With the continuous occurrence of spinal cord injuries, more and more attention is being paid to the treatment methods for spinal cord injuries. Occupational therapy, with the main purpose of enabling patients to adapt to their personal, family, social and labor needs after discharge from the hospital, is gaining importance. In addition, occupational therapy rooms provide patients with simple aids or home modifications to facilitate the successful completion of family life activities. Rehabilitation is a lifelong process that requires readjustment in every aspect of life. The following is a brief description of occupational therapy related to spinal cord injury.
The purpose of occupational therapy: prevention of complications, training of residual functions, self-care of daily life, return to the family, and return to society.
Treatment stages.
Phase I: bedside training is the main focus; prevention of joint contracture, swelling and deformation and other secondary diseases as the main content; this phase prohibits the movement of the injured part of the joint and the movement of the injured part of the weight-bearing or the need to do resistance movement.
1, good limb position maintenance: the occupational therapist should choose the appropriate type of splint if necessary, and accurately combine and make the splint suitable for the patient’s functional needs. For example, the ankle joint should be kept in a neutral position by means of an ankle-foot orthosis or by wearing a “thong shoe”.
2.Maintenance of joint mobility: maintenance of joint mobility of all extremities.
3.Preventing hand swelling: when lying in bed, use a pillow to lift the upper limb above the shoulder to promote venous and lymphatic return.
4.Muscle strength maintenance and intensive training: mainly intensive training for residual muscle strength;
5.Production of self-help tools: According to the patient’s functional level, the “call system” that can be manipulated can be made to observe the condition in time, and the switch and start of the common household items can be modified to enable partial self-care.
6.Psychological support: In the initial stage, patients may not be able to accept it and need the joint support of family and society, especially the communication and encouragement among patients.
Phase II: Acquisition of various abilities is the main focus; the most important thing at this time is the prevention of pressure sores on the sciatic bone, femoral ridge, sacrum, and various bone protrusions, while carrying out various functional training that are compatible.
1. Adaptation training from prone to sitting position. Initially, it usually causes postural hypotension, which is usually manifested by pallor, cold sweat and vertigo. The postural adaptation training can be performed on the electric rising bed, and the angle can be adjusted to the upright position according to the situation.
2.Maintenance of joint mobility, expansion training and strengthening training of muscle strength;
3.Functional training: This training should be started as early as possible, from simple to complex functional activities to master the ability to control movement in various positions. For example: the use of skateboards for bed – wheelchair transfer; ground – wheelchair transfer method.
4, the choice of orthotic devices: according to the different stages of injury, choose different orthotic devices.
The third stage: adapt to the family, adapt to the training of society.
1, for the living environment, the following adjustments need to be made.
(1) The bottom of the sink needs to be enough space to accommodate both lower limbs in the wheelchair, so that the patient’s body is closer to the sink;
(2) The faucet needs to be adjusted and replaced accordingly;
(3) Nail clipping and hair combing generally require the use of self-help tools.
2. Psychological and social support: In addition to functional training, emphasis should be placed on the patient’s adaptation in psychosocial aspects, as well as on the adaptation of the patient’s family members. The patient and the patient’s family members should be absorbed as members of the treatment team at the beginning and actively participate together, analyze the problem, and find a solution, and evaluate the results.
3. Occupational preparation: Occupational preparation is not only limited to the physical aspects of functioning, but also includes various factors such as mental endurance, degree of energy concentration, time perception, mental state, and the ability to interact and cooperate with others.