The most obvious consequence of spinal cord injury (SCI) is paralysis. However, SCI also has widespread consequences for many body functions, including bladder, bowel, respiratory, cardiovascular and sexual function. It also has social, financial and psychological implications, and increases people's susceptibility to late-life renal complications as well as musculoskeletal injuries, pain, osteoporosis and other problems.
There is limited high quality evidence to guide clinicians in their interventions, so a sensible trial-and-error approach is extensively discussed with practical examples.
This review outlines the principles of physiotherapy rehabilitation for people with SCI and the evidence underpinning the effectiveness of commonly used physiotherapy interventions. It is divided in:
- recommendations on objective, standardized assessment, using the SCIM and WISCI scales to set treatment goals, monitor progress and predict long term outcome.
- presentation of interventions with focus on three common problems: 1) weakness, 2) contractures and 3) poor motor control.
- discussion of the wide scope of practice, future developments and clinical and interpersonal skills needed in SCI rehab.