2191<\/a><\/span> <span class=\"reference-text\">Postma K, Haisma JA, Hopman MT, Bergen MP, Stam HJ, Bussmann JB. <a class=\"external text\" href=\"https:\/\/academic.oup.com\/ptj\/article\/94\/12\/1709\/2741898?login=false\" rel=\"nofollow\">Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial<\/a>. Physical therapy. 2014 Dec 1;94(12):1709-19.<\/span><\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-14\">\u2191<\/a><\/span> <span class=\"reference-text\">Kang SW, Shin JC, Park CI, Moon JH, Rha DW, Cho DH. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/3101835\" rel=\"nofollow\">Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients<\/a>. Spinal Cord. 2006 Apr;44(4):242-8. <\/span><\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-15\">\u2191<\/a><\/span> <span class=\"reference-text\">Cavka K, Fuller DD, Tonuzi G, Fox EJ. Diaphragm Pacing and a Model for Respiratory Rehabilitation After Spinal Cord Injury. J Neurol Phys Ther. 2021 Jul 1;45(3):235-242.<\/span><\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-16\">\u2191<\/a><\/span> <span class=\"reference-text\">Barbosa PH, Glinsky JV, Fachin-Martins E, Harvey LA. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/s41393-020-00610-4\" rel=\"nofollow\">Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review<\/a>. Spinal Cord. 2021 Mar;59(3):236-47.<\/span><\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-17\">\u2191<\/a><\/span> <span class=\"reference-text\">Popa C, Popa F, Grigorean VT, Onose G, Sandu AM, Popescu M, Burnei G, Strambu V, Sinescu C. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3019008\/\" rel=\"nofollow\">Vascular dysfunctions following spinal cord injury<\/a>. J Med Life. 2010 Jul-Sep;3(3):275-85. 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J Neurotrauma. 2018 May 1;35(9):1091-1105.<\/span><\/li>\n<li id=\"cite_note-:4-19\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:4_19-0\">19.0<\/a><\/sup> <sup><a href=\"#cite_ref-:4_19-1\">19.1<\/a><\/sup><\/span> <span class=\"reference-text\">Sachdeva R, Nightingale TE, Krassioukov AV. <a class=\"external text\" href=\"https:\/\/www.mdpi.com\/1422-0067\/20\/10\/2464\/htm\" rel=\"nofollow\">The Blood Pressure Pendulum following Spinal Cord Injury: Implications for Vascular Cognitive Impairment<\/a>. 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NeuroRehabilitation. 2004;19(2):91-101.<\/span><\/li>\n<\/ol>\n<\/div>\n<p><!-- \nNewPP limit report\nCached time: 20220725180322\nCache expiry: 0\nDynamic content: true\nComplications: ()\nCPU time usage: 0.202 seconds\nReal time usage: 0.215 seconds\nPreprocessor visited node count: 761\/1000000\nPost\u2010expand include size: 133\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 3\/40\nExpensive parser function count: 0\/100\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 28373\/5000000 bytes\n--><br \/>\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00%   16.250      1 Special:Contributors\/Spinal_Cord_Injury_Physiotherapy_Treatment_Principles\n100.00%   16.250      1 -total\n--><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Original Editor &#8211; Ewa Jaraczewska based on the course by Melanie Harding Top Contributors &#8211; Ewa Jaraczewska, Jess Bell and Kim Jackson Contents 1 Introduction 1.1 SCI Physiotherapy Treatment Basic Principles 2 Early Management 2.1 Neurological Recovery 2.2 Prevention of Complications 2.2.1 Respiratory Complications 2.2.2 Integumentary (Skin) Complications 2.2.3 Cardiovascular Complications 2.2.4 Musculoskeletal Complications 2.2.5 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3316","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/3316","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/comments?post=3316"}],"version-history":[{"count":3,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/3316\/revisions"}],"predecessor-version":[{"id":14229,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/3316\/revisions\/14229"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/media?parent=3316"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}