Spinal cord injury is caused by various pathogenic factors that damage the structure and function of the spinal cord, resulting in impairment of spinal cord function (motor, sensory, firing, diaphoresis, sexual function, psychological, etc.) below the level of injury, and it is a serious disabling injury that often results in varying degrees of quadriplegia or paraplegia, severely affecting the patient’s ability to care for himself and social activities. About 70% of spinal cord injuries are traumatic: traffic accidents, work-related injuries, sports injuries, etc. The main causes of non-traumatic spinal cord injuries are cervical spondylosis, spinal cord cavitation, spinal cord tumors, poliomyelitis, tuberculosis, and deformities. The most vulnerable parts of the spine are the lower cervical spine 5~7, the middle thoracic spine 4~7, and the thoracolumbar spine 10~l2. Fabienne is divided into tetraplegia and paraplegia according to the level of spinal cord injury: tetraplegia: complete or incomplete paralysis of the limbs and trunk (including the respiratory muscles), caused by cervical marrow injury. Paraplegia: is a complete or incomplete paralysis of the lower extremities and trunk, caused by injury to the thoracolumbar spinal cord. When a spinal cord injury occurs, the patient enters a state of “spinal shock” in which the skeletal muscles innervated by the spinal cord below the level of the injury become hypertonic or disappear, and reflexes disappear. After spinal cord injury, in addition to motor and sensory dysfunction, it often causes a series of systemic changes and complications. Pressure sores, also known as decubitus ulcers, are a major comorbidity of spinal cord injury and are caused by tissue necrosis due to impaired local blood circulation as a result of excessive pressure on local tissues. Decubitus ulcers mainly occur on bony protrusions that are under constant pressure in the prone or sitting position. The most common sites are the sacrococcygeal region, greater trochanter, sciatic tuberosity, knee, fibula, ankle, heel, and fifth metatarsal. The occipital region and elbow are also at risk for decubitus ulcers in people with cervical marrow injuries. Decubitus ulcers can also occur in the ribs, spine and anterior and posterior iliac crest if the patient uses a plaster undershirt. The use of braces, casts, splints, etc. on paralyzed limbs can also cause decubitus ulcers. Decubitus ulcers do not form when the patient’s skin is not under pressure. Therefore, the key to preventing decubitus ulcers is to reduce the pressure on the skin by frequent position changes. Patients should be turned once every two hours, alternating between supine and lateral positions, day and night. Turning patients regularly not only prevents prolonged skin pressure, but also prevents urine stagnation in the urinary tract, which is beneficial to kidney function. For the susceptible parts of decubitus ulcers, close them from pressure by adjusting the cushion pillows accordingly. Each time you turn the patient, check carefully for any signs of pressure on the patient’s skin, no matter how slight, and draw attention to them. For example, if skin redness occurs in the sacrococcygeal region, take turns in the left and right lateral positions until the redness disappears completely. For wheelchair users, it is important to do support weighing every 30 minutes for 1-2 minutes each time. Self-care of the paralyzed areas of the body. Patients must learn to carefully inspect their skin for indentations, abrasions and spot infections in the morning and at night. Special attention should be paid to areas prone to decubitus ulcers. Patients can use a mirror to check areas that they cannot see directly, and those who cannot check themselves should ask others to help them do so. Only then can the patient avoid decubitus ulcers later in life. In spinal cord injury, paralysis occurs in the respiratory muscles innervated below the level of the injury, which affects the strength and synergy of the remaining respiratory muscles and significantly reduces the mobility of the thorax. Patients with cervical medulla injuries experience severe problems; whereas lower thoracic and lumbar medulla injuries have little to no effect on the patient’s lung function. The respiratory muscles consist of three main groups of muscles: the diaphragm (C5) is the most important inspiratory muscle with no expiratory effect, the intercostal muscles and auxiliary muscles (C2 to T7), and the abdominal muscles (T6 to T12) are the expiratory muscles. In patients with injuries below C4, lung volume can be reduced to 58% of normal values, and approximately 73% in the upper thoracic segment. Due to paralysis of the abdominal muscles, patients cannot cough, so at least for the first 3 weeks after injury, these patients are subjected to thoracic therapy. Breathing exercises: inspiration: deep breathing exercises are required for all patients to ensure good ventilation. Specialized diaphragmatic, lateral rib, and apical lung breathing exercises are performed with the help of a therapist, if possible. Exhalation: During effective exhalation, the therapist applies pressure on the patient’s chest wall with both hands. And the two hands are separated as much as possible to create a light passive exhalation. This way, subsequent inhalation will also be more adequate. For patients with partial or complete paralysis of the abdominal muscles, who are unable to perform coughing actions, the therapist should use both hands to apply pressure under their diaphragm to replace the function of their abdominal muscles and help the patient to perform effective coughing actions. The methods to assist the patient in coughing are: 1. single sputum expulsion method; 2. double sputum expulsion method. Therefore, patients are given prophylactic sputum evacuation therapy 3 to 4 times a day during the first two weeks of injury, which can prevent dyspnea, sudden onset of hyperthermia, etc. Patients with quadriplegia need to do prophylactic postural drainage at least once a day. In patients with injuries above C5, if a more severe cold occurs, they should be bedridden for 24h to prevent aspiration of nasal secretions into the lungs causing pulmonary bleeding, and also to assist the patient in removing secretions from the nose and throat. For the treatment of urinary retention and incontinence in patients with spinal cord injury: 1, catheterization: there are two methods of preserved catheterization and intermittent catheterization, in the early urethral sphincter spasm period using preserved catheterization. In general, intermittent catheterization is mostly used, and it is gradually extended to 8h once every 4~6h at the beginning to reduce the stimulation of the urethra by the catheter. When intermittent catheterization is used, the patient’s fluid intake should be limited to about 2000ml every 24h to avoid excessive bladder expansion. 2. Voiding training: a. Timed voiding, through regular stimulation of the “trigger point” or catheterization to stimulate bladder contraction, gradually forming a voiding reflex. b. Voiding awareness training, allowing the patient to do normal voiding movements, so that The patient should perform normal voiding movements so that the synergistic muscles can cooperate to facilitate the formation of the voiding reflex. As far as possible, urination should be done in the standing or sitting position to facilitate the discharge of precipitation in the bladder, so that the residual urine is relatively reduced and facilitates the drainage of bladder infection. c. Learn to self-catheterize, it is impossible for patients with spinal cord injury to be hospitalized for a long period of time, and they should learn to catheterize by themselves, in general, such as intermittent catheterization once every 4-6 hours, which can be done in a clean state, that is, the catheter is instructed to wash his hands twice under running water with soap. Therefore, patients can be trained to urinate on the commode at regular intervals, together with stimulation of the “trigger point” by percussion and squeezing of the lower abdomen. Achieve self-care ability. High spinal cord injuries (including cervical medullary and upper thoracic injuries) can occur soon after the injury, muscle spasm can occur in the limbs, but also in the thoracic spine, abdominal, manifested as stiffness of the limbs, joint movement is limited, the patient is very painful, for the physical treatment of spasm can be used continuous pulling techniques to inhibit the role of spasm. At the same time, hydrotherapy can be performed, using the temperature of the water to relieve the effect of spasticity. Medication can also be used, taking some antispasmodic drugs such as: 1. Baclofen, 10mg per tablet, taken orally starting with half a tablet, 3 times a day, and then every other week, increasing by half a tablet daily until the total amount reaches 80~100mg. The dose should not be increased too quickly, otherwise there are reactions such as nausea and drowsiness. 2, local injection: local injection with a 5% solution of phenol; it can also make local spasm relieved, but it is not suitable for systemic spasm. Spinal cord injury leads to varying degrees of lifelong disability in patients. When a healthy, vibrant, normal person suddenly becomes a disabled person who is dependent on others, the psychological impact can be imagined. Patients begin to understand what it means to lose motor, bowel, and sexual functions in their daily lives. Doubt, fear and anxiety naturally lead the patient to consider questions such as: Will this situation last? Will I be able to walk again? A more negative attitude can develop when the patient keeps exercising every day in order to recover, but makes little progress. Therefore, it is important for the patient to know not only the potential for physical recovery, but also the extent of the limitations in life due to the disability. Not only the patient but also the patient’s relatives need to adjust to the living environment, and they all need to clearly understand what the patient’s disability means in the context of family life. The therapist also needs to help the patient’s relatives become knowledgeable about care, so that they can avoid being overprotective of the patient and understand what the patient can do for themselves and how to give the necessary help in what situations. Communication between the patient and family members should be encouraged, and relatives should always feel free to talk with the patient about deeper topics, not only about each other, but also about others. Only then can the patient hold a realistic attitude and make full use of his or her own abilities to achieve maximum recovery.