Understanding Spinal Cord Injury: How Exercise Physiology Plays a Crucial Role in Rehabilitation
Spinal cord injury (SCI) is a life-changing condition that significantly impacts an individual’s physical, emotional, and social well-being. The spinal cord is the main communication pathway between the brain and body, and when disrupted, SCI can cause impairments in nearly every aspect of a person’s life. Rehabilitation for SCI is a complex process that requires a multidisciplinary approach, with Exercise Physiology playing a vital role.
What is Spinal Cord Injury?
The spinal cord is a key part of the central nervous system, acting as a communication link between the brain and body. SCI results when this pathway is damaged, often due to trauma such as motor vehicle accidents or falls. In Australia, over 20,000 people are living with SCI, with 23% under the age of 35, and the vast majority under 65.
SCI can lead to three main types of impairments:
- Muscle weakness or paralysis: This can range from complete paralysis to very weak muscles.
- Sensory impairment: Reduced or absent sensation below the level of injury.
- Autonomic dysfunction: Impairment of autonomic functions such as sweating and blood pressure regulation.
Levels and Types of Spinal Cord Injury
The severity of the impairments caused by SCI is determined by two main factors:
- Level of Injury: The closer the injury is to the brain, the more function is impaired.
- Tetraplegia occurs when the injury is in the cervical (neck) region, typically resulting in impairments in arm, trunk, and leg function.
- Paraplegia occurs when the injury is below the neck, leading to impairments in trunk and leg function, while arm function remains intact.
- Completeness of Injury: Partial injuries of the spinal cord allow some connections between the brain and body, preserving some function below the level of the injury. The amount of preserved function can vary widely, even among individuals with injuries at the same level.
The Impact of Spinal Cord Injury
Physical Challenges
SCI leads to a range of physical challenges, including paralysis, muscle weakness, and loss of sensation. The severity of these challenges depends on the injury’s level and completeness. Additionally, individuals with SCI may face secondary complications such as pressure sores, respiratory issues, spasticity, and impaired autonomic functions like reduced sweating or low blood pressure.
Psychological and Emotional Impact
The psychological impact of SCI is profound, with many individuals experiencing depression, anxiety, and a sense of loss due to the drastic changes in their physical abilities. Adapting to life with SCI requires significant mental resilience, along with strong support systems.
The Role of Exercise Physiology in Spinal Cord Injury Rehabilitation
Exercise Physiology is essential in the multidisciplinary rehabilitation of SCI. Exercise Physiologists focus on using exercise as a therapeutic tool to enhance physical function, promote independence, and improve the overall quality of life for individuals with SCI.
Initial Assessment and Goal Setting
Rehabilitation begins with a comprehensive assessment of the individual’s physical abilities, limitations, and overall health status. This assessment helps identify specific needs and goals, such as improving strength, mobility, cardiovascular fitness, and functional independence.
Designing a Tailored Exercise Program
Based on the initial assessment, Exercise Physiologists design a personalised exercise program tailored to the individual’s specific needs and goals, typically including:
- Strength training: Aimed at maintaining or improving muscle mass and strength, particularly in the upper body for individuals with paraplegia, or in limbs with preserved function for those with tetraplegia.
- Cardiovascular exercise: Exercises such as wheelchair pushing, hand cycling, or swimming are used to improve heart and lung health.
- Flexibility and range of motion exercises: These exercises help prevent joint stiffness and maintain mobility in limbs with limited or no voluntary movement.
- Functional mobility training: This focuses on improving the ability to perform daily activities, such as transferring from a wheelchair to a bed or car, which is crucial for independence.
The Benefits of Exercise for People with Spinal Cord Injury
People with mobility impairments are often among the most physically inactive, leading to further health problems. Exercise can significantly enhance the quality of life for those living with SCI by improving functional independence and reducing depression and anxiety.
Aerobic Exercise
Aerobic exercises improve cardiorespiratory fitness, reduce the risk of cardiovascular disease, and may reduce the incidence of urinary tract infections. For individuals with SCI, these exercises can help improve endurance, enabling them to better navigate their environments and engage in daily activities.
Strength Training
Strength training targets both non-paralysed and partially-paralysed muscles, improving overall strength and function. For those with SCI, increased strength can enhance the ability to perform daily tasks independently, such as transferring from a wheelchair or lifting objects.
Reducing Shoulder Pain
Exercise interventions that avoid painful movements and include specific upper-limb strengthening can also reduce shoulder pain, a common problem for manual wheelchair users. This pain reduction can lead to improved participation in daily activities and a higher quality of life.
Psychological Benefits of Exercise
Exercise offers significant psychological benefits, including reducing symptoms of depression and anxiety, improving mood, and enhancing overall psychological resilience.
Types of Exercise Recommended for People with Spinal Cord Injury
Given the wide variation in the effects of SCI, exercise prescriptions must be individualised. Some individuals with SCI may walk and live independently, while others may require a motorised wheelchair and personal support for daily activities.
General Exercise Recommendations
While specific exercise prescriptions vary, general guidelines include:
- Physical activity: Individuals with SCI should be as physically active as possible, aiming for at least 30 minutes of moderate-intensity aerobic activity on most or all days of the week.
- Strength training: Strength training should target major muscle groups and include flexibility exercises for major joints to maintain mobility and prevent stiffness.
The Importance of a Multidisciplinary Approach
While Exercise Physiology plays a critical role in SCI rehabilitation, successful outcomes are often the result of a multidisciplinary approach. Collaboration with physiotherapists, occupational therapists, psychologists, and medical professionals ensures that all aspects of the individual’s health and well-being are addressed, creating a comprehensive rehabilitation plan.
Challenges and Considerations in SCI Rehabilitation
Addressing Individual Differences
One of the main challenges in SCI rehabilitation is addressing the unique needs and goals of each individual, as no two spinal cord injuries are identical. Exercise Physiologists must consider factors such as the level and completeness of the injury, the individual’s pre-injury fitness level, and personal goals and preferences when designing an exercise program.
Ensuring Accessibility and Inclusivity
Accessibility is a significant consideration in SCI rehabilitation. Exercise Physiologists must ensure that prescribed exercises are accessible and safe for individuals with varying levels of ability. This may involve adapting exercises, using specialised equipment, or providing alternative options to accommodate the individual’s needs.
Long-Term Commitment
SCI rehabilitation is a long-term commitment, requiring consistent effort and dedication from both the individual and their healthcare team. Maintaining motivation can be challenging, particularly when progress is slow or when faced with setbacks. Exercise Physiologists play a crucial role in providing encouragement, setting achievable goals, and celebrating milestones to keep individuals motivated and engaged in their rehabilitation journey.
For more information on our EP programs for rehabilitation following a serious injury such as spinal cord injury, click here. Let us know how we can help manage your condition, and start your journey to #ChronicGains!
