Spinal Injury: Functional Rehabilitation

Medical University of South Carolina, Charleston. Textbook/reference for physical therapy students and practitioners.

Preface Spinal cord injury causes a host of physical and psychosocial problems that can interfere with an individual's health, feelings of well-being, and participation in activities and relationships within the family and community. The goal of rehabilitation after spinal cord injury is to enable the person to resume and then continue a lifestyle that is healthy, fulfilling, and integrated with his or her family and community. Physical therapists play a central role in this process, working with recently injured people and their families to maximize physical capabilities and mobility, and to develop the knowledge and skills needed to remain healthy. Three major elements are required for a therapist to fulfill this role most effectively. The first requirement is a basic understanding of spinal cord injuries and issues relevant to disability. Pertinent areas of knowledge include the disablement process, pathology, mechanisms of injury, physical sequelae, medical and surgical management, the prevention and management of complications, psychosocial impact, disability-related civil rights, functional potentials, equipment options, and wheelchair-accessible architectural design. This knowledge base is needed for optimal program planning and implementation. The second requirement is a knowledge of the physical skills involved in functional activities and the process involved in acquiring these skills. It is not enough merely to know the eventual outcome, which may take months to accomplish. The therapist must know how to design and implement therapeutic programs to develop the needed strength, flexibility, and motor skills involved in functional activities. Many a therapist has been baffled when faced, on the one hand, with a text that explains the maneuvers that a person with a spinal cord injury performs during functional tasks and, on the other hand, with a newly injured person who can barely remain conscious while sitting upright, much less even begin to perform the skills shown in the book. The third major element required for effective participation in rehabilitation is an approach to the individual that promotes self-respect and encourages autonomy. Unfortunately, this element is often overlooked. Although we health professionals have as our stated goals the independent functioning of our patients, we often unwittingly encourage dependence. Many practices in health care serve to encourage "compliance" and to discourage autonomous behavior. If the rehabilitation effort is to be successful, the social environment of the rehabilitation unit must be structured in a way that fosters the development of self-reliant attitudes and behaviors. In order to prepare readers to work effectively with people who have had spinal cord injuries, a text must encompass all of the elements described above. Spinal Cord Injury: Functional Rehabilitation was written to provide such a comprehensive treatment of the subject. The reader will gain a broad knowledge base relevant to spinal cord injuries and will develop an understanding of both the physical skills required for functional activities and the therapeutic strategies for achieving these skills. As importantly, the reader will gain an appreciation for the importance of psychosocial adaptation after spinal cord injury and will develop some insight into the impact that rehabilitation professionals can have in this area. CHANGES IN THE SECOND EDITION In the years since the publication of the first edition, a number of developments have occurred in the area of rehabilitation after spinal cord injury. Clinical and basic science research has deepened our understanding of the neuropathological changes associated with spinal cord injury, factors associated with neurological return, and appropriate interventions for spinal cord injury and its sequelae. Several new clinical practice guidelines now exist describing optimal care in a variety of areas relevant to spinal cord injury. Finally, health care delivery has changed dramatically in recent years as funding sources have shortened the time allotted to acute care and inpatient rehabilitation. This edition was written to reflect all of these changes. It provides updated information from clinical and basic science research, uses terminology and presents interventions that are consistent with published clinical practice guidelines, and includes strategies for delivering quality rehabilitative services in today's health care environment. This edition also reflects feedback from a variety of clinicians, academic faculty, and students. Thanks to suggestions from these sources, the book now contains chapters on skin care and respiratory management. Additional content areas that have been added or expanded in the text include the Nagi Model of Disablement, complications and their prevention and management, interventions appropriate for individuals with incomplete spinal cord injuries, post-discharge follow-up, community reintegration, erectile dysfunction, infertility, functional potentials, precautions, strategies for enhancing motor learning, and detailed information on muscle innervation. In addition to providing content that was not presented in the first edition, the second edition has several features that are designed to enhance learning and the development of clinical problem-solving skills. These new features include chapter openers presenting schematic representations of each chapter's content and its relevance to the disablement process, problem-solving exercises presented as boxed materials in each chapter, and bulleted summaries that highlight major points in each chapter. Portions of this edition are included on the web site for this book (prenhall/somers) instead of in the text itself. This arrangement made it possible to provide readers with important additional content without increasing the length (and therefore cost) of the book. The web site includes two full chapters (Chapter 14, Bowel and Bladder Management, and Chapter 15, Architectural Adaptations) and two appendixes (A, Solutions to Problem-Solving Exercises, and B, Spinal Segment Innervation of the Extremities).

Martha Somers