What is spinal cord injury rehabilitation?

Spinal cord injury rehabilitation is a medical specialty that deals with the treatment and rehabilitation of patients with spinal cord injury. Apart from paralysis, those affected often suffer from other symptoms associated with the causative spinal cord injury, which requires more complex treatment.

Spinal cord injury rehabilitation represents an interdisciplinary area, linking the fields of neurology, orthopedics and trauma surgery, psychiatry and psychotherapy, as well as physical and rehabilitative medicine.

Spinal cord injury: a severe disruption to life

The term "spinal cord injury" is a colloquial expression for paraplegia or tetraplegia, which are explained in more detail below.

It is a part of the symptomatology of the spinal cord injury. This refers to damage to the spinal cord, where a distinction is made between complete spinal cord injuries, in which the entire diameter of the spinal cord is affected, and incomplete spinal cord injuries, in which only part of the spinal cord is damaged.

In cases of spinal cord damage, both afferent and efferent pathways can be affected. Afferent pathways transmit signals related to touch, pain, temperature, and proprioception (the awareness of the position and movement of body parts in space) from the periphery to the brain. Efferent pathways carry impulses for conscious and unconscious motor activity from the brain to the muscle cells in the skeletal muscles or organs.

Incomplete spinal cord injuries do not necessarily result in paralysis, meaning a loss of motor function. However, in the case of a complete spinal cord injury, all pathways, including motor ones, are affected, which leads to paraplegia or tetraplegia.

The extent of paralysis and sensory disturbances depends on the level of the injury. Since the neural pathways are interrupted at the site of the lesion, symptoms affect the part of the body located below that point. However, this boundary is only a rough guideline due to the course of the nerves. The higher the damage occurs on the spinal cord, the more severe the limitations for the patient. An injury in the upper cervical region (neck area) leads to respiratory paralysis, as the efferent nerves that control the diaphragm are affected. Without artificial ventilation, this type of injury is fatal.

Spinal cord injuries can occur in different ways, and symptoms may appear suddenly or gradually depending on the cause. Possible causes include:

• Injury, e.g., in a traffic accident (the full extent of the damage may only become apparent later due to swelling of the injured tissue)

• Tumors

• Infarction

• Hemorrhage

• Spinal canal stenosis (narrowing of the spinal canal)

• Cerebrospinal fluid (CSF) flow obstruction

• Infection (e.g., poliomyelitis, Coxsackie virus, chickenpox)

• Multiple sclerosis

• Congenital malformation

• Iatrogenic (medically induced), for instance during surgery.

How does paraplegia occur?

Paraplegia is the complete paralysis of both legs. It is the result of damage to the motor pathways of the spinal cord and is therefore a symptom of a complete or incomplete spinal cord injury.

What is the difference between paraplegia and tetraplegia?

In paraplegia, only the legs are affected by paralysis, while in tetraplegia, both the arms and legs are affected. In the case of tetraplegia, the damage to the motor pathways of the spinal cord occurs in the cervical spinal cord, i.e. around the cervical vertebrae. Damage to the thoracic or lumbar spine results in paraplegia.

Where can I find experienced specialists for spinal cord injury rehabilitation?

There is no specialist training or additional qualification for a specialist in spinal cord injury rehabilitation, as it constitutes an overlap between different medical specialties. This is why there are spinal cord injury centers in which doctors from different specialist areas, such as neurology, orthopedics and trauma surgery, psychiatry and psychotherapy, as well as physical and rehabilitative medicine, work together with other professional groups such as physiotherapists and occupational therapists, as well as specially trained nursing staff and speech therapists. Such centers specialize in the treatment and rehabilitation of people with spinal cord injuries and therefore have extensive experience.

Which treatments and therapies are used? 

The treatment of a spinal cord injury should always follow a holistic approach. Which treatments are used always depends on the type of injury, symptoms and the patient's individual requirements. Pain therapy, operations (to maintain continence, for example) and artificial respiration are some of the therapies used in spinal cord injury rehabilitation. Others include patient education, acupuncture, art, music, occupational therapy, psychotherapy, physiotherapy and physical therapy.

Acute treatment and early rehabilitation for spinal cord injury

An acutely occurring spinal cord injury is a medical emergency. The acute treatment includes the stabilization of vital parameters, clinical neurological and imaging diagnostics, and, if necessary, the elimination of a reversible cause, such as a hemorrhage or an infarction of the spinal cord. Possible complications, such as a paralytic ileus, must also be treated.

The acute treatment phase is also referred to as Phase A of rehabilitation. In Phase B, early rehabilitative therapies are already initiated, but intensive medical treatment remains necessary at the same time. The goal of this phase is to regain autonomy in basic functions, such as independent breathing. Complications like contractures, pressure sores, or pneumonia should be prevented.

In Phase C, patients still rely on medical and nursing care but can actively participate in rehabilitative therapies. The aim here is to restore various functions, such as mobility with or without assistive devices, or the ability to eat independently. After this phase, early rehabilitation is complete, followed by additional phases that serve, among other things, for vocational and social reintegration.

The speed at which the phases of rehabilitation are navigated is highly individual. It is also possible for individuals to skip phases or to not complete a phase for life. On average, the duration of initial inpatient rehabilitation for paraplegia is 150 days, while for tetraplegia, it is 200 days.

Pain therapy and medication

Patients with spinal cord injury often suffer from chronic neuropathic pain. Various therapy options are available for treatment, and several approaches are typically combined. The most important types of pain therapy include:

• Supportive pain therapy: e.g. acupuncture, massages, psychotherapy, relaxation techniques, biofeedback...

• Medication-based pain therapy: use of non-opioid analgesics on their own or in combination with weak or strong opioids, neuroleptics, antidepressants, tranquilizers, muscle relaxants, cortisone

• Invasive pain therapy: insertion of a pain catheter that allows the application of a local anesthetic close to the spinal cord; nerve stimulation procedures or deep brain stimulation (DBS)

Where can I find an experienced specialist in spinal cord injury rehabilitation?

At PRIMO MEDICO you will find exclusively experienced specialists and clinics for spinal cord injury rehabilitation in Germany, Austria or in Switzerland. You can currently find recognized experts in the following cities:

• Spinal Cord Injury Rehabilitation in Bad Wildungen