Phases Of Rehabilitation:
Phase I
ImmediateJy after SCI, diere is loss of function due to neurotrauma and immobilization. The principle emphasis of rehabilitation :s to lesser the adverse effects of immobilization. It includes all therapeutic intervention during the critical and acute care stages of rehabilitation and may last from a few day to several weeks, when the patient may begin activities out of bed. Goals may address prevention of secondary complications. These patient are treated in other Hospitals and usually refered in MRC after this phase.
Phase II
It is the early rehabilitation phase. Out of bed activities are tolerated for longer periods of time and the patient begins to work toward specific long-tenn goals and he is able to participate in therapeutic programs for a minimum of 3 hours a day. The patient who was refd. in MRC in this phase, showed maximum functional improvement.
Phase III
It is the most active and often the most rewarding period. The efforts of weeks and months of work are realized and tangible results can be seen. The patient gains varying level of independence in specific skills and may begin to believe that there is life after disability. The patient to taught advanced skills in transferring, wheel chair mobility, grooming and other ADLs.
Phase IV
Is aimed at a smooth transition to home. The patient is discharged from the rehabilitation from the rehabilitation center at this stage.
Phase V
Comprises of outpatient and other follow-up services, as well as community reintegration. Individuals may return to work or school and resume other family responsibilities.

Quadriplegics in MRC
Early treatment of the quadriplegic patient in the acute stage of trauma consisted of careful turning in bed clenical braces sensory stimulation and passive ROM exercises to maintain freedom of joint movement and to prevent muscular contractures and decubitus. After the traction period, general conditioning exercise~ are provided including proper breathing and training in rolling from side to side. Self-care is begun as soon as possible to relieve anxieties regarding non sensitive and non moving body parts and to prevent dependency on others for any functions the patient is able to accomplish.
Treatment considerations during the bed stage
During all treatment in this phase, the patient, are encouraged to use all possible active movement to increase physical endurance, strength and functional ability.
1) To Monitor bed positioning daily for prevention of decubitus and contractures.
2) To massage gently and stimulate sensory receptors of the upper extremities for sensory awareness and tactual localization.
3) To Move the upper extremities in gentle, full passive ROM daily to monitor changes in range, informing the patient when the extremity is moved in which direction and how many times. Encourage the patient to watch the extremity during massage and passive joint ROM.
4) To Precede active ROM exercises by gentle manual resistance to joints and muscle groups in the hands and arms for sensory stunubtion and motor facilitation.
5) To Attach suspension slings to the traction bar above the bed to support the arms as well as to stimulate available active movements of the shoulders and elbows.
6) To Use assistive devices (e.g., bathmitt, a universal palmar cuff, plate guard, etc.). These devices encourage exercise through active arm movement, increase body awareness, encourage self-esteem by providing independent function and decrease dependency.
7) To Provide splinting to prevent tightening of muscles and deformity.
8) To Provide prism glasses to prevent the patient from developing eyestrain while viewing television, reading, seeing and talking with visitors.
Wheel Chair Phase: When the patient has progressed to sitting in a wheel chair, guidelines are determined for treatment planning. During all evaluation procedures, the therapist assists the patient-in movements when necessary. Fatigue or discouragement should not be allowed.
The following evaluation areas are examined:
1) Joint ROM.
2) Muscle strength.
3) Sensation.
4) Propriception (position sense).
5) Patterns of movement (reaching, grasping).
6) Functional activities (gross grasp, prehension, coordination, strength and tenodesis function).
7) Trunk control for free movements of upper extremities in isolated asymmetric use and use in ADL.
8) Need for assistance devices or splints.
9) Self-care and all ADL.
10) Prevocational evaluation.
Functional Splints: Early use of appropriate splints benefits the quadriplegic patient by providing muscle exercise, mechanical function for purposeful activity and assurance that the patient is capable of accomplishing tasks.
The quadriplegic patient is provided with a tenodesis or flexor-hinge hand splint when he or she has achieved active hyperextension of the wrist.
If the patient does not have active wrist extension against gravity and resistance, other types of hand-wrist tenodesis splints may be needed to provide the function of grasp.
The use of these devices depends on the motivation of the patient since they require tolerance to noise and the pressure o harnesses and special rigging as well as acceptance of complicated assistive equipment to substitute for natural functions.

Paraplegia :
Bed Phase : While confined to bed, the paraplegic patient benefits from and upper extremity activity program to strengthen the arms and hands to provide iwtial self-care assistance, to learn body image and self-awareness, to learn the extent of current functions and to provide a sense of self-worth through accomplishment of achievable tasks on a daily basis.
The longer the patient remains away from productive activity, the more difficult is his or her adjustment to the benefits of rehabilitation. The following activities and adaptations are suggested to encourage a positive attitude toward maintenance of restoration of productive abilities:
1) Inclined bed table, lap board and prism glasses for ease in performing upper extremity activity in bed.
2) Devices with extended handles for reaching and self-care a long-handled sponge for bathing; a reacher or picking up item.
3) Increasing involvement in daily self-cafe program.
4) Low-exertion upper extremity activities for active exercise of the arms while supine, such as reading, book games and manual activities.
5) Activities that offer resistance in hand and arm functions to increase strength and to decrease mental frustration from in activity.
Self-care activity increases self-awareness, responsibility and self-esteem When the restrictions on mobility are removed, the patient can begin self-care activities such as bathing in bed or in the wheel chair using a long handled sponge to reach the feet.
Wheel Chair Phase : Some adjustment time may be required or the patient to regain a sense of balance and body use when first moving from the bed into a wheel chair. When this is accomplished, all bathing and grooming can be done before a mirror and upper extremity dressing can be done in a wheel chair. Self-care activities not only provide independent functions but also provide important daily exercise in balance, strength and co-ordination.
Since functioning form wheel chair will in most cases become a way of life for the paraplegic person, it is essential that the wheel chair be equipped to meet all physical, personal and functional needs.
Assistive Devices : The paraplegic person needs fewer assistive devices than does the quadriplegic person for independent living. The paraplegic patient generally uses a seat board and special cushior; for the wheel chair, a transfer board, a long-handled reacher for dressing qr retrieving objects from high places or the floor and wheel chair accessories. The chair should have both a firm back and a firm seat. Working from a regular chair increases trunk and upper extremity strength and mobility.