When caring for someone with a spinal injury, repairing damage created by an injury is the ultimate goal. By using various treatments, greater improvements can be achieved, and therefore, treatment should not be limited to one method. Furthermore, increased activity will increase the chances of his recovery.
Video Rehabilitation in spinal cord injury
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The process of rehabilitation after spinal cord injury usually begins in an acute care setting. Occupational therapy plays an important role in SCI management. Recent studies emphasize the importance of early occupational therapy, starting as soon as the client is stable. This process includes teaching coping skills, and physical therapy. Physical therapists, occupational therapists, social workers, psychologists, and other health care professionals typically work as teams under the co-ordination of physiotherapists to decide on the patient's shared goals and develop appropriate disposal plans for the patient's condition. In the first step, the focus is on support and prevention. Interventions aim to give the individual a sense of control over situations in which the patient may feel slightly independent.
As patients become more stable, they can either move to a rehabilitation facility or remain in an acute care setting. Patients begin to take more active roles in their rehabilitation at this stage and work with the team to develop functional goals that make sense.
Respirasi
In the acute phase the physical and occupational therapist focuses on the patient's respiratory status, prevention of indirect complications (such as pressure sores), maintaining the range of motion, and keeping the muscles active.
Depending on the Neurological Level of Impairment (NLI), the muscles responsible for extending the thorax, which facilitates inhalation, may be affected. If the NLI is such that it affects some ventilation muscles, more emphasis will be placed on the muscles with full function. For example, the intercostal muscles receive their innervation from T1-T11, and if anything is damaged, more emphasis needs to be placed on unaffected muscles that are conserved from higher levels of CNS. Because SCI patients suffer from decreased total lung capacity and tidal volume, it is important for physical therapists to teach accessory breathing techniques in SCI patients (eg apical breathing, glossopharyngeal breathing, etc.) that are not normally taught to healthy individuals.
Functional electrical stimulation
Physical therapists can help immobilized patients with effective coughing techniques, secretion cleansing, chest wall stretching, and suggest belly support belts when needed. The amount of time a patient is immobilized may depend on the extent of spinal injury. The physical therapist works with the patient to prevent any complications that may arise because of this immobilization. Other complications arising from immobilization include muscle atrophy and osteoporosis, especially in the lower extremities, increasing the risk of fractures in the femur and tibia. While the passive weight of the paralyzed lower limb appears ineffective, emphasizing bone through muscle contraction initiated by functional electrical stimulation (FES) has yielded positive results in some cases. The intensity, frequency, and duration of stress on bone appear to be an important determinant of improved bone parameters. Generally, effective frequency with three or more weekly training sessions. The study of duration indicates that several months for one or more years of FES is required.
Improve locomotor function
Improved locomotor function is one of the primary goals for people with spinal cord injuries. SCI care can focus on specific goals such as restoring walking or moving to an optimal level for individuals. The most effective way to restore the mover is with a complete overhaul, but techniques have not been developed for regeneration. Treadmill training, over groundtraining, and functional electrical stimulation can all be used to improve walking or locomotion activity. This activity works if neurons from the central pattern generator (CPG) circuit, which produces rhythmic movements of the body, still function. With inactivity, the neurons of CPG decline. Therefore, the above activities are important to keep the neurons active until regeneration activities are developed. A systematic review of 2012 found insufficient evidence to conclude that locomotor training strategies improve the most walk function for people with spinal cord injury. This shows that it is not the type of training that is being used, but the goals and routines that have the greatest impact. Applying spinal cord stimulation (transcutaneous or epidural) during weight-backed walking has been shown to increase locomotor output.
Maps Rehabilitation in spinal cord injury
Post-discharge rehabilitation therapy
Although rehabilitation interventions were conducted during the acute phase, recent literature showed that 44% of the total hours spent on rehabilitation during the first year after spinal cord injury, occurred after exit from inpatient rehabilitation. Participants in the study received 56% of their total physical therapy hours and 52% of the total hours of occupational therapy after they returned home. This suggests that the length of inpatient rehabilitation is reduced and that post-discharge therapy may replace some inpatient care.
Functional independence
Whether the patient is placed in inpatient rehabilitation or discharged, occupational therapists seek to maximize functional independence at this stage. Depending on the extent of spinal cord injury, whatever patient sparing has been optimized. Bed mobility, transfers, wheelchair mobility skills, and other activities of everyday life (ADL) are just a few of the interventions that the occupational therapist can help. The main problem for patients with spinal cord injury is limited range of motion. Massage therapy has been used to assist in various movement rehabilitation. Literature has shown that participants with spinal cord injuries who have massage therapy added to their rehabilitation experience significant improvements observed by physical therapists in functional living activity and range of gestures. This could be due to a decrease in the amplitude of the H-Reflex measured by EMG which is essential for the comfort of spinal cord injury patients to reduce cramps and seizures.
ADL can be difficult for someone with spinal cord injury; However, through the rehabilitation process, individuals with SCI may be able to live independently in communities with or without full-time care, depending on the extent of their injuries.
Further interventions focus on support and education for individuals and carers. It includes evaluation of limb function to determine what the patient is capable of doing independently, and teaches the patient self-care skills. Independence in daily activities such as eating, bowel and bladder management, and mobility is the goal, as acquiring competence in self-care tasks contributes significantly to individual confidence and reduces the burden on caregivers. Problems of quality of life such as sexual health and function after spinal cord injury are also discussed.
Tools
Aids such as wheelchairs have a great influence on the quality of life of patients, and careful selection is essential. Teaching patients how to transfer from different positions, such as from a wheelchair to a bed, is an essential part of therapy, and devices such as shear transfer boards and handles can assist in these tasks. Individuals who can transfer independently from their wheelchair to the driver's seat using a sliding sliding board may be able to re-drive in a customized vehicle. Independence is full of driving also requires the ability to load and unload a person's wheelchair from a vehicle. In addition to acquiring skills such as wheelchair transfers, individuals with spinal cord injuries can greatly benefit from reconditioning exercises. In most cases, spinal cord injuries leave the lower limbs either completely paralyzed, or with inadequate strength, endurance, or motor control to support safe and effective physical exercise. Therefore, most exercise exercises use the use of crankshaft ergometry, wheelchair ergometry, and swimming. In one study, subjects with traumatic spinal injuries participated in a progressive exercise training program, involving arm ergometry and resistance training. Subjects in the exercise group experienced significant increases in strength for almost all muscle groups when compared to the control group. Exercise also reported less stress, fewer symptoms of depression, greater satisfaction with physical function, less pain, and better quality of life. Physical therapists are able to provide a variety of exercise interventions, including, range of passive exercise, upper body motion (crankshaft ergometry), functional electrical stimulation, and electrically stimulated endurance exercises all of which can improve arterial function in those living with SCI.. Physical therapists can improve the quality of life of individuals with spinal cord injuries by developing customized exercise programs to meet the individual needs of patients. Customized physical activity equipment can also be used to allow sports participation: for example, sit-skis can be used by individuals with spinal cord injuries for cross-country skiing or decline.
The patient's living environment can also be modified to improve independence. For example, ramps or elevators can be added to the patient's home, and part of the rehabilitation involves an investigative option to return to previous interests as well as develop new activities. Community participation is an important aspect in maintaining quality of life.
Gait training
The weight supported by treadmill training is another intervention that physiotherapists can help. The weight supported by treadmill training has been investigated in an attempt to prevent bone loss in the lower extremities in individuals with spinal cord injury. Studies have shown that early buildup after an acute spinal cord injury by standing or walking a treadmill (5 times a week for 25 weeks) results in no loss or only moderate loss of trabecular bone compared with immobile subjects who lose 7-9% of trabecular bone. in the tibia. Weight-weighted walking training, among patients with incomplete spinal cord injury, has also recently proven to be more effective than conventional physiotherapy to improve the parameters of spatial-temporal and kinematic forces.
The combination of body-backed treadmill load training (BWSTT) and robot-assisted BWSTT is being implemented into several training programs. Benefits include: (1) assist in reproducing foot movements and optimizing road patterns (speed, step length, amplitude); (2) training sessions can be extended and running speed can be adjusted, improve motor results; (3) provide movement consistency, in which a trainer's manual/instruction manuals may vary (although a trainer should analyze gait patterns and training outcome measures and supervise training). It is important to note that the patient must be an active participant during the robot movement and try to move with the robot. This type of training will be carried out during the initial rehabilitation and develop into an independent movement as improvements are made. However, robot-assisted BWSTT is expensive and often unaffordable by physiotherapy clinics. Alternatively, the development of non-motor exoskeletons is currently being investigated for patients with incomplete SCI. The development of locomotor exoskeleton devices will provide a cheaper alternative to robotic devices. Exoskeleton can be used in areas that are not able to buy robotic devices, or, in areas that can not provide adequate physiotherapy treatment.
Restorative neurology offers a different paradigm for treating spinal cord injury by focusing on remaining rest of motor control and on the intrinsic function of the sub-lesional spinal medullary segment.
References
Source of the article : Wikipedia
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