"Management of patients with spinal disease/injury in MRC" 

After thorough assessment and group discussion among the team personalities, an appropriate aim and goal, is set up with special consideration of level, nature and severity of lesion, job and psychological status of the patient. Goal oriented management and treatment programme is usually initiated with serial assessment programmes every week and modification of management accordingly.

A) Correct Positioning of the patient in the bed in order to: 

• Obtain correct alignment of the fracture.

• Prevent contractures.

• prevent pressure sores.

• Inhibit the onset of severe spasticity

B) Turning the pt. in the bed-every 3 hrs, day and night: 

• The supine and side lying positions are used for the acute lesion. 

• In cervical & upper thoracic injuries, the prone position is not allowed. 

C) Bed side therapies: 

• Resp therapy.

• Passive movements.

• Active movements.

• Resisted movements.

D) Initial Physical re-education:  

The ultimate aim of rehab is to achieve the highest degree of fitness, independence balance and control which the patients lesion permits. 

• Readjustment of the vasomotor control-esp. postural hypotension-reflexes are trained in variety of ways by means of deep breathing, tilting exs in bed, frequent changes of position and graduated balance exercises in the sitting and standing position. 

• Postural sensibility-In addition to touch, pain and temp and motor power of the trunk and limbs, pts c SCI also loses his postural or kneesthetic sense, below the level of the lesion. Postural control is achieved largely through those muscles which have a high innervation and low distal attachment eg. latissimus dorsi. 
  
  pt. develops his new postural sense primarily by visual control- exercises in front of mirror, 
        - Exercises without the aid of the mirror.
        - Finally functional activity without conscious effort to
           balance.

• The reeducation and hyperdevelopment of the normal parts of the body to compensate for the paralysed muscles. 

• Balancing exs : 
     - in sitting position.
     - in the wheel chair.
     - in standing frame.

E) Basic Functional movements and personal independence

• Mobilization and strengthening of the trunk and limbs.

• Preliminary training for functional activities
    - Lifting & moving sideways.
    - Lifting & moving forwards.
    - Moving the paralysed limbs.
    - Independent sitting from the supine position lying
      down from the sitting position.
    - Supine to prone (Rolling).
    - Bed mobility & mat activities.

F) Wheel chair mobility

     The most for SCI patients (quadri or para) as this is the only means for quick mobility prior to orthosis for para & essentially the one & only means to achieve functional on mobility on Wheelchair possible depending on lesion of the patients.
    For quadris depending on motor skills like the strength of scapular, sh & elbow muscles. Also ROM, spasticity,  shifting skills, balance in sitting, ability to transfer on all surfaces. The patients are taught various techniques to transfer.
   It is the only means for patients to do ADL & self-care and job specific training.
For paras- Depending on the level, determining the type of orthosis needed, patients can still need a mode of mobility for indoors & outdoors too.
Includes W/C maneuvers, transfers-dependent & independent.

G) Gait Training in Paras

           - HKAFO, KAFO, AFO, Reciprocal gaiter

Essential components

           - Strength & balance
           - Ability to don & doff the orthosis
           - Strengthening of upper extrenity Hip & Abd, back ms, 
              quadrations lumborum
           - Trg in parallel bars
           - Type of gait
           - Transfer
           - Functional independence using crutches

Apart from the ADL and self care  and job specific activity, training is given for Psychological boosting and preparation for copping up the residual disabilities (in the family and social life it is taught properly.) The prognosis and possibility of developing different complications and how to prevent and combat those complications in future are also taught. patients are suggested for regular check up by neurologists, medical specialists and also in MRC for modification of guided lines.

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