2 Physiotherapy Exercises for Spinal Cord Injury

A.STRENGTHENING EXERCISES:

These consist of exercises to strengthen the lower limb muscles in case of lower motor neuron type of palsy. Strengthening of the upper limb is essential as this will help the patient to enable efficiency in activities like transferring,use of walking aids like crutch, and also helps in over all functional rehabilitation. Strengthening of trunk muscles is essential for better trunk control and stability which will help in better balancing in sitting or standing.

 Quadratus lumborum is the most important trunk muscle in case of spinal cord injury that has got no hip flexors because it enables the patient to hike the pelvis.

Use of tilt table: In the initial stages when there is no trunk stability patient can be trained for weight bearing on lower limbs by using tilt table.In this the patient’s trunk and the lower limbs are strapped to the tilt table and then the table is tilted such that the patient is in erect position.Moreover tilt table can also be used in the initial stage to prevent the chances of orthostatic hypotension. 

For preventing hypotension in the initial stages the patient is made to lie on the tilt table and the table is gradually tilted everyday at increasing range so that the autonomous nervous system is made to get conditioned as a result the reflex vasoconstriction can bestimulate d in erect position. This will help in preventing or treating orthostatic hypotension.

Transfer activities: To make the patient independent in ADL, it is necessary to train him to use the wheelchair. Easy ways of transfer from bed to wheelchair from wheelchair to low stool and from low stool to floor and back to wheel chair should be taught to patient. The patient also should be trained for balance in sitting position if his trunk muscles are also affected. Patient should also be taught various ways of locomotion in emergency situation like shuffling in sitting position, semi crawling in prone position with the help of weight bearing on the forearm.

B.GAIT TRAINING:

Spinal cord injury can be made to ambulate with the help of crutches and calipers. There are various types of gait that can be taught with the assistance of axillary crutches like shuffling gait, dragging gait and swing gait. However walking should be trained in a gradual manner. The lower limbs are supported with appropriate orthosis and the patient is made to sand in the parallel bar. The patient is advised to do hyperextension at the hips and trunk to maintain erect posture and balance. 

Hyperextension of the hip locks the hip with the help of ischio-femoral ligament and thus provides stability. Once the patient is confident in standing gait training is started by instructing the patient to lift one leg and take weight on other extremity. Stepping forward is taught next and the physiotherapist progresses to walking in parallel bars.After this patient is made to walkout of the parallel bar with the help of walker.Depending on the trunk stability and confidence of the patient progression can be made to axillary crutches. Elbow crutches or canes can be given only if the upper limb musculature becomes quite strong to weight bear efficiently and within the safely limit of the patient. 

Even if the patient is not going to be a community walker, it is important to give him gait training so that can achieve some independency in activities of daily living and to maintain his self-esteem. Weight bearing on the lower limbs in erect posture also acts to slowdown the process of osteoporosis and prevent tightness.

Use of orthosis or appliances: lower limb orthosis or gaiter may be used depending on the muscular status in the lower limbs.