Rehabilitation exercises can include joint range of motion training, muscle strengthening exercises, postural correction exercises, balance training, and sit-and-stand exercises. The appropriate method should be selected based on individual needs.
- Strength Training:
The focus of training varies depending on the patient's clinical presentation. For patients with complete spinal cord injury, strength training focuses on the upper limb muscles, while for patients with incomplete spinal cord injury, residual muscles should also be trained. Active exercises can be used for strength level 3; for strength level 2, assisted and active exercises can be used; for strength levels 1 and 0, only functional electrical stimulation can be used. The goal of strength training is to achieve strength level 3 or above. To enable patients with spinal cord injury to use wheelchairs, crutches, or walkers, they should focus on strengthening their shoulder girdle muscles, both in bed and while sitting. This includes upper limb support training, triceps and biceps training, and grip strength training.
- Sitting Training:
This type of training can be performed on a mat or in bed. Sitting can be divided into long sitting (knee extended) and upright sitting (knee flexed 90°). Before starting sitting training, the patient must have a certain degree of trunk control or muscle strength, and the range of motion of each lower limb joint, especially the hip joints, should be close to normal. Sitting training can be performed in both long sitting and upright sitting positions. Sitting training also includes static balance training while sitting, as well as dynamic balance training for forward, backward, left, right, and rotational trunk movements.
- Walking Training:
The goals of walking training are:
① Therapeutic walking: Generally suitable for patients with injuries in the T6-T12 plane.
② Functional walking at home: Allows walking indoors, but the walking distance cannot reach 900 meters. This is generally seen in patients with injuries in the L1-L3 plane.
③ Functional walking in the community: Patients with injuries below the L4 plane can walk up and down stairs while wearing ankle-foot orthoses and independently perform activities of daily living. Walking training is divided into walking within parallel bars and walking with crutch training. Begin by practicing standing and walking on parallel bars, then gradually transition to balance training and walking with crutches. During walking training, maintain an upright upper body, steady gait, and a consistent pace. Once endurance improves, practice navigating obstacles, ascending and descending stairs, and falling and standing up after a fall.
- Wheelchair Training:
Two to three months after injury, when the patient's spine is stable and sitting training is complete (i.e., when the patient can sit independently for at least 15 minutes), begin wheelchair training. Upper limb strength and endurance are prerequisites for good wheelchair control. Wheelchair training includes forward and backward driving, left and right turning, walking with the front wheels lifted and rotating, climbing inclines and navigating obstacles, ascending and descending stairs, negotiating narrow doorways, and safely falling and sitting upright. Every 30 minutes of sitting, support the torso with your upper limbs or tilt the torso to relieve pressure on the buttocks to prevent pressure sores on the ischial tuberosities.
- Use of Orthoses:
Appropriate lower limb orthoses are necessary for many paraplegics to stand and walk. Common orthoses include knee-ankle-foot orthoses and hip-knee-ankle orthoses.