Preliminary training for functional activites.

• AIM - The Occupational Therapeupic approach for SCI patients in MRC
1. To achieve maximum independence in bed and wheel chair activities / gait (according to the level and extent of injury).
2. To increase strength and endurance of trunk and upper limb.
3. Independent sitting balance.
4. Independent sitting from supine.
5. Independent rolling.
6. Independent wheel chair mobility.


• Pre-Requites
1. Spinal stability
2. Free from bed sores.
3. Ability to transfer from. wheel chair to the mat with some.

Duration about 4-8 weeks.

Exercises

1. Strength and Endurance
1. Supine resisted exercise of upper limb with weights, each exercise 3 sets with 10 repeated movements.
2. Shoulder flexion with elbow extended and then with elbow flexed. Elbow flexion, horizontal shoulder abduction with elbow flexed.
2. Partial Sit Ups
• T8 & below level of patient can reach the toe with hands raising the head and shoulder clearing inferior angle of scapula. This is to be done within tolerance limit. T6 and above patient with jackets.
3. Modified Push Ups
• For patient with jackets or brace in sitting position, lean back on arms, trunk is raised and lowered by flexing and extending the elbows. Patient with out jacket prone lying hands at shoulder level, trunk is raised and lowered by flexing and extending the elbows.
4. Resisted exercise for UMB with push up blocks
• Patient with SLR more than 100 degree short sit position, knee is over the edge of mat, I use push up blocks, patient raises the buttocks by extending the arms. Progress to difficult by raising the height of blocks. Patients with SLR less than 100 degree can do this exercise in long sitting position.
5. Sitting balance
• Patient with SLR less than 100 degree in long sitting position with the feet flat on the ground practice sitting-without hands on the mat. To improve balance, shift arms to the front side on or overhead. Don't allow hands on the mat: Trunk is pushed forward, posterior and lateral to gain balance and advanced sitting balance.

Ball activities:
Carefully chosen activities using a gymnastic ball can form a useful part of t/t program -

1. The patient is able to achieve new skin with which he can observe for himself and is not dependent upon the therapist telling him that the movement was little better.
2. The ball support the weight of a part of the body and the desired muscles can be activated without so much effort, even when the patient is still not able to move independent.

1. The patient moves the ball in a specific direction.
2. The patient maintains a certain position and prevents movement of the ball.
3. The ball moves or is moved and the patient reacts.

The resulting muscle activity still adheres to the principle of tentacle and bridge. The tentacle is that part of body which moves in space from the part supported on the ball. The bridge is the part or parts of the body supported below ball with floor.

The patient lies on his back with both his feet supported on a ball. He raises his buttocks off the supporting surface and does not allow the ball to move at all. The patient's arms remain at his sides as he straightens his knees by pressing the ball away from him and lifts his buttocks off the plinth. Both knees remain extended position. The trunks control side flexors work activity to prevent the ball moving sideways. The patient is asked to raise his sound arm to about 90 degree flexion at the shoulder.
It improves :

1. Trunk control as well as stability.
2. Self assisted bridging.
3. Pelvic control as well as stability.

Lying prone on the ball weight supported through both arms:
From a kneeling position on the floor. The patient lies over the ball in front of him. The therapist helps him to place his paralysis hand flat on the floor and to maintain extension of elbow as he brings his weight forwards. The patient brings his weight further forward until his feet leave the floor. He holds his legs extended and adducted and tries to maintain his trunk in a straight line without his abdomen sagging.
It improve :

1. More active control of the abdominal
2. Weight bearing to the weaker muscle.

The patient sits on the ball, his trunk is upright and in line with the diameter of the ball. His legs are slightly abducted with knees over his feet, i.e., his thighs in lipe with his feet. The therapist stands behind the patient to adjust his position.

The patient draws the ball forward below his legs while maintaining extension of his thoracic spine The therapist helps to stabilize the thorax, using one of her arms supporting the front of his chest and her other hand assisting extension from behind with one of her legs moves the ball forwards in the required direction.

Scooting in sitting position, patient scoots forward, backwards and sideways is taught for bed mobility and bed to wheel chair, be careful of bed sores while teaching this.

• SUPINE - SITTING: T10 or below with jacket. From supine position patient may be able to come straight on to elbows and then onto the hand.
• T8 AND ABOVE: Supine to sideways by the therapist and then taught to push up sideways as a unit to rolling with jacket. Patient may be rolled as a unit to prone by therapist with jacket. Patient should not fling or throw his arms forcefully because it may create a torque at the fracture site.
• AND ABOVE WITHOUT JA CKET : Start from supine, patient initiates rolling by throwing both arms back and for~e to create a momentum to create a roll.
• T8 AND BELOW WITHOUT JACKET: may be encouraged to use their abdominalis.

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