Rehabilitation for patients with paraplegia or quadriplegia due to spinal cord injury

The article is professionally consulted by Master, Specialist Doctor I Nguyen Thi Thanh Binh - Rehabilitation Doctor - Department of General Surgery - Vinmec Da Nang International General Hospital. The doctor has 30 years of experience in the specialty of Rehabilitation.

Spinal cord injury is a condition in which part of the spinal cord is damaged and causes damage to the area of ​​the body below the injury. Depending on the location of the spinal cord injury, it will cause paraplegia or quadriplegia. Paralyzed patients need spinal cord injury rehabilitation to improve health and quality of life.

Spinal cord injury is a condition in which part of the spinal cord is damaged, affecting the corresponding part of the body due to the control of the damaged segment of the spinal cord. The spinal cord is a nerve tract located in the spinal canal, originating from the brain down along the spine. Both motor and sensory information must travel through the spinal cord. Therefore, when the spinal cord is injured, the part of the body below the injury site may be limited or completely lost in mobility and sensation.
The degree of spinal cord injury is divided as follows:
Paralysis of both limbs and part of the body: Injury to the spinal cord from the back down will cause loss of sensation, paralysis of both limbs and part of the body under. Quadriplegia: Injury to the cervical spinal cord will cause quadriplegia, loss of sensation and motor paralysis in both arms and legs. Causes of spinal cord injury can be listed as:
Traffic accidents Work, daily life, sports accidents Spina bifida in children Spinal diseases (spinal tuberculosis, myelitis, fibromyalgia, myeloma, spinal tumor, herniated disc compressing the spinal cord...) Injury to the spinal cord is very serious and leaves severe sequelae for the patient. Therefore, people with spinal cord injuries need care and treatment to improve the quality of life as well as the patient's health and life.

2.1 Manifestations of spinal cord injury causing paralysis of both legs Patients with paralysis of both legs and part of the lower body due to spinal cord injury have the following manifestations:
Loss of sensation and ability to control movement in the legs. There may be loss of sensation and partial paralysis of the body. Possible loss of bowel and urinary control. There may be flaccid paralysis or spastic paralysis of both legs. 2.2 Manifestations of spinal cord injury causing quadriplegia Patients with quadriplegia due to spinal cord injury have the following manifestations:
Loss of sensation and ability to control movement from the neck or chest down, which may spread to both arms and hands. Shortness of breath due to paralysis of the respiratory muscles. Decreased ability to regulate temperature and perspiration. Disorders of intestinal and urinary control. Spastic paralysis of both arms and legs (quadriplegia).

The goal of rehabilitation treatment for spinal cord injury is to prevent and minimize complications caused by the injury, and at the same time to help the patient be independent and self-reliant in taking care of themselves, to return to normal soon. family, work, society and daily life.
The typical spinal cord injury rehabilitation treatment time can be up to 4 months in the hospital or treatment facility, and continues to last at home, including 3 stages: acute, middle and integration.
3.1 Rehabilitation of acute spinal cord injury (stage of spinal shock) The content of rehabilitation program for acute spinal cord injury includes:
Detect and solve problems caused by spinal cord injury paralysis living. Hygiene, skin care, prevention of pressure ulcers by changing the patient's position about every 2-3 hours; have the patient lie on an air mattress or a water mattress; In areas where the skin is close to the bones, it is necessary to put a soft pillow to avoid pressure; Prevent ulcers in places such as occipital bone, shoulder blade, sacrum, buttocks, thigh bone, ankle and heel. Preventing pneumonia, ensuring the airway is always open in patients with spinal cord injury by performing thoracic vibrating techniques, postural drainage. Take care of the digestive tract by building and implementing a reasonable diet for the patient, exercising the intestines. Urinary tract care is performed as soon as the injury is detected to avoid bladder strain, urinary retention causing urinary tract infections upstream, bladder rehabilitation exercises for patients with spinal cord injury. Prevention of contractures - muscle atrophy and stiffness of paralyzed limbs. Early passive exercise gently by placing the patient in the correct position on the hospital bed, combined with orthopedic equipment if necessary. Begin balancing exercises to prepare the patient for the next stage. Do psychotherapy. 3.2 Rehabilitation of spinal cord injury in the rehabilitation phase The goals of spinal cord injury rehabilitation in the rehabilitation phase include:
Exercise independence while in bed. Practice self-care, personal hygiene including skin, digestive and urinary tract. Practice independent mobility in a wheelchair. Begin teaching the patient to use assistive devices such as splints or crutches to assist in moving the leg. To achieve the goals of rehabilitation for spinal cord injury in the convalescent stage, the following should be carried out:
Get the patient out of bed as soon as possible and practice with a tilted table. For muscle groups that are not paralyzed such as wrists, arms, and around the shoulders, it is necessary to exercise strongly. In case of paralysis of the limbs, it is necessary to strongly exercise the body muscle group. Instruct and train the patient to sit up with and without assistance. Practice balancing while sitting for patients with spinal cord injury in both static balance and balance when moving (grabbing objects). Practice mobility from bed to wheelchair and vice versa. Practice balance while standing, practice standing and moving with the help of tools. Practice daily activities and play habits such as washing face, brushing teeth, dressing, playing gymnastics, ... 3.3 Rehabilitation of spinal cord injury in the integration phase Objectives of injury rehabilitation Spinal cord injury in the integration stage is to create a comfortable and favorable environment for the patient to quickly reintegrate back into family and social life.

To achieve this goal, the following measures should be taken:
Mobility: Create a path or environment for easy movement, limit obstacles, assist the patient to handle. Living: Bed with wheelchair height; wardrobe, personal belongings are always within reach; the toilet has a large enough door size, suitable for patients with spinal cord injury; . Eating and drinking: There are aids to help patients eat more comfortably. Social: Helping patients of working age find suitable jobs and generate income, helping patients integrate into the community.

Patients with paralysis of both limbs or extremities due to spinal cord injury need special care to improve their health and quality of life, avoiding mental effects:
Nutrition is always adjusted to suit each stage and ensure adequate substances and vitamins to quickly restore health, prevent complications of ulcers. Regularly take care of your skin and keep it clean and dry. Pay attention to urinary tract hygiene to prevent infection. Regularly encourage, talk and encourage patients with spinal cord injury to overcome guilt, low self-esteem, negative psychology, ...

In order to limit the serious effects caused by spinal cord injury, it is necessary to pay attention to prevention in daily activities and labor such as:
Always maintain and ensure safety in living, working, and exercising sports, vehicle control and traffic participation. Periodic health examination to promptly detect diseases that can affect and damage the spinal cord. Educate on the consequences of spinal cord injury, teach proper first aid to prevent and limit secondary injuries.

Rehabilitation for patients with paraplegia or quadriplegia due to spinal cord injury includes 3 stages from immediately after the injury is detected, the middle stage until integration to bring the patient back to life soon. everyday with better quality and health.
Currently, the Rehabilitation Gym at Vinmec International General Hospital is fully equipped with the most modern and synchronous machines.
Closed continuous gym chain from gross to fine motor for Rehabilitation of movement, living and hand function training. A system of high-class specialized machines, beds, and tools from the Netherlands, Italy, Japan, etc. integrates the application of advanced informatics technology to help optimize the treatment and rehabilitation process for patients. Intensive rehabilitation treatment rooms: Rehabilitation after surgery; Pediatric respiratory physiotherapy; Shock wave treatment; Treatment with magnetic fields... High-class machines, training beds, and specialized tools from the Netherlands, Italy, Japan... integrates the application of advanced informatics technology to help optimize the treatment process. , rehabilitation for patients Rehabilitation gym provides the following services:
Rehabilitation after orthopedic surgery: Joint replacement; bone fusion; ligament regeneration ... Rehabilitation of central and peripheral nervous diseases Rehabilitation for cancer patients Rehabilitation of spinal diseases such as: back pain, neck pain, neck pain, degeneration spondylolisthesis, disc herniation... Especially with the implementation and rehabilitation instructions for patients from a team of experts and experienced doctors at Vinmec, it will bring opportunities for recovery and improvement. best quality of life for the patient.