PHYSIOTHERAPY FOLLOWING A SPINAL CORD INJURY IN LONDON AND ESSEX
Sunday 30th June 2024
Gemma B
PHYSIOTHERAPY FOLLOWING A SPINAL CORD INJURY IN LONDON AND ESSEX
WHAT IS A SPINAL CORD INJURY?
The spinal cord is a long structure through which sensory and motor information pass between the brain and the body. The column is divided into regions: cervical (7 vertebrae), thoracic (12 vertebrae), lumbar (5 vertebrae), sacral (5 fused vertebrae) and coccygeal (4 fused vertebrae). An injury to the nerves in the spinal canal may affect the conduction of signals that control sensations, movements and the ability to control the bowel and bladder. There are two types of injury: incomplete and complete, which can prevent transmission of all or just some neural messages across the site of the lesion.
WHAT CAUSES A SPINAL CORD INJURY?
The causes of a spinal cord injury vary. Approximately 84% are as the result of high energy trauma such as a road traffic accident, violence, sporting injury or a fall. 1/3 of individuals with acute spinal cord injury also have other associated major injuries or other spinal fractures so a through medical assessment is essential. A spinal cord injury could also be because of non-traumatic causes such as degeneration, inflammation, vascular, tumour, infection or tuberculosis.
HOW IS IT DIAGNOSED?
A spinal cord injury is typically diagnosed through a combination of physical examinations and imaging. Imaging may include CT scans=https://www.nhs.uk/conditions/ct-scan and MRI scans. Using this information, the team should be able to determine the extent and location of injury.
WHAT IS THE PROGNOSIS?
The prognosis will vary depending on the severity and level of injury. The functional outcomes depend on many individual factors including age, health, pre-morbid function, co-morbidities, associated injuries, secondary complications, motivation and psychosocial well-being. Accurate prediction of outcomes based on early examination is limited.
The majority of recovery of function occurs within the first 6 months. In incomplete injuries, it is widely accepted that recovery can continue up to 2 years. In some cases, recovery can continue after that.
WHAT IS MEANT BY THE LEVEL OF INJURY?
The level of spinal cord injury refers to the specific segment affected. "C" refers to the highest part of the spine known as the cervical spine (Affects approximately 50%), "T" refers to the middle portion of the spine known as the thoracic spine (Affects approximately 35%), "L" refers to the lower part of the spine, the lumbar spine (Affects approximately 11%) and "S" refers to the sacrum, a triangular bone at the base of the spine (Affects approximately 4%). The most used classification system is known as the ASIA scale.
Health professionals can use the level of injury to determine treatment options and potential outcomes for individuals. Most individuals regain one level of motor function from their initial ASIA classification that is completed within 72 hours of injury. Approximately 50% initially diagnosed with and ASIA B or C can improve over the first 3 months by 1 ASIA level.
HOW IS IT TREATED MEDICALLY?
Medical treatment for spinal cord injury is directed at minimising further damage while managing other injuries and optimising neurological recovery. Treatment will depend on the stability of the injury, the level of compression and the individual’s underlying health. Early management includes keeping oxygen, carbon dioxide and blood pressure within a normal range. Individuals who are managed conservatively, are often treated with spinal orthosis to immobilise the neck or trunk. Individuals may require surgery to relieve direct pressure on the spinal cord or prevent secondary injury.
WHAT IS REHABILITATION?
Gold standard rehabilitation involves a multidisciplinary approach including Physiotherapy, Occupational therapy and Psychological support to help individuals regain function, independence and quality of life. At Estuary Physio, our role is to exploit active recovery as well as minimise the risk of secondary complications that can occur as a result of the injury. Our treatment is based on up-to-date research. Treatment might include a combination of land based and hydrotherapy sessions. Sometimes, we will recommend going to specialist centre with equipment.
WHAT IS GOAL SETTING?
Goal setting can be as simple as a conversation between therapist and individual or can be more complex and a formal process whereby the individual and multidisciplinary team come together, along with family if appropriate, to discuss goals. It ensures goals are realistic, engaging, directed towards things that are important to the individual. These goals can also be used to evaluate the effectiveness of a current treatment programme.
WHAT EQUIPMENT IS NEEDED?
Every spinal cord injury is different, so adaptive tools may benefit some more than others. Assistive devices are convenient, keep individuals safe and promote independence. This can be helpful but should only be used if needed, for that reason we recommend that individuals are assessed and recommended equipment on a case-by-case basis. If a wheelchair is required, our Physiotherapy team are able to work closely with a Neurological Occupational Therapist to help make recommendations on wheelchair prescriptions.
WHAT EQUIPMENT CAN HELP ME WALK?
- A body weight support device lifts part of your weight through a harness as you walk. This could be on a treadmill, parallel bar or on the ground.
- Assistive devices such as walking frame, walking sticks, tripods and crutches can all be used to help support with walking.
- Orthotics may be used to support the ankle, right up to the trunk if required.
- Pads can be attached to the skin to stimulate a muscle contraction and generate joint movements.
- Robotic Exoskeleton combines manual assistance with robotics to power leg movements.
HELPFUL RESOURCES:
Aspire Leisure Centre
NHS - Spinal Injuries Association
OTHER CONDITIONS WE TREAT:
We understand that our clients often have a range of medical conditions. Our therapists have a broad range of backgrounds. For example, someone who has a spinal cord injury may have a traumatic brain injury and benefit from an approach combining specialists in both areas. Find a list of our services here.
Booking an appointment
If you would like to find out more about Estuary Physios musculoskeletal service, please get in touch with us today and speak with one of our clinicians.
Medical Review
The information on this page has been reviewed for accuracy by Barry Ford BSc MCSP, Physiotherapist
