How is NeuroRehabilitation planned after a spinal cord injury?
A spinal cord injury (SCI) can affect movement, sensation, breathing, blood pressure, bladder, bowel, skin and sexual function below the level of injury. Planning NeuroRehabilitation starts with understanding the injury and the person’s goals.
Understanding the injury
The level of injury (cervical, thoracic or lumbar) and whether it is complete or incomplete are assessed with a standardised neurological examination. A review in Nature Reviews Disease Primers describes diagnosis based on a thorough history, a standardised neurological examination and imaging of the spinal cord, and emphasises that managing complications such as bowel and bladder dysfunction, pressure sores and infections is key [1].
Main components of the plan
- Preventing complications: skin care and pressure relief, bladder and bowel programmes, breathing exercises, prevention of blood clots, joint mobility and management of spasticity and pain.
- Mobility: strengthening, sitting balance, transfers, wheelchair skills and, where possible, standing and walking training. In some incomplete injuries, robotic or body-weight-supported gait training may be considered as part of physiotherapy. A Cochrane review of locomotor training after spinal cord injury found the evidence inconclusive: no one training approach, including robotic-assisted training, was shown to improve walking more than other forms of physical therapy, and larger trials are needed [2].
- Arm and hand function: especially important in cervical injuries, with occupational therapy and assistive devices.
- Daily life: self-care, home adaptations, return to work or study, and psychological support for the person and family.
A team approach over time
NeuroRehabilitation after SCI involves physicians in physical medicine and rehabilitation, physiotherapists, occupational therapists, nurses, psychologists, urologists and other specialists as needed. Goals change over time, so regular follow-up continues long after the initial NeuroRehabilitation period.
Frequently asked questions
Can function change after a spinal cord injury? This depends mainly on the level and completeness of the injury. Some people, especially with incomplete injuries, regain some function; others focus on independence with adapted techniques. An individual examination is needed to discuss realistic goals.
Is NeuroRehabilitation only about walking? No. Bladder, bowel, skin, breathing, pain, arm function and mental health are equally important parts of the plan.
See also: Spinal cord injury guide · Who plans and supervises the programme?
Please note: NeuroRehabilitation results vary from person to person. What is possible for an individual depends on their condition, and any plan requires an individual medical assessment.
Assessment and contact
This page is general health information and does not replace an in-person examination. In an emergency, call your local emergency number.
Sources
- Ahuja CS, et al. Traumatic spinal cord injury. Nat Rev Dis Primers. 2017. PMID: 28447605
- Mehrholz J, et al. Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev. 2012. PMID: 23152239