presented by Candy Tefertiller
Predicting outcomes after spinal cord injury (SCI) is difficult. Therefore, providing the most efficacious treatment interventions after SCI can be challenging. Interventions must be based on a framework that includes current translational research along with an understanding of the neurophysiological changes that occur after SCI. Clinicians must be able to identify appropriate functional expectations after SCI based on level of injury, severity of injury, and currently available research. Clinicians must also be able to properly educate and empower individuals with SCI and their families to live independently and maximize quality of life by minimizing the complications associated with impaired mobility. After completing this course, clinicians will improve their knowledge of spinal cord injury rehabilitation, including the many challenges and opportunities associated with providing care for this unique population.
Candy Tefertiller, PT, DPT, ATP, NCS, is the Director of Physical Therapy at Craig Hospital. Candy received a BS in Biology from Mount Olive College in 1997 and a master’s in Physical Therapy from East Carolina University in 2000. She then completed a Doctorate of Physical Therapy degree from Rocky Mountain Health Care University in 2008. Candy has been working in the field of neurological rehabilitation since 2000. She received an assistive technology practitioner (ATP) certification in 2005 and became a certified neurological clinical specialist (NCS) in 2007. She has been involved in numerous research projects and has focused much of her career on interventions and program development promoting recovery after neurologic injury or disease. Candy is a member of the American Physical Therapy Association and the Neurologic Section.
It’s important for clinicians to understand the differences between recovery-based, compensatory-based and restorative-based therapies as well as the neural mechanisms associated with each type of rehabilitation approach.
This chapter will discuss functional expectations that should be achieved by an individual who sustains an SCI regardless of their level of injury. Some of the goals individuals with SCI should achieve prior to leaving inpatient rehabilitation that will be discussed in this chapter include upright tolerance, ability to utilize appropriate seating systems to support posture and maximize function, ability to utilize appropriate mobility device(s) to maximize functional mobility and independence, and maintaining intact skin.
There are many important areas to address when providing rehabilitation for an individual with a cervical spinal cord injury to ensure they achieve maximum function, independence and quality of life. The following are important components of a rehabilitation program that individuals with cervical SCI should be engaged in: respiratory training, bed mobility, transfers, wheelchair mobility, weight shifts, skin care, bowel/bladder training and care, sexual function, psychosocial health, and community mobility/travel.
There are many important areas to address when providing rehabilitation for an individual with thoracic and lumbar SCIs to ensure they achieve maximum function, independence, and quality of life. The following are important components of a rehabilitation program that individuals with thoracic/lumbar SCI should be engaged in: respiratory training for intercostal muscles, bed mobility, transfers (car, floor, community, recreation), wheelchair mobility skills (wheelies, ramps, curbs, stairs, loading into car), ambulation potential, skin care, bowel/bladder training and care, sexual function, and health and wellness.