Spinal Cord Injury by Physiotherapists
Spinal cord injury (SCI) is an uncommon but very serious condition usually from a high velocity incident but can also be caused by 00004000 tumours, infections and loss of blood supply to the spinal cord. It occurs predominantly in younger persons who undertake more risky activities but can present at any age, with motor vehicle accidents the most common cause. SCI needs intensive and skilled management from a multidisciplinary team to achieve the best outcome of independence for the patient. The resulting injuries from this condition are known as paraplegia or quadriplegia.
The initial medical evaluation is performed to establish the respiratory status of the patient and deal with any other of the likely multiple injuries. Once the patient is stabilised the doctors try and work out the level in the spine where the damage has occurred, an important fact as it relates closely to medical and therapy management. A low lumbar fracture will have no effect on the arms or the ability to breathe so the patient will have good trunk and arm power and the aerobic ability to develop independence. Cervical and upper thoracic injuries impair the respiratory ability of the patient and limit arm function, making rehabilitation much harder.
Assessment of the patient's respiratory status is the initial concern of the physiotherapist, often in the intensive care unit. The physiotherapist will attempt to encourage the patient to expand their lungs, deep breathe and cough any secretions up to clear their chest. Paralysis of the lower trunk can reduce propulsive force and thereby the effectiveness of coughing, a process which the physiotherapist helps by stabilising the lower abdomen during attempted coughing. Suction may be needed in severe cases and coughing can be promoted by using a cough assist machine.