The principles of staged rehabilitation of the patients presenting with a severe injury to the spinal cord

Abstract

The article features the practices related to the multi-faceted rehabilitation of patients presenting with the severe combined injuries that affect both the spine and the spinal cord. The issues of interest in terms of the immediate post-operative rehabilitation as well as the experience gained during the treatment of major locomotor disorders are defined and discussed. The article presents the guidelines concerning the development of the rehabilitation programs and the major drug-free rehabilitation strategies including those based on the application of the up-to-date robot-assisted technologies. The training devices and other instruments of the domestic and foreign production being currently put into use are considered along with the practical guidelines designed to facilitate decisions making as regards the prescription of one or another treatment modality taking into account the relevant indications. It has been found that the precise body weight support systems efficiently help to improve walking performance through unloading of the patient’s body which is conducive to the sensory stimulation that best fits the concrete patient. The advantage of robot-assisted rehabilitation consists of the possibility to do training in the sub-maximum regimen that enables the patient to carry out the exercises controlled in terms of both their overall number and intensity level. The immediate post-operative rehabilitation aims primarily at the enhancement of motor performance by allowing the patient to develop the ability to stand upright within the shortest time possible. it would take roughly 20-40 days for a patient to adapt to standing upright in the absence of the specialized training devices whereas the use of the tilt tables with built-in robotic continuous passive and active motion devices for the training of the lower extremities eliminates a number of factors impeding rehabilitation of the patients and thereby makes it 2-3 times faster for a patient to adapt to standing upright. The suspension systems have been found to be promising for the rehabilitation of the patients experiencing the locomotor problems following a severe injury to the spinal cord.

Keywords

vertebral spinal trauma / motor disorders / remedial gymnastics / botulinum toxin therapy / physical therapy / rehabilitation

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