Working with individuals with spinal cord injury “really makes you realize how much we can take for granted with our own health,” said Julie Coté, a physical therapist at Magee Rehabilitation, where large populations of their patients have spinal cord injuries.
Spinal cord injuries are most frequently caused by car accidents, motorcycle accidents, falls, or acts of violence like gunshot injuries. Auto accidents and recreational accidents are more common in the younger population (teens through younger adults) while falls are more common in older patients.
Spinal cord injuries can be complete or incomplete. A complete injury to the spinal cord leads to a loss of both sensation and strength below the level of injury. Someone who has a spinal cord injury in their mid or low back will lose function in their legs (paraplegia) vs. someone with an injury in their neck that will lose function in both arms and legs, also known as tetraplegia. An individual with an incomplete spinal cord injury will have some preserved sensation and/or strength below the level of their injury.
There are a lot of variations within incomplete spinal cord injury as well. “Some of our patients with incomplete spinal cord injury walk again for exercise but still require a wheelchair as their primary way of getting around.” Coté said.
Right after the injury
Helene Usher, an occupational therapist at Thomas Jefferson University Hospital works with spinal cord injury patients in the early stages of their journey in Comprehensive Acute Rehabilitation.
“I see patients either before their surgery or right after. If before surgery, we educate them on what is happening and if cleared to do so, do some light stretching,” she said.
“Once they are cleared after surgery, we get them up and out of the wheelchair. They are light-headed and weak with no tolerance for gravity so it is a scary time for them. We try to give back some control over their bodies.”
Building strength and mobility
Once these patients are released from the hospital they are usually transferred to an inpatient rehabilitation center like Magee Rehabilitation for several weeks to several months where they learn how to live as independently as possible. Once they are able to return home, they generally continue physical and occupational therapy at an outpatient center, such as at Magee Riverfront.
“How they get around after a spinal cord injury is very different and requires a lot more effort,” Coté said. Physical therapists will work with patients on building mobility and function, such as getting in and out of bed, getting in and out of a wheelchair, balance, pushing a manual wheelchair, and walking if they are able.
Within their physical therapy department, Magee also offers a comprehensive Locomotor training program, a rehabilitative approach used for recovery of walking over a treadmill. This therapy uses current knowledge of how the brain and spinal cord control stepping and how the nervous system learns (or relearns) a skill. Magee offers both a robotic (Lokomat by Hocoma) and/or manually facilitating (Therastride by Innoventor) locomotor training therapy options, dependent upon the person’s needs. Magee’s experience with Locomotor Training led to an opportunity to be one of two founding members of the NeuroRecovery Network (NRN) sponsored by the Christopher and Dana Reeve Foundation (CDRF) and the Centers for Disease Control and Prevention.
Occupational therapists will work with them on daily self-care skills, such as dressing, bathing, toileting, managing bowel and bladder function, and using various assistive technologies as well as skills for driving and returning to work.
In Magee Rehabilitation’s Day Rehab program, spinal cord injury patients receive a combination of occupational therapy and physical therapy five days a week for six hours a day. They also receive nursing, psychology, and therapeutic recreation and social work services.
For someone with a spinal cord injury, it can be challenging to find ways to exercise again as access to equipment in a typical neighborhood gym can be difficult, so Magee also offers several wellness programs for patients once they graduate from formal therapy.
The wellness program at Magee Riverfront offers wheelchair accessible gym equipment including upper body strength training equipment, standing frames, arm bikes and NuStep (a seated stepping machine). Magee also offers exercise equipment that operates with functional electric stimulation (FES) in the form of a stationary bike and a seated stepping machine. This technology allows an individual without active movement to exercise using electric stimulation to facilitate movement. Additionally, Magee offers wheelchair sports programs Wheelchair Basketball, Wheelchair Rugby, Wheelchair Tennis.
Learning to walk again
Christine Taylor who was paralyzed on her right side after a medical injury is one of the many former patients who use the wellness gym. She knows how completely life-changing a spinal cord injury can be.
“On December 13, 2011, I went in for a medical procedure and when I woke up afterwards I couldn’t feel a thing on my right side,” she said.
She was in Jefferson Hospital for a month where she learned how to transfer from bed to wheelchair and bed to commode. She also spent two weeks in in-house therapy at Magee before transitioning into outpatient.
When she was released to go back to her home in West Deptford, New Jersey, they had to put a lift in the garage so she could get in and out of the house and her husband Charlie had to put rails in the bathroom for her.
“My husband had to get a lot of help from friends to transform the house. The floor in the living room is now called the dance floor because we had to put wood and plastic down so I could safely wheel the chair around. It is too hard on carpet,” she said.
Her type of injury called hemiplegia is the most severe type of partial paralysis. Taylor was in a wheelchair for 6 months. She then began to walk, first with a walker and then a cane. Three years later and she still walks with a brace.
A big part of Taylor’s therapy was in the locomotor program. “I am so grateful for this because without it I probably wouldn’t be walking,” she said.
Taylor was a nurse practitioner when she got hurt, and today still can’t go back to work. Although she can walk now, her right arm still has no feeling from the elbow down. “I don’t know where my hand is,” she explained. “I can’t cook because I keep burning myself.”
When asked how she has persevered through all she has been through, she said, you got to laugh at yourself or you will cry. When I started therapy, I decided that in order to get better I couldn’t get angry. The absolute love and support of my husband and family and friends gets me through.”
“I lost a couple of friends after my injury. Some people I guess just can’t handle it, but five friends came back into my life and they dedicated one day a week for months to take me to Magee for rehab. I am incredibly indebted to them.”
Life in a wheelchair
Travis Hames of Northeast Philadelphia also did his rehab at Magee, but his spinal cord injury is classified as an ASIA A, American Spinal Injury Association’s classification for a complete spinal cord injury, so his experiences differ in some ways from Taylor’s.
On August 14 of this year, Hames was on his way to work on his motorcycle when he got into an accident with a taxi cab. Today he is in a wheelchair, but does have some movement and strength in his legs.
He had to undergo two surgeries at Thomas Jefferson University Hospital and then went to Magee Rehabilitation for a couple of months. He is still at day rehab at Magee’s Riverview facility.
“With this type of injury, it is very hard to notice any progress, but the staff helps you with everyday living and building your strength,” he said. “I knew I was not going to be the same again so I focused on what I could get back as fast as I could.”
“It is important not to succumb to feeling bad and to work as hard as you can. A strong work ethic and the support of friends and family are very important,” he said.
Tracey Romero Sports Medicine Editor, Philly.com