View source for Disabled Village Children:Rehabilitation Therapy Following Spinal Cord Injury

{{bctrail|segments=3|chaptitle=Chapter 23: Spinal Cord Injury|pagetitle=Rehabilitation Therapy Following Spinal Cord Injury}}
{{DISPLAYTITLE:Rehabilitation Therapy Following Spinal Cord Injury}}
{{SideSupplement|bookabbreviation=dvc|pagealt=is from<br>pages 182 to 183 of|chapterpdf=http://hesperian.org/wp-content/uploads/pdf/en_dvc_2023/en_dvc_2023_23.pdf|bookurl=Disabled Village Children|booktitle=Disabled Village Children}}
{{chaptertoc|In this chapter:|
 <ul class{{=}}"noprint">
<li>[[Disabled Village Children:Chapter 23: Spinal Cord Injury|Chapter 23: Spinal Cord Injury]]</li>
    <li>[[Disabled Village Children:Early Questions That a Spinal Cord Injured Child and Family May Ask|Early Questions That a Spinal Cord Injured Child and Family May Ask]]</li>
    <li>[[Disabled Village Children:Helping the Child and Family Adjust|Helping the Child and Family Adjust]]</li>
    <li>[[Disabled Village Children:How to Prevent More Severe Spinal Cord Injury in Case of Accident|How to Prevent More Severe Spinal Cord Injury in Case of Accident]]</li>
     <li>[[Disabled Village Children:Early Care for the Spinal Cord Injured Person|Early Care for People with Spinal Cord Injuries]]</li>
    <li>[[Disabled Village Children:Physical Therapy Following Spinal Cord Injury|Rehabilitation Therapy Following Spinal Cord Injury]]</li>
<li>[[Disabled Village Children:Maintaining Healthy Positions|Maintaining Healthy Positions]]</li>
<li>[[Disabled Village Children:Early Physical Re-education|Early Physical Re-education]]</li>
    <li>[[Disabled Village Children:Dysreflexia (Sudden High Blood Pressure with Pounding Headaches)|Dysreflexia (Sudden High Blood Pressure with Pounding Headaches)]]</li>
 <li>[[Disabled Village Children:Self Care|Self Care]]</li>
    <li>[[Disabled Village Children:Keeping Active|Keeping Active]]</li>
    <li>[[Disabled Village Children:Other Parts of This Book with Information Useful For Spinal Cord Injury|Other Parts of This Book with Information Useful For Spinal Cord Injury]]</li>
<li>[[Disabled Village Children:The Story of Jésica|The Story of Jésica]]</li>
 </ul>
}}
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===ASSISTED BREATHING AND COUGHING===
Persons with spinal cord injury in the neck or upper back often have part of their breathing muscles paralyzed. Slowly the remaining muscles become stronger and breathing improves. But breathing often stays weak. The person may not be able to cough well and can more easily get pneumonia.

To help the person cough, place hands as shown below. Ask him to cough, and as he does, push firmly inward on the chest. Be careful not to move the backbone.

====TWO-PERSON ASSISTED COUGH====
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<td style="width:50%;"><div class{{=}}speechbub style="position: relative;  ">[[Image:DVC_Ch23_Page_182-2.png|200px|left|alt=two women press down on a person's chest and talk]]
<div style="position: absolute; width:100px; left: 42px; top: 4px;">Now cough.</div></div></td>
<td style="padding-left:25px;">''Do this several times a day when the person has a cold, and more often if the person develops more trouble breathing or seems to have a lot of mucus in his lungs or throat.''</td></table>
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====ONE-PERSON ASSISTED COUGH====

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<td style="padding-bottom:25px;width:50%;">
<div class{{=}}speechbub style{{=}}"position: relative; ">
[[Image:DVC_Ch23_Page_182-3.png|240px|center|alt=man presses down on child's chest and talks]]
<div style{{=}}"position: absolute; width:100px; left:73px; top:6px;">Breathe deep.</div></div></td>
<td>[[Image:DVC_Ch23_Page_182-4.png|250px|right|alt=child lies facing down with hips propped up]]</td></tr>

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<td style="padding-right:40px;">''To help the child breathe deep and to stimulate the breathing muscles, press lightly here while the child tries to breathe deeply in and out.<br><br>Do this for a few minutes, several times a day.</td>

<td style="width:60%;padding-left:40px;">''If the person has a lot of mucus in her lungs, it also helps to lie her down, like this, and pat her back briskly. This helps loosen the mucus so that it can be coughed out. Be sure she drinks lots of water to help loosen the mucus.</td>

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===MOVEMENT AND EXERCISE===

Do range-of-motion exercises for about 10 minutes for each arm and leg. In the first weeks, do the exercises twice a day. Later, once a day may be enough. If any signs of contracture develop, spend more time and effort on those parts of the body. From the start, exercises should be both '''''passive''''' (someone else moves the child’s body parts) and whenever possible, '''''active''''' (the child does it himself).

[[Disabled_Village_Children:Range-of-Motion_(Rom)_Exercises|'''Range-of-motion exercises''']] should begin with great care the day after the spine is injured. The exercises will help to improve the flow of blood (which reduces the chance of bed sores), to prevent contractures, and to build the strength of the muscles that still work. Range-of-motion exercises should be '''continued throughout life''', when possible as a part of day-to-day activity.
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<td style="font-size:larger;padding-left:20px;padding-top:20px;">'''CAUTIONS:'''</td></tr>

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*Until any breaks or tears in the spine have healed (6 weeks or more) exercise must be very gentle and limited, with smooth motions and no jerking.

<div style="margin-left:30px; margin-bottom:10px;">&diams; Especially at first, take great care that exercises do not move the position of the back and neck. Start with feet, ankles, hands, wrists, and elbows.</div>
<div style="margin-left:30px; margin-bottom:10px;">&diams; If exercises trigger severe muscle spasms or jerking, do not do them until the break is healed.
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*Do not use force in trying to get the full range of motion, as joints can easily be damaged.
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*For children with quadriplegia,often it is better to stretch the fingers only when the wrist is bent down like this, 

<div class{{=}}speechbub style{{=}}"position: relative;width:280px;float:left">
[[Image:DVC_Ch23_Page_183-1.png|250px|left|alt=wrist bent down with straight fingers and a wrist bent back with bent fingers]]
<div style{{=}}"position: absolute; width:100px; left:0px; top: 80px;text-align:left;">''but not when it is bent back like this.''</div></div>
This way enough contracture is left to be useful for taking hold of things. Although the fingers lack movement by muscles, they close around an object when the wrist is bent back.

If possible, get instructions from an experienced rehabilitation therapist
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*Try to keep the full range of motion of all parts of the body. But '''work most with those joints that are likely to develop contractures''', especially:
<div style="margin-left:30px; margin-bottom:10px;">&diams; paralyzed parts that tend to hang in one position, such as the feet,</div>
<div class{{=}}speechbub style{{=}}"position:relative; height:100px; width:400px; ">[[Image:DVC_Ch23_Page_183-2.png|100px|right|alt=a leg with paralyzed parts]]
<div style{{=}}"position:absolute; width:150px; left:450px; top:0px;text-align:left; font-style:normal;">Prevent this through [[Disabled_Village_Children:Stretching_Exercise_to_Help_Your_Child_Put_Her_Foot_Down_Flat|exercises]] and by [[Disabled_Village_Children:Maintaining_Healthy_Positions#contracture|supporting feet]].</div>
<div style{{=}}"position:absolute; width:85px; left:225px; top:20px;text-align:left; font-style:normal;">muscle shortening</div>
<div style{{=}}"position:absolute; width:85px; left:350px; top:0px;text-align:left; font-style:normal;">foot hangs</div>
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<div style="margin-left:30px; margin-bottom:10px;">&diams; or, joints that are kept straight or bent by spasticity or by [[Disabled_Village_Children:Chapter_8:_Contractures:_Limbs_That_No_Longer_Straighten#muscle|muscle imbalance]]. <br><br>For example:</div>
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<td valign=bottom style="width:33%;padding-top:25px;">
<div class{{=}}speechbub style{{=}}"position:relative; ">
[[Image:DVC_Ch23_Page_183-3.png|100px|center]]
<div style{{=}}"position:absolute; width:110px; left:-10px; top:-90px;text-align:left;">In quadriplegia the muscles that straighten the elbow are usually paralyzed,</div></div></td>

<td valign=top rowspan=2 style="width:15%;text-align:right;">''It is important that the arms can straighten until they bend backward a little—which  is the only way he can lift himself with his arms.</td>
<td rowspan=2 style="width:20%;">[[Image:DVC_Ch23_Page_183-4.png|100px|left]]</td>
<td style="padding-left:25px;padding-top:50px; width:30%;">''For this reason, straight arm positioning and early range-of-motion exercises for the elbow are essential. While he is still kept lying down, teach him to straighten his elbows by turning his hands up and then lifting his arms.</td></tr>

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<td style="padding-right:40px;padding-top:15px;">''while the muscles that bend the elbow stay fairly strong. These muscles keep the elbow bent, and in time they shorten so that the arm can no longer straighten fully.</td><td> [[Image:DVC_Ch23_Page_183-5.png|200px|center]]</td></tr>


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{{Previous and next sections|Early Care for the Spinal Cord Injured Person|Maintaining Healthy Positions}}
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