It is important to note: we are focusing on patients with complete SCI injuries.
For incomplete SCI injuries, the prognosis is much better.
The following are some approaches to comprehensive rehabilitation training for patients with different injury levels.
1, completely unable to take care of their own lives, almost all rely on the help of others C4 and above injury patients.
The following training can be done for such patients.
Early respiratory training;
Active slant bed standing training;
Training for endurance in a wheelchair;
Learn to control the electric wheelchair with ventilator by tongue and jaw;
Use a mouth stick or head stick to perform various activities within the patient’s capabilities;
Control the “Environmental Control Unit” (ECU) with the mouth stick, head stick or jaw;
Learn to control the tiltable backrest power wheelchair to decompress the hip periodically;
2. Patients who are basically unable to take care of themselves and need a lot of help with C5 injury.
The following training can be done for such patients.
Training for endurance in a low-backed wheelchair;
Learning to use and maneuver the wheelchair;
Learn to perform forward hip decompression with a lasso attached to the wheelchair post;
Learn to apply the BFO;
Learning to use the ratchet mechanism of the wrist-hand orthosis;
Inclined bed standing;
Muscle strength training of residual muscles: biceps, deltoids, etc;
Endurance training and hand function reconstruction.
Physical therapy such as myoelectric biofeedback and functional electrical stimulation (FES), etc.
3, basically can take care of their own lives, need a moderate amount of help C6 injury patients.
The following training can be done for such patients.
Add the following in addition to the C5 plane training content.
Drive a normal wheelchair by hand;
Practice unilateral alternate hip decompression;
Learning to compensate for hand function with a wrist-actuated orthosis;
Muscle strength training: biceps, radial wrist extensors;
Use skateboard to do various transfer movements training.
4.Patients with C7 injury who can basically take care of themselves and need little help and have the possibility of being independent in a wheelchair.
The following training can be done for such patients.
Sitting position or decompression in a wheelchair ;
Muscle training: C7 should be vigorously trained deltoids, pectoralis major, triceps, latissimus dorsi;
Endurance training;
Inclined board bed stand;
Use the skateboard to do various transfer movements training;
Weak grip learning with wrist-driven grip support and endurance training;
Physical therapy such as myoelectric biofeedback and FES;
Hand function reconstruction.
5.Patients with C8-T2 injury who can take care of their own life and be independent in wheelchair but cannot walk and can only do therapeutic standing.
The following training can be done for such patients.
Strengthen the strength intensity and endurance training of the upper limb muscles;
Bracing and decompression exercises in the seated position;
Transfer training;
Practice wheelchair balancing on the rear wheels and getting on and off the roadside stones, which are more skillful wheelchair handling techniques;
Use the long lower limb support to stand in the parallel bar training.
6.Patients with T3-T12 injury who can take care of themselves and are independent in wheelchairs and can walk therapeutically.
The following training can be done for such patients.
In addition to the training done in patients with C8-T2 mainly performed.
A.Standing training
B. Walking training.
①.Standing balance
②.Step training
③. Repeated stride training with crutches or orthoses outside the double bar
④.Step to the outside
⑤.Step to the inner side
7.Patients with L1-2 impairment who can take care of themselves, are independent in wheelchairs, and can perform functional walking at home.
The following training can be done for such patients.
Walking training;
①.Step training;
②. Repeat stepping training outside the double bar with a double crutch or orthosis;
③.Step to the outside;
④.Try to walk on uneven surface;
⑤.Standing up from the chair alone with hands;
⑥.Going up and down stairs;
⑦.Going up and down slopes;
⑧.Fall down safely and get up again (i.e. fall training).
8.Patients with L3 or lower impairment who can take care of themselves and can walk functionally in the community.
The characteristics of such patients.
The following training can be done for such patients.
The use of sandbags and other equipment to perform the residual muscle strength training of both lower limbs;
Four-point gait exercises with crutches;
Use cane exercises.