I. Definition: The spinal cord is the channel that connects the central nerves to the peripheral nerves and is a key link in transmitting commands from the brain to all parts of the human body. A spinal cord injury is usually a result of an external blow to the spine, resulting in a vertebral fracture that causes damage to the spinal cord. It can also be a consequence of diseases such as myelitis, spinal cord tumors, and spinal cord vascular lesions.
Second, the clinical manifestations: the main functional disorders of spinal cord injury
1, paralysis: thoracic and lumbar injuries lead to paralysis of the lower extremities, and neck injuries can lead to quadriplegia.
2, sensory impairment: paralyzed limbs are usually accompanied by corresponding sensory impairment, or even loss.
Urinary and fecal incontinence: urinary incontinence is very common, and there is often difficulty in urination. The stool is usually constipated and can also be incontinent.
4.Pain: Many patients have pain below the injury site.
5, muscle spasm: spinal cord injuries above the waist often appear muscle spasm, affecting limb movement, care, and sometimes can cause pain.
6, pressure sores (bedsores) is the most common complications of spinal cord injury, which can lead to infection and activity disorders.
7, psychological disorders. Most patients have varying degrees of psychological disorders, and this aggravates the condition.
8, other: infection, autonomic regulation disorders, heterotopic ossification, breathing difficulties, etc.
Third, rehabilitation assessment.
1, the assessment of the degree of spinal injury.
The relationship between the spinal injury plane and prognosis
Plane force mobility ability life ability
Cervical vertebrae 1-4 depend on diaphragmatic pacing to maintain respiration, and can be manipulated in a voice-activated manner completely dependent on
Cervical spine 4 Use of a powered high back wheelchair, sometimes requiring assisted breathing Highly dependent
Cervical spine 5 Hand-operated high-backed wheelchair on a flat surface, requiring upper extremity aids Mostly dependent
Cervical 6 Hand-operated wheelchair, wears tops independently, can drive specially adapted cars Moderate dependence
Cervical spine 7-8 Wheelchair functional, independent bed-wheelchair/toilet/bathroom transfer Mostly self-care
Thoracic spine 1-6 independent in wheelchair, walking short distances with long-legged orthoses mostly self-care
Thoracic spine 12 long-legged orthopedic brace for walking with crutches, wheelchair required for long-distance mobility Basic self-care
Lumbar spine 4 short-legged orthopedic device to support walking with a cane, do not need a wheelchair Basic self-care
3.Assessment of activities of daily living
Items: bowel movement, urination, repair, toilet use, eating, transferring, walking, dressing, stair climbing, bathing, etc.
IV. Timing of rehabilitation treatment
The sooner you start rehabilitation after spinal cord injury, the better. Generally, 7-10 days after fracture fixation or spinal trauma, non-traumatic spinal cord injury (myelitis, etc.) can be treated in the rehabilitation medicine department when the condition is stable (usually around 10 days). As for the early treatment at the bedside, it should be done even earlier. Early treatment can effectively avoid comorbidities, such as pressure sores, pneumonia, urinary tract infections, etc. It can also effectively improve the patient’s state of mind.
V. Potential for rehabilitation treatment
Patients with spinal cord injury have a strong potential for recovery. Generally, the early recovery process is completed within a few days to 6 months. Patients can also have further recovery in the following 2 years or so. The presence of early movement of the distal limb, such as active movement of the toes, often predicts good recovery potential. It is important to note that spastic movements are of no prognostic value. Those with sensation in the paralyzed area have a better chance of recovery of motor function. Areas with normal sensation have a greater than 50% chance of motor recovery. Active participation in functional exercise is the most powerful recovery factor. Every patient has to make a 100% effort for a 1% hope. Even if the disease history is long, there must be great potential to be realized without rehabilitation.
VI. Features of rehabilitation treatment
Comprehensive rehabilitation is the most important feature. The hospital will ensure the use of various effective technical means so that all patients can receive the most reasonable and personalized rehabilitation treatment. It will not only guarantee the efficacy of treatment during hospitalization, but also devote itself to establishing a system of lifelong services for patients to ensure that they receive timely rehabilitation guidance and achieve the best short-term and long-term rehabilitation effects. The specific contents of rehabilitation treatment include.
1.Physical therapy: including muscle strength training, balance and coordination training, standing and walking training, wheelchair training, posture and transfer training, weight reduction training, physiotherapy, myoelectric biofeedback therapy, etc.
2.Operational therapy: including activities of daily living training, recreation and work training, etc.
3.Orthotic application: including ankle-foot orthosis, knee-ankle-foot orthosis, interactive walking orthosis, upper limb orthosis, etc.
4.Psychotherapy: including psychological guidance, biofeedback therapy, etc.
5.Chinese traditional rehabilitation treatment: including acupuncture, medicine, manipulation treatment, etc.
6.Pressure sore treatment: including pressure treatment, trauma treatment, physiotherapy, nutritional support, etc.
7.Pain management: including drugs, closure, physiotherapy, psychological guidance, etc.
8.Spasm management: including removal of causative factors, oral medication, nerve block, retraction training, etc.
9, incontinence treatment: available artificial body nerve – visceral nerve reflex arc surgery treatment. Another available home-based catheterization. Cystostomy, etc.
10, sexual dysfunction and fertility treatment: including drugs, appliances, injections, behavioral therapy, psychotherapy, artificial fertility techniques, etc.