A spinal cord injury (SCI) happens when there’s damage to your spinal cord a thick bundle of nerve fibers that allows your brain to communicate with other nerves almost everywhere else in your body. These injuries can range from minor and manageable to severe and permanent.

The spinal cord is one of the two components of your central nervous system Your nervous system is like a multilane expressway to and from your brain, the other component of the CNS. It has lanes for traffic leaving your brain and other lanes for traffic heading to your brain.

Your spinal cord connects to your spinal nerves, which are like on- and off-ramps that connect to peripheral nerves that branch out everywhere else in your body. Nerve signals are the cars that travel this expressway and use those on- and off-ramps.

Spinal cord injuries are like closures that affect the lanes in this expressway. But unlike a real-life expressway, the spinal cord has no detours. The traffic that uses the closed lanes can’t reach where it’s going. If the damage is severe enough, the closure might be permanent.

PROBLEMS ASSOCIATED WITH THIS CONDITION

Spinal cord injuries (SCI) can lead to a variety of problems, depending on the severity and location of the injury. Common issues associated with SCI include:

• Loss of Movement: This can range from partial to complete paralysis, affecting different parts of the body depending on the injury’s location.
• Loss of Sensation: This includes changes in the ability to feel heat, cold, and touch.
• Bladder and Bowel Dysfunction: Loss of control over bladder and bowel functions is common.
• Pain: This can include neurogenic pain (caused by nerve damage) and musculoskeletal pain.
• Spasms and Reflex Activities: Exaggerated reflex activities or spasms can occur.
• Sexual Dysfunction: Changes in sexual function, sensitivity, and fertility can result from SCI.
• Respiratory Issues: Difficulty breathing, coughing, or clearing secretions from the lungs can occur, especially if the injury is in the upper spinal cord.
• Gait Disturbances and Soft-Tissue Contractures: These can affect mobility and lead to long-term complications.
• Mental, Emotional, and Social Effects: SCI can lead to significant changes in mental health and social interactions.

HOW CAN THESE DIFFICULTIES IMPACT ON FUNCTION?

Spinal cord injuries (SCI) can significantly impact various aspects of an individual’s function. Here are some ways the problems associated with SCI can affect occupational performance:

• Loss of Movement: This can lead to difficulties in performing daily activities such as dressing, grooming, and transferring from one position to another. Individuals may require assistive devices or adaptive techniques to regain some level of independence.
• Loss of Sensation: This can increase the risk of injuries, such as burns or pressure sores, as individuals may not be able to feel pain or temperature changes. It can also affect fine motor skills, making tasks like writing or buttoning clothes challenging.
• Bladder and Bowel Dysfunction: This can lead to incontinence or the need for catheterization, which can be time-consuming and impact social participation and self-esteem.
• Pain: Chronic pain can limit an individual’s ability to engage in activities and can lead to decreased participation in work, leisure, and social activities.
• Spasms and Reflex Activities: These can interfere with movement and positioning, making it difficult to perform tasks that require fine motor control or sustained positions.
• Sexual Dysfunction: This can affect intimate relationships and emotional well-being.
• Respiratory Issues: Difficulty breathing can limit physical activity and endurance, impacting an individual’s ability to perform tasks that require sustained effort.
• Cardiovascular Dysautonomia: Conditions like autonomic dysreflexia can cause sudden changes in blood pressure, leading to dizziness or fainting, which can be dangerous during activities.
• Gait Disturbances and Soft-Tissue Contractures: These can affect mobility and the ability to perform tasks that require standing or walking.
• Mental, Emotional, and Social Effects: SCI can lead to depression, anxiety, and social isolation, which can further impact an individual’s motivation and ability to engage in daily activities.

OCCUPATIONAL THERAPY TREATMENT AVAILABLE

Occupational therapy (OT) plays a crucial role in the rehabilitation of individuals with spinal cord injuries (SCI). Here are some of the key treatments and interventions available:

Activities of Daily Living (ADL) Training: Occupational therapists help individuals relearn and practice essential daily activities such as dressing, grooming, toileting, and feeding. This training often involves the use of adaptive equipment to enhance independence.

Restorative Strategies: These focus on recovering physical functions affected by SCI. Through task-specific, highly repetitive exercises, OT can help spark neuroplasticity, allowing the central nervous system to rewire itself and regain function.

Compensatory Strategies: When restorative strategies are not sufficient, compensatory techniques are employed. This may include modifying the environment, adapting activities, or using assistive devices to help individuals perform tasks despite their limitations.

Splinting and Positioning: Occupational therapists provide splints and exercise programs to maintain functional positioning, prevent contractures, and maintain aesthetics.

Environmental Modifications: OT practitioners assess and modify the individual’s home and work environments to ensure accessibility and safety. This can include installing ramps, grab bars, and other adaptive equipment.

Education and Training: Occupational therapists educate individuals and their families about SCI, its effects, and how to manage daily activities. This includes training on the use of adaptive tools and techniques to maximize independence.

Psychosocial Support: OT addresses the mental, emotional, and social aspects of SCI. This includes providing support for coping with changes in function, facilitating social participation, and promoting mental well-being.

Community Reintegration: Occupational therapists assist individuals in returning to their communities and resuming roles in work, education, and leisure activities. This may involve vocational training and support for finding employment.

Pain Management: OT can help manage chronic pain through various techniques such as relaxation exercises, ergonomic adjustments, and adaptive strategies to reduce strain during activities.

Respiratory Therapy: For individuals with high-level SCI, OT may include respiratory therapy to improve breathing, coughing, and clearing secretions from the lungs.

PHYSIOTHERAPY TREATMENT AVAILABLE

For people with a spinal cord injury, NDIS physiotherapy will involve:

• Discussing your health history, therapy goals and circumstances (such as your home and work situation, availably of support, and other factors which may influence how therapeutic support is delivered).
• An assessment of your current functional capacity and ability to participate in important activities.
• Setting relevant goals.
• Identifying any barriers that could limit the achievement of your goals.
• Identifying and delivering physiotherapy treatments (such as strengthening exercises, pain management techniques, and motor skill development) to support achievement of your goals.
• Measuring therapy outcomes and adjusting goals and treatments accordingly.

Common examples of physiotherapy for spinal cord injury include:

Gait (walking) training

If you are able to walk, your physiotherapist might design a program to enhance the quality or speed of your gait, or your ability to walk longer distances. This may involve the use of splints or assistive devices (such as crutches) if needed. It might also include exercises designed to strengthen specific muscle groups or improve your balance to foster better mobility.

Wheelchair training

If you’re using a wheelchair, physiotherapy might involve working on your seating position and posture to optimise efficiency and comfort. You might also practice using the wheelchair in your community, and over different terrains such as slopes, gutters, and uneven ground. Your physio might also work on your endurance, falls prevention/recovery techniques, and support you to get involved in wheelchair sport.

Bed mobility and transfer training

An SCI can affect your ability to move around in bed and transfer safely and effectively. Your physiotherapist can train you to roll over and sit up in bed, and to transfer in and out of bed and on and off chairs and the toilet.

Balance training

Muscle weakness and sensory changes affect balance, so physiotherapy may involve training to maintain or improve your balance in sitting and standing. Regular standing practise can help with improving spasticity, blood pressure control, bone mineral density and bladder and bowel function. If independent standing isn’t possible, this may be achieved using assistive devices such as splints, frames, or a standing wheelchair.

Maintaining fitness and physical health

Regular exercise is an essential part of a healthy lifestyle and helps to reduce your risk for developing numerous health conditions, including type 2 diabetes and cardiovascular disease. However, research also shows that people with a spinal cord injury have lower average levels of physical activity compared to the general population.

Physiotherapy can help you stay healthy and fit by supporting you to get involved in a regular exercise routine, which may include the use of adaptive equipment. An accredited exercise physiologist can also help with this.

Maintaining mental health

Similarly, research shows that compared to uninjured people, those living with a spinal cord injury are at a higher risk of developing mental health conditions (including depression and anxiety), along with higher levels of distress and lower levels of life satisfaction. Regular exercise is proven to support mental wellbeing and positive mood, and to ease anxiety and depression symptoms.

Contracture prevention

Paralysis and spasticity can lead to muscle shortening and joint stiffness, which can adversely affect function. Physiotherapy techniques such as positioning and stretches can reduce the risk of developing contractures or help to manage existing ones.

Strength training

Muscle weakness is one of the primary features of spinal cord injury and physiotherapy usually involves strengthening exercises. Your strength training program will be focused on helping you achieve a goal, such as improving your shoulder strength for wheelchair mobility or improving leg strength for standing balance and walking.

Breathing function

A spinal cord injury to the neck can affect the muscles involved in breathing, potentially leading to problems such as chest infections. Physiotherapy can help with training in breathing techniques and assisted coughing.

Pain management

Pain is very common in people living with a spinal cord injury, with up to 70% experiencing pain for more than six months. This includes musculoskeletal pain caused by muscle spasms or altered use of the arms or shoulders, along with pain caused by changes in nervous system function (known as neuropathic pain).

Physiotherapy techniques such as pain education, exercises, and manual therapies may help to relieve pain and restore function.