Hesperian Health Guides

Early Physical Re-education

The goal for a spinal cord injured person is to become as independent as possible in doing what he or she wants and needs to do. But even before the skills of daily living are relearned, the person needs to learn to protect the body where functions that used to be automatic have been lost. The protective functions that may be lost or changed include:

  1. Adjustment of blood pressure to changes in body position.
  2. Feeling (including pain) that protects from injuries (such as bed sores).
  3. Sense of body position and ability to keep balance.
  4. Muscle strength and coordination.
  5. Control of body temperature—especially keeping cool in hot weather.

1. A sudden drop of blood pressure in the brain when the person rises from lying to sitting, or sitting to standing, can cause dizziness or fainting. This is a common problem in spinal cord injury because the blood pressure adjustment mechanism is partly lost. Little by little the body can be helped to re-adapt, but precautions are needed. (These same precautions are for anyone who has been kept lying down a long time.)
Before beginning to sit, raise the head of the bed –a little more and a little longer each day.
a person lays down with the head of the bed slightly raised

Start like this for 15 minutes.
a person lays down with the head of the bed raised high
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In a week or 2 build up to this for 3 hours. If the person begins to get dizzy or faint when sitting, tilt him back and lift his feet.

boy sits with hands at his sides to do lifting exercises
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Lifting exercises help the body relearn to adjust blood pressure — and also prevent bed sores and strengthen arms. Before beginning to stand, make a standing board, and strap the child to it. Start at a low angle, and stand the board up more—and longer—each day.
2. The loss of feeling in parts of the body can lead to pressure sores and other injuries, such as burns and cuts. This is because the body no longer feels pain and does not warn the child to change position or move away from danger.
It is important that the child learn to protect himself by changing positions often and avoiding injuries. This includes:
  • learning to roll over
  • turning at least every 4 hours when lying or sleeping
  • lifting from sitting every 15 minutes (see "Changing positions")
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  • examining the whole body every day for signs of injuries or sores)
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  • washing daily
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  • learning to protect himself from burns and other injuries. For example,
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DO NOT sit on or touch hot objects (or roads). DO NOT sit, lie or sleep near an open fire.
Keeping clean is very important for persons with reduced feeling, especially if they lack bladder and bowel control. Take care to bathe daily. Wash and dry the genitals, the butt, and between the legs as soon as possible each time they get wet or dirty.
If redness, diaper rash, or sores develop, wash more often and keep the sore area dry. Keep the legs spread open and exposed to the air. When they must be covered, use soft absorbent cotton cloth. Putting a little vinegar in the rinse water after bathing the child, and after washing diapers and underclothes, helps prevent skin rash and infection.
For treatment of specific skin infections (fungus, yeast, bacteria) consult a health worker or a medical book (like Where There Is No Doctor, see Chapter 15).
3. Loss of ability to sense what position the body is in affects a person’s sense of balance. So does loss of muscle control. The child needs to develop new ways to sense the position of his body and keep his balance. Start with the child sitting on a bench, if possible in front of a mirror. Help the child progress through these stages:
  • both hands on bench
  • both hands on knees
  • lift one arm sideways, forward, and back
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  • After doing this in front of a mirror, have him do it without the mirror.
  • As the child gains better balance, start doing different movements with first one and then both arms, such as lifting weights or playing ball.
boy sits and balances in front of a mirror
A child with mid-back injury will balance in this position.
mirror— the bigger the better
legs and feet apart
pillow to avoid pressure sores
feet flat on floor

Note: Some children may have so much difficulty with balance that they may have to start in a wheelchair or a chair with high back and arm supports.

4. Muscle re-education. All muscles that still work need to be as strong as possible to make up for those that are paralyzed. Most important are muscles around the shoulders, arms, and stomach.
Weight-lifting is a good exercise to strengthen shoulders.
child lifts bags hanging from a tree
bags full of sand or stones
child pumps water into a bucket
Look for ways to make the exercises useful and fun.
5. Temperature control. Normally, when a person feels hot, he sweats and the blood vessels beneath the skin swell. This automatic cooling system is partly lost in persons with high spinal cord injury. In hot weather, they may get high fever or can even die of heat stroke.
For this reason they must learn (and be allowed) to rest quietly in the shade, in the coolest place possible, during the hottest part of the day. Children with spinal cord injury can learn to paddle around very well in old tire tubes. They love it, and it is excellent arm and shoulder exercise. However, it is very important that someone watches them.
A green leafy cover helps cool the air.

water dripping to keep person wet
child lays in the shade with a fan and water dripping on him
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If he can spend part of the hottest hours of the day in a shaded, shallow pool or pond, this is ideal.

TAKE CARE also to protect against cold. Body temperature can also drop too low.

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For hot weather, a plastic spray bottle works very well for cooling the body.
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This page was updated:21 Nov 2019