Traumatic spinal cord injury (TSCI) is a frequently occurring injury with an incident rate of 75.6 per million individuals living in South Africa and results in motor, sensory and autonomic impairments, as well as functional limitations, reduced independence and altered social roles. These injuries occur as a result of assault (60%), vehicular-related accidents (26%) and falls (12%), however little epidemiological information is available in a South African Context.
Typically, following TSCI, individuals are transported to the nearest trauma centre to undergo surgical interventions and initial phase inpatient rehabilitation. Unfortunately, the largest public-sector rehabilitation centre, situated in Cape Town, services only 40% of individuals originally admitted to the facility, leaving a large shortfall in the availability and access to rehabilitation services. As acute-phase and continued rehabilitation following TSCI has been shown to increase the individual’s independence, physical functioning and quality of life, this shortfall of service deliver has lasting implications.
Rehabilitation following TSCI is an intricate process consisting of three phases, namely the acute, subacute and chronic phases. These phases correspond with processes underlying neurorecovery, with the acute and subacute phases lasting generally 12-18 months post-injury, progressing into a period of plateaued neurorecovery, the chronic phase. The focus of rehabilitation varies throughout these phases, as highlighted below.
- Acute and Subacute phases
- Preventing secondary complications
- Promoting and enhancing neuroregeneration
- Maximizing functional capacity
- Chronic phase
- Promoting compensatory or assistive movements to overcome limitations in functioning
When considering the rehabilitation process following TSCI, it is important to consider the timing of the intervention, the intensity and duration of the intervention strategy, as well as individual characteristics.
|Timing||Intensity and duration||Individual characteristics|
|Research shows that with a longer duration between injury and initiation of rehabilitation, the lower the gains in physical function. Therefore, a greater availability to quality rehabilitation promotes improved therapeutic outcomes.||Numerous gait retraining protocols have been developed, however body-weight supported training has shown the greatest benefit. Functional Electrical Stimulation (FES), involving low-level stimulation of affected muscles, has shown to improve muscular strength and function.||Numerous characteristics affect therapeutic outcomes, including the individual’s age, medical aid status and availability to resources, muscular compensation patterns and alcohol consumption following injury. Furthermore, the characteristics and severity of the TSCI will largely affect rehabilitation outcomes.|
Considering the above, it is clear that rehabilitation interventions play an important role in maximising physical functioning and promoting healing following TSCI. Unfortunately, access to these intervention strategies is limited in South Africa.
BA (HMS) Biokinetics (Hons)
ACSM Certified Exercise Physiologist
Joseph, C.; Scriba, E.; Wilson, V.; Mothabeng, J.; Theron, F. 2017. People with Spinal Cord Injury in Republic of South Africa- Country Report. American Journal of Physical Medicine & Rehabilitation. [Online]. 96(2), pp.109-111. [Accessed 31 January 2019]. Available at: https://insci.network/insci/pub/People_with_Spinal_Cord_Injury_in_South_Africa.pdf Burns, A.; Marino, R.; Kalsi-Ryan, S.; Middleton, J.; Tetreault, L.; Dettori, J.; Mihalovich, K.; Fehlings, M. 2017. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine Journal. [Online]. 7(3S), pp 175S-194S. [Accessed 31 January 2019]. Available at: https://journals-sagepub-com.uplib.idm.oclc.org/doi/pdf/10.1177/2192568217703084