Spinal Rehabilitation

Foundations & Assessment - Backbone Blueprint

• Core Principles
  • Biopsychosocial model.
  • Goal-oriented: Functional restoration.
  • Interdisciplinary team.
  • Patient education for self-management.
• Assessment Protocol
  • History
    • Pain profile.
    • ⚠️ Red flags (neuro deficits, cauda equina, systemic symptoms).
    • Yellow flags (psychosocial).
  • Physical Examination
    • Observation: Posture, gait.
    • Palpation: Tenderness, spasm.
    • ROM: Spinal segments.
    • Neurological: Motor (MRC 0-5), Sensory (dermatomes), Reflexes (DTRs 0-4+, Babinski).
    • Special tests: SLR, Spurling’s.
  • Functional Scales
    • VAS (pain).
    • ODI (lumbar disability).
    • NDI (cervical disability).
  • Imaging
    • X-ray: Initial, trauma, instability.
    • MRI: Soft tissues, neural elements (disc, cord).
    • CT: Bony detail, complex fractures.

⭐ Early identification of red flags (e.g., progressive neurological deficit, saddle anesthesia, unexplained fever) is critical to rule out serious spinal pathology requiring urgent intervention.

Common Conditions Rehab - Ache Avengers

• Low Back Pain (LBP)

  • Classification: Acute (<6 weeks), Subacute (6-12 weeks), Chronic (>12 weeks).
  • ⚠️ Red Flags: Cauda equina (bowel/bladder, saddle anesthesia), unexplained weight loss, fever, trauma, progressive neuro deficit, cancer Hx.
  • Rehab:
    • McKenzie Method (extension bias, centralization).
    • Williams' Flexion Exercises (stenosis, flexion bias).
    • Core stabilization (Transversus abdominis, multifidus, e.g., McGill's Big 3).
    • Aerobic conditioning.

• Cervical Pain (Neck Pain)

  • Key: Postural correction, ergonomic adjustments (workstation).
  • Exercises: ROM, stretching, cervical isometrics, deep neck flexor (DNF) strengthening (chin tucks).

• Lumbar Disc Herniation

  • Common: Posterolateral, radicular pain.
  • Rehab:
    • Directional preference exercises (e.g., McKenzie extension).
    • Nerve gliding techniques.
    • Core stability for prevention.
    • Avoid: Sustained flexion, poor lifting mechanics.

• Spondylolisthesis

  • Focus: Segmental stabilization, core (transversus abdominis) & glute strength.
  • Avoid: Lumbar hyperextension, high-impact activities. Bracing if symptomatic.

• General Rehab Principles

  • Pain Management: Cryo/thermotherapy, TENS, NSAIDs (short-term).
  • Patient Education: Body mechanics (lifting, sitting), activity pacing.
  • Functional Restoration: Graded activity, return to work/sport.

⭐ Most acute LBP resolves in 6 weeks with conservative care; imaging often not needed initially without red flags.

SCI Rehabilitation - Cord Crusaders

Goal: Maximize functional independence & quality of life (QoL), prevent complications. Multidisciplinary team approach.

• Phases of SCI Rehab:

  • Acute: Medical stabilization, prevent secondary injury.
  • Subacute (Rehabilitation Unit): Intensive therapy, functional goals.
  • Chronic/Community Reintegration: Maintain function, QoL, vocational rehab.

• Key Management Areas:

  • Mobility: Bed mobility, transfers, wheelchair (W/C) skills, gait training (orthotics, FES).
  • ADLs: Self-care, adaptive devices.
  • Bladder: Intermittent catheterization (IC) preferred. Prevent UTIs.
  • Bowel: Timed program, diet, digital stimulation.
  • Skin: Pressure relief (turn q2h bed, shift weight q15-30min W/C).
  • Respiratory: Crucial for high cervical lesions (e.g., C1-C4 often ventilator-dependent).
  • Spasticity: Stretching, meds (e.g., Baclofen).
  • Pain: Neuropathic, musculoskeletal.

• Autonomic Dysreflexia (AD):

  • Occurs with lesions T6 or above.
  • Symptoms: Sudden ↑BP, pounding headache, bradycardia, sweating above lesion.
  • Management: Sit patient up, loosen constrictive clothing, check bladder/bowel, antihypertensives if needed.

![ASIA Impairment Scale (AIS) Worksheet](https://ylbwdadhbcjolwylidja.supabase.co/storage/v1/object/public/notes/L1/Orthopaedics_Rehabilitation_and_Physical_Medicine_Spinal_Rehabilitation/efec5443-00f0-4ebc-9cde-40a27add24e9.png)

⭐ Autonomic dysreflexia (AD) is a potentially life-threatening hypertensive crisis in individuals with SCI at or above T6, typically triggered by noxious stimuli below the level of injury.

📌 ASIA Scale: American Spinal Injury Association Impairment Scale for classifying severity (A=Complete to E=Normal).

High‑Yield Points - ⚡ Biggest Takeaways

• SCI levels dictate functional outcomes: C5 (elbow flexion), C6 (tenodesis grasp), C7 (independent transfers).
• Autonomic Dysreflexia (SCI above T6): medical emergency with hypertension, bradycardia, triggered by noxious stimuli.
• Prevent pressure ulcers with regular 2-hourly turning, meticulous skin inspection, and appropriate support surfaces.
• Neurogenic bladder (intermittent catheterization) and bowel (timed programs) require diligent management.
• Manage spasticity post-SCI with physiotherapy, oral baclofen/tizanidine, or botulinum toxin injections.
• The ASIA Impairment Scale is crucial for classifying SCI severity and predicting neurological prognosis after injury.
• Early and comprehensive rehabilitation significantly improves functional independence and quality of life post-SCI.