Spinal cord injury (SCI) is often caused by spine fractures, dislocations, or gunshot wounds, commonly seen in car accidents, falls, sports injuries, crush injuries, and gunshot wounds. Spinal cord injury is a major cause of disability, often resulting in severe impairments, including loss of motor function (paralysis), sensory disturbances, bladder dysfunction, muscle spasms, joint contractures, pain, bedsores, psychological disorders, sexual dysfunction, and even respiratory issues. The primary goal of spinal cord injury rehabilitation is to maximize residual function to compensate for lost abilities. For example, in cases of lower limb paralysis where mobility and walking are impaired, strengthening upper limb and trunk muscles to move the body and use crutches for walking can partially compensate for the loss of lower limb function.

bubble_chart Treatment Measures

Early Rehabilitation of SCI

As soon as a spinal cord injury occurs, rehabilitation intervention should begin promptly alongside clinical treatment to prevent complications and reduce the degree of disability.

(1) Self-care

Assess and train in activities such as bathing, toileting, dressing, eating, grooming, and personal hygiene. For C4 and above injuries, train in the use of Environmental Control Units (ECU), which allow completely paralyzed patients in bed or wheelchairs to operate lights, TVs, phones, etc., through blowing or jaw movements. For C6 and below, train in eating, grooming, and dressing; for C8 and below, train in eating, grooming, dressing, and bowel/bladder management.

(2) Prevention of Bedsore

Teach patients to self-examine pressure points on the skin, perform alternating buttock lifts by supporting with hands hourly, and frequently change positions while lying down.

Focus on training muscles such as the deltoid, biceps, triceps, and latissimus dorsi using resistance training and progressive resistance training. For optimal muscle strengthening, devices like the Cybex II are most effective. Muscle training enhances upper-body support and the ability to maintain sitting or standing postures, laying the foundation for future wheelchair control or crutch-assisted walking.

(4) Basic Transfer Training

For C1-level injuries, train patients in transfers between wheelchairs and treatment beds, treatment platforms, cars, and toilets.

(5) Balance Retraining

For C6 and below injuries, start with seated balance training. Once the patient can sit upright with legs straight, progress to stability training, such as extending arms forward and maintaining posture. Apply slight pushes to challenge balance, or engage in activities like passing a ball with a partner or alternating forward punches while seated.

(6) Basic Wheelchair Mobility

Initially, teach how to control and propel the wheelchair forward, backward, and in turns. Then progress to navigating slopes and finally transferring from the wheelchair to a bed or floor and back.

(7) Physical Therapy

Apply non-thermal ultrashort wave therapy, ultraviolet therapy, direct current iodine iontophoresis, and ultrasound therapy to the injured area to reduce inflammatory exudates, prevent adhesions, and promote neural recovery.

Mid-to-Late Stage [Third Stage] Training for SCI

After initial training, when patients achieve basic independence in a wheelchair and master self-care skills, focus shifts to consolidating and advancing these skills. For those with potential to walk, standing and gait training begins. For non-ambulatory patients, refine wheelchair-living skills and strengthen residual muscle power and overall endurance.

Depending on injury level (C5-T1 and below), train in transfers using sliding boards (bed↔wheelchair, wheelchair↔bathtub, wheelchair↔toilet), navigating curbs, and balancing on rear wheels.

(2) Standing and Gait Training

For injuries below T2, train patients to stand therapeutically with lumbosacral orthoses and KAFO (Knee-Ankle-Foot Orthosis) support. Parallel bar walking is introduced, and for injuries below T6, KAFO-assisted walking on flat surfaces is trained.

Rehabilitation for Major Complications

(1) Bedsore

1. Preventive measures: (1) Pressure relief: Alternate buttock lifts in a wheelchair by hand support. (2) Avoid wrinkled clothing. (3) Proper sleeping posture: Use pillows and sandbags to maintain alignment and prevent lumbar contractures. Regularly reposition to avoid prolonged pressure on any area.
2. Skin Care: (1) Regularly clean the skin with soap in warm water. (2) Keep the skin dry and apply skin moisturizer, with regular tuina for pressure areas. (3) Frequently inspect the skin to avoid injury. (4) Expose pressure-prone skin to ultraviolet light with mild erythema dosage, once every 1-2 days, for a course of 12–15 sessions, and repeat the irradiation periodically.

1. Preventive measures: Pay attention to hygiene, drink enough water, and keep the urine bag in a low position.
2. Rehabilitation training: Train bladder function—regular water intake, scheduled catheter opening to allow the bladder to fill and empty, which aids in the recovery of autonomous bladder function. Generally, limit daily water intake to 2000ml, open the catheter once per hour. If the patient's urine output is <400ml, open the catheter every 6 hours. Maintain sterility. If a urinary tract infection occurs, promptly use antibiotics and therapies such as ultrashort wave.

Injuries above C4 can affect the phrenic nerve, paralyzing the diaphragm and leading to suffocation. C5 injuries may result in quadriplegia, with lung capacity reduced to half of normal. Injuries above T10 weaken abdominal and intercostal muscles, reducing oxygen intake and causing breathing difficulties. Therefore, maintaining effective respiration is crucial for preventing respiratory infections.

1. Preventive measures: (1) Back tapping manipulation to assist coughing and expectoration. (2) Frequent position changes. (3) Encourage deep breathing (diaphragmatic breathing to strengthen respiratory muscles).
2. Rehabilitation measures: (1) Breathing and coughing exercises. (2) Encourage deep breathing (diaphragmatic breathing) to strengthen respiratory muscles. If a lung infection occurs, promptly administer antibiotics, implement postural and tracheal drainage, local ultrashort wave therapy, and ultrasonic antibiotic aerosol inhalation.

Early passive mobilization of major joints such as the ankles, knees, and hips, along with muscle tuina, should be performed several times daily to maintain joint range of motion. Simultaneously, apply traction and prolonged stretching to the knees and hips, such as maintaining hip extension for 5 minutes or placing a sandbag on the thighs in a prone position to sustain hip extension.

(5) Spasticity

All SCI patients experience varying degrees of spasticity. If spasticity is severe enough to prevent sitting in a wheelchair, moving, or performing daily activities—or even causes contracture deformities—the following methods can be applied sequentially.

1. Medication: Baclofen is a muscle relaxant effective for flexor spasticity caused by spinal cord injury, with few side effects. Other options include dantrolene and diazepam.
2. Weight-bearing: Use knee orthoses such as knee-ankle (KAO) or knee-ankle-foot orthoses (KAFO) for weight-bearing exercises.
3. Prolonged stretching: Apply sustained traction with joint hyperextension.
4. Functional stimulation: For paraplegic patients, functional electrical stimulation (FES) can reorganize limb movement, accelerate spontaneous recovery of voluntary motor control, promote the reconstruction of basic motor mechanisms at the spinal level, alleviate spasticity, increase muscle mass, enhance strength, improve blood circulation, and boost metabolic function, gradually improving overall physical capabilities.
5. Hydrotherapy—perform active and passive exercises in water.

Heterotopic ossification occurs in 16-35% of spinal cord injuries, typically around joints below the injury level, presenting with redness, swelling, heat, and hardening. It often appears one month post-injury and may result from vigorous movement or hematoma injury. If it occurs, cease activity and resume lighter exercises after one week.

Currently, the effective preventive drug for heterotopic ossification is Didronel (etidronate disodium), a natural phosphate that regulates ossification biology. It has high affinity for calcium ions in hydroxyapatite, concentrating in metabolically active bone areas and preventing soft tissue calcification in vivo.

(7) Psychological Issues and Treatment in SCI

Patients with SCI have suffered tremendous physical and social harm. These patients require assistance in all aspects of daily life, such as bathing, dressing, eating, toileting, and changing positions—essentially reverting to a childlike state physically. Therefore, the psychological reactions of patients progress through various stages from the time of injury: the shock phase, denial phase, anger phase, grief phase, and acceptance phase. Rehabilitation workers should understand the characteristics of each stage and adopt appropriate measures. During the anger phase, they should offer more understanding; during the grief phase, provide patient guidance and prevent suicide; and during the acceptance phase, actively assist patients in arranging a new life, offering encouragement and introducing inspiring stories of accomplished individuals with disabilities to help them start anew.

SCI Vocational Rehabilitation

After receiving training in vocational skills and psychological adjustment, some SCI patients can participate in work within their capabilities, such as watch repair, household appliance repair, shoe repair, and other tasks that involve upper limb operation.

In rehabilitation medical institutions, the primary focus for SCI patients is vocational counseling and employment training. This involves understanding the patient's vocational interests, educational background, previous vocational training, skills, work experience, and aspirations for future employment. Subsequently, a pre-employment assessment of the patient's vocational abilities and an analysis of job characteristics are conducted to evaluate their employment potential and feasibility. If employment is deemed possible after evaluation, the patient is advised to undergo relevant vocational skills training.