Physical therapy for paraplegia is a major part of the spinal cord injury rehabilitation process.
Physical Therapy for Paraplegia vs. Quadriplegia
Physical therapy goals are going to differ for those with paraplegia and those with quadriplegia.
Because patients with paraplegia have fully functioning arms, physical therapy for paraplegia is going to focus mainly on developing strength in the core and legs.
In contrast, patients with quadriplegia have paralysis in their upper and lower extremities, so they should focus on recovering arm functions before leg functions.
The spinal cord heals by levels, so it’s unlikely for a spinal cord injury patient to regain leg function before arm or torso function.
Each level of the spinal cord connects to a different set of nerves responsible for sending messages to different parts of the body.
Generally, functions will return from top to bottom from your neck to shoulders, down your arms, trunk, and legs.
Physical therapists are responsible for much more than making sure that you’re performing exercises.
They must get to know you, educate you, and find out what motivates you.
They help guide your physical recovery and keep you accountable.
Power of Repetition
Repetition is a crucial factor for paraplegia recovery.
After a spinal cord injury, the communication between your brain and body gets disrupted.
The messages that are being sent to your body can’t get past the site of injury, so your body doesn’t know how to react. Similarly, your brain can’t receive stimuli from your body.
The severity of your spinal cord injury will determine how many neural circuits survived. The more survived circuits, the more control or sensation you will have in areas below the injury.
Repetition focuses on strengthening and reteaching neural circuits that survived the injury.
It helps familiarize your body with movements, so the more you repeat, the easier the task gets.
The spinal cord has plasticity, which is the ability to reorganize itself. Rehabilitation that emphasizes massed practice will enhance activity-dependent plasticity in the spinal cord.
Factors that affect neuroplasticity include:
- Intensity: This involves how many repetitions you perform, how long you train, and how much you’re challenging yourself. The higher the intensity, the greater the recovery outcome.
- Specificity: Neuroplasticity is task-specific, so the training of one function doesn’t necessarily transfer over to other functions.
- Timing: The most recovery occurs during the first six months following a spinal cord injury, and although recovery can still happen past the initial six-month period, performing high repetitions during this time window is crucial to optimize recovery.
Types of Physical Therapy for Paraplegia
No two spinal cord injuries are the same.
Depending on the level and severity of your injury, the types of exercises you will be doing in physical therapy will vary.
Did you know that even parts of your body that you have no control over can participate in exercise?
Passive range of motion exercise does not require any effort on the patient’s part, which makes it ideal for those with complete injuries. A physical therapist or caregiver will move paralyzed regions of your body for you.
However, because people with paraplegia have fully functioning arms, they can perform many passive leg exercises on their own.
Passive range of motion exercises ensure that your joints are being used to their full range of movement and help promote sensory feedback to improve neuromuscular function
Benefits of performing passive exercise include increased blood flow, flexibility, and reduced pain.
Below are some passive range of motion exercises that will benefit those with paraplegia. Be sure to perform them slowly and gently.
- Trunk Twists: Have the patient lay down on his/her back with knees bent. Then, tilt the knees to one side, making sure that the shoulders don’t move. Repeat to the other side.
- Knees to Chest: Have the patient lay down with one leg bent. Bring the knee up towards the chest and then straighten it, bringing it down next to the other foot. Repeat with the other leg.
- Hip Abductions: Have the patient lay down with legs straight. Then, hold one leg from underneath the calf and pull to the side, so that the foot is moving outward. Bring the leg back in towards the center and repeat.
- Ankle Rotations: Place one hand on the patient’s ankle and the other on the foot. Rotate the foot clockwise and then counterclockwise.
- Toe Curls: Push the patient’s toes forward so that they curl in and then backward.
Gait training is a type of training that focuses on developing your walk.
The lower your level of injury, the more overall function you’ll have, and the easier gait training will be.
Gait training works on building strength and endurance in your legs so that you can walk longer distances without tiring.
Gait training may involve the use of weight-bearing devices that’ll help take the pressure off your legs so that you can focus on making walking motions.
Another technique that helps take some pressure off your lower extremities is getting into the pool. Buoyancy will help keep you afloat so that you can feel lighter and focus more on your form and motions.
Gait training also utilizes equipment like walkers, canes, and parallel bars. Using assisting devices will help you get the most realistic feel for walking again because it teaches you how to shift your weight and balance.
If you’re not yet ready for gait training, leg exercises will be helpful for developing strength.
Consider buying a resistance band or a leg lifter to help you stretch your legs. The video below will teach you how to stretch your ankles, hamstrings, gluts, and lateral rotators.
If you have some motor control in your legs, try these additional exercises:
- Leg Raises: Lay on your back with one leg bent. Raise the straight leg up, hold for 5 seconds, and then slowly bring it back down.
- Seated March: Take a seat and move your legs up and down in a marching motion. Try to bring your knees up as high as possible.
- Knee Extensions: Take a seat and move one of your legs forward (as if you’re kicking a ball) so that your leg is straightened. Hold it for a few seconds before bringing it back down.
Those with thoracic spinal cord injuries are going to experience weakness in their core.
The core is responsible for stability and balance. When you have a weak core, even the simplest tasks like reaching over for a pencil can cause you to lose balance and fall over.
Core strength is essential for sitting, standing, and walking.
Check out the video below for seated core exercises that you can do from the comfort of your wheelchair.
Another way to work on your core is to use a stability ball.
Just by sitting on it, you’re engaging your core muscles to sustain your center of gravity.
Try switching it out for anything you need a regular chair for.
You can also use a stability ball to practice crunches without straining your tailbone.
As your core muscles get used to balancing on the ball, it’ll become easier to use for longer periods.
Physical Therapy for Paraplegia
What a lot of people don’t realize is that the exercise that you do during your physical therapy session is usually not enough.
Make sure to continue high-repetition exercises at home for the best results.
Hopefully, this article helped expand your understanding of the importance of physical therapy for paraplegia and gave you some good exercise ideas to work on repetition from home.