Topic of the Month - SCI and Wellness

Topic of the Month 2007:  SCI and Wellnee 

A greater number of persons who incur a spinal cord injury are surviving long-term. This leads to many sequelae associated with chronic SCI. These may include secondary orthopaedic conditions (e.g., rotator cuff injury and carpal tunnel syndrome), bony changes (e.g., osteopenia and osteoporosis), postural changes (e.g., scoliosis), muscular changes (e.g., atrophy and tissue fibrosis), integumentary changes, and cardiovascular/pulmonary changes (e.g., reduced metabolism, global deconditioning, decreased exercise tolerance). Evidence suggests that several of these sequelae are simply a consequence of the immobility produced by the patients' spinal cord injuries. If this is the case, restoration of activity or mobility may help to mitigate some of these secondary issues.

Part of our responsibility as physical therapists is to restore or maximize our patients' functional independence. Typical rehabilitation interventions include functional mobility training, transfer training, self-care/ADL training, equipment recommendation and training, home/worksite assessment, and patient/family education. Patients and their families are typically discharged with a HEP for maintaining ROM and strength to assist with the performance of daily activities. Where does physical fitness and wellness come into play? With the restoration of function being our primary concern, how much do we as physical therapists pay attention to the health and wellness of our patients living with chronic SCI? What are the modifiable risk factors that we can counsel our patients on in order to promote better and longer lives? What equipment should be recommended to local wellness facilities to promote inclusion of wheelchair users? How do we promote participation in the types of activities that will help patients to achieve optimum health post-injury?

One of the modifiable risk factors we as clinicians may address is body mass. Obesity has been closely associated with the development and  progression of cardiovascular disease, diabetes, and stroke. How are we as clinicians addressing these issues, especially once our patients have been discharged from formal rehabilitation? How can we maybe better address these concerns?

This is a link to a publication from Hershey Medical Center of Penn State University. It talks a bit about the parameters of ideal body weight for persons with paraplegia and tetraplegia.