Acute Medical Phase
Milestones
- ●Spinal stabilization (surgical or conservative).
- ●Management of spinal shock (flaccid paralysis below the injury level).
- ●Stabilization of respiratory and cardiovascular function.
Physio Interventions
- →Respiratory physiotherapy (chest clearance, assisted coughing) for cervical injuries.
- →Aggressive prevention of pressure sores (turning every 2 hours).
- →Passive range of motion (PROM) to preserve joint flexibility.
Warning Signs
- ⚠️Autonomic Dysreflexia (sudden, dangerous spike in blood pressure).
- ⚠️Deep Vein Thrombosis (DVT).
- ⚠️Respiratory failure.
Psychological Insight"Intense trauma and grief. Psychological support for the patient and family is mandatory. Focus on surviving and stabilizing."
Early Inpatient Rehabilitation
Milestones
- ●Spinal shock resolves; true level of neurological injury becomes clearer.
- ●Ability to sit in a customized wheelchair for extended periods.
- ●Beginning to learn compensatory strategies and basic transfers.
Physio Interventions
- →Sitting balance and core control training.
- →Upper body strengthening (crucial for wheelchair mobility and transfers).
- →Bed mobility training (rolling, sitting up).
Warning Signs
- ⚠️Orthostatic hypotension (dizziness when sitting up).
- ⚠️Severe spasticity developing.
- ⚠️Skin breakdown over the sacrum or heels.
Psychological Insight"A period of intense learning and adaptation. Mourning the loss of function while simultaneously needing to find the energy to participate in hours of daily rehab."
Advanced Inpatient / Early Outpatient Rehab
Milestones
- ●Mastery of wheelchair skills (propulsion, wheelies, navigating curbs).
- ●Independence in transfers (bed to chair, chair to car) for lower-level injuries.
- ●For incomplete injuries, potential initiation of gait training.
Physio Interventions
- →Body Weight Supported Treadmill Training (BWSTT) or Robotic Exoskeleton training for neuro-recovery.
- →Advanced wheelchair skills training.
- →Functional Electrical Stimulation (FES) for muscle atrophy and neuro-facilitation.
Warning Signs
- ⚠️Shoulder pain and overuse injuries from wheelchair propulsion.
- ⚠️Depression due to prolonged hospitalization.
Psychological Insight"Transitioning back home can be highly stressful. Home modifications (ramps, accessible bathrooms) need to be finalized."
Long-Term Outpatient & Community Integration
Milestones
- ●Return to home, community, school, or adapted employment.
- ●Maximized independence based on the level of injury.
- ●Participation in adaptive sports.
Physio Interventions
- →Maintenance of strength and cardiovascular fitness.
- →Ongoing management of spasticity and posture.
- →Exploration of new assistive technologies and adaptive equipment.
Warning Signs
- ⚠️Loss of bone density (osteoporosis) leading to fracture risk.
- ⚠️Urinary tract infections (UTIs) or chronic pressure sores.
Psychological Insight"Redefining identity and finding purpose post-injury. Peer support groups and adaptive sports organizations play a massive role in long-term mental health."
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Free Initial Assessment
Includes clinical check, analysis, and personal recovery planning for Spinal under Dr. Karolin Rockson, PT (BPT), Ex. CMC - Vellore.