Preface

Spinal cord injury (SCI) causes a host of physical and psychosocial problems that can interfere with an individual’s health, feelings of well-being, and participation in activities and relationships within the family and community. The goal of rehabilitation after spinal cord injury is to enable and empower the person to resume and then continue a healthy, fulfilling lifestyle, integrated with their family and community. Physical therapists play a central role in this process, working with recently injured people and their families to maximize physical capabilities and mobility and to develop the knowledge and skills needed to remain healthy. Three major elements are required for a therapist to fulfill this role most effectively.

The first requirement is a basic understanding of spinal cord injuries and issues relevant to disability. Pertinent areas of knowledge include neuropathology and neurological return, neuroplasticity, physical sequelae, medical and surgical management, the prevention and management of secondary conditions, psychosocial impact, disability-related civil rights, functional potentials, equipment options, and wheelchair-accessible architectural design. These areas of knowledge are integrated with an understanding of the relationships among functioning, disability, and health. This foundation of knowledge and understanding is needed for optimal program planning and implementation.

The second requirement is knowledge of the physical skills involved in functional activities and the processes involved in acquiring these skills. It is not enough merely to know the eventual outcome, which may take months to accomplish. The therapist must know how to design and implement therapeutic programs to develop the needed strength, flexibility, and motor skills involved in functional activities. Many a therapist has been baffled when faced, on the one hand, with a text that explains the maneuvers that a person with a spinal cord injury performs during functional tasks and, on the other hand, with a newly injured person who can barely remain conscious while sitting upright, much less even begin to perform the skills shown in the book.

The third major element required for effective rehabilitation is an approach to the individual that promotes self-respect and encourages autonomy. Unfortunately, this element is easily overlooked. Although we health professionals have the independent functioning of our patients as our stated goals, we can unwittingly encourage dependence. Many practices in health care serve to encourage “compliance” and discourage autonomous behavior. If the rehabilitation effort is to be successful, the social environment of the rehabilitation unit must be structured in a way that fosters self-reliant attitudes and behaviors.

In order to prepare readers to work effectively with people who have sustained spinal cord injuries, a text must encompass all of the previously described elements. Spinal Cord Injury: Functional Rehabilitation was written to provide such a comprehensive treatment of the subject. The reader will gain a broad knowledge base relevant to spinal cord injuries and will develop an understanding of both the physical skills required for functional activities and the therapeutic strategies for achieving these skills. As importantly, the reader will gain an appreciation for the importance of psychosocial adaptation after spinal cord injury and will develop some insight into the impact that rehabilitation professionals can have in this area.

Spinal Cord Injury: Functional Rehabilitation uses the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for understanding both the impact of spinal cord injury and the role of rehabilitation. The ICF is introduced in Chapter 1. Each subsequent chapter uses language and concepts consistent with the ICF and begins with an image that illustrates how the content of that chapter relates to the ICF.