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Chapter 8 presents strategies for functional rehabilitation after spinal cord injury, including compensation versus restoration, movement strategies, therapeutic exercise, functional training, and equipment selection.
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Function is a major focus of rehabilitation. Functional rehabilitation aims to optimize the individual's ability to perform activities and participate in all aspects of life. Each daily activity involves performing a set of skills and requires the physical prerequisites of adequate strength, necessary joint range of motion, and muscle flexibility to carry out the actions involved. During rehabilitation, the aim is to assist the patient in developing the needed skills and physical prerequisites and introduce the equipment the person will require for safe and independent functioning.
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COMPENSATION VERSUS RESTORATION
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People recovering from spinal cord injury (SCI) can regain function through compensation, restoration of more normal movement capabilities, or a combination of the two. The strategies used depend largely on the person's voluntary motor function below the lesion (Fig. 8-1).
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Functional independence is optimized through compensation when voluntary motor function is absent below the lesion (American Spinal Injury Association [ASIA] Impairment Scale [AIS] A or B classifications). Compensation involves regaining functional independence through means other than using the musculature that is no longer innervated. Rehabilitation emphasizes functional training that develops new motor skills using compensatory movement strategies. These strategies allow people who have sustained spinal cord injuries to use their remaining (innervated) musculature to complete functional tasks. In addition to functional training, rehabilitation involves the development of the strength and flexibility needed to perform functional skills; provision of equipment such as ambulatory assistive devices, orthoses, wheelchairs, and adaptive devices for activities of daily living (ADLs); and adaptation of the home environment, including environmental control units (ECUs).
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In contrast, individuals who have preserved voluntary motor function or return of voluntary motor function after injury (AIS C or D classifications) have the potential to relearn more normal movement patterns. Rehabilitation for people with these incomplete spinal cord injuries emphasizes restoring normal movement capacities and minimizing compensation to the extent possible. An emerging understanding of the central nervous system's potential for adaptation after spinal cord injury has given rise to interventions designed to target this neuroplasticity.1,2
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MOVEMENT STRATEGIES FOLLOWING SPINAL CORD INJURY
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Normal movement involves the coordinated action of an array of skeletal muscles functioning in concert to move the trunk and extremities. Damage to the spinal cord disrupts this normal pattern ...