Most people with spinal cord injury have altered senses and impaired muscle function below the level of injury. Some of the examples include problems with bowel/bladder control and sexual dysfunction. Apart from these physical problems, spinal cord injury also means a great emotional burden for the patient and their family/friends. It is also a challenge for the healthcare and social care system.
Learning to walk again is an important goal for every person with spinal cord injury. Being able to walk independently greatly improves life quality and allows the patient to continue with their everyday activities. However, learning to walk again is a complex task. It requires high motivation and a great effort from the patient. Someone with this disability also needs support from society and the health system.
Before you start gait training
Many doctors will examine you after a spinal cord injury; neurologists, neurosurgeons, anesthesiologists, physiatrists, internists, etc. You will also undergo many medical procedures, such as MRI scans or evoked potential tests. All of that is meant for doctors to know the severity of your injury, the level of pain, other health problems you may have, and your general state. These will also help to create the best and individualized rehabilitation program for you.
You’ll probably want to step on your feet immediately, but remember that this is not possible. Gait training will be one of the final steps in your rehabilitation process. However, many steps preceding are supposed to prepare you for it.
Early after the injury, your rehabilitation is aimed towards the prevention of complications. The goal is to keep your heart and lungs working normally and look for problems that may arise from immobility, for example, pressure ulcers, abnormal contractions, and stiffness of muscles and joints (contractures).
You will learn how to breathe in and out deeply and to cough through a series of exercises. You will often be moved on your bed to prevent the formation of pressure ulcers, and the places where they commonly occur will be monitored and moisturized.
Contractures can be prevented in multiple ways: by stretching affected muscles, wearing casts and splints, by the use of special ‘tilt’ tables, etc. It is also important that, from the first day, you do the exercises to keep your muscles in shape as much as possible to prevent them from wasting.
Once you’re stable, the focus will move more toward improving your muscle activity and strength. You will continue to perform all their previously instructed exercises, but you’ll continue to learn some more as time goes on. First of all, the key will be to train you to perform minor tasks such as eating or grooming or at least participating in them.
These will help with the next steps in the rehabilitation process and will also help you feel more independent and better about yourself. You will also be taught how to change your position in bed by rolling, sitting, and transferring from bed to your wheelchair. These will make you feel much more independent.
Wheelchair is not your enemy
No one likes to be wheelchair-bound, but wheelchair training is essential for every person with a spinal cord injury. Learning to use a wheelchair enables you to participate in normal daily activities. It is a prime step towards reintegrating you back to society.
Your injury level determines which type of wheelchair you need, for example, a powered or a manual wheelchair, chin-, or hand-controlled. Your level of injury will also affect the highest wheelchair skill you’ll be able to learn. The basic skills you have to learn include:
- Going forwards and backward.
- Opening and closing doors.
- Taking turns.
- Handling slopes (very important to use ramps to access most of the facilities).
Using escalators, steps, and moving on rough terrain are some of the more advanced skills.
Keep in mind that, even with all your hard work, learning to walk again may turn out not to be an achievable goal. Even if you do start walking, it is impossible to walk long distances. If so, a wheelchair will be your only way to move around – therefore, you must learn to operate it as well as possible. Proper training will also prevent complications, such as overuse injuries.
Learning to walk
To learn to walk again, you’ll first have to learn how to stand and maintain balance. Assistive devices, such as standing wheelchairs or tilt-tables, can help you attain this position.
Falling is the main threat in this stage due to long time immobility. The person with spinal cord injury is more prone to falling as well as fractures. Fractures lead to more inactivity and potential complications. Because of that, you should avoid it at all costs.
To learn walking, you will need various devices, for example, parallel bars, walking frames, braces, walkers, crutches, and canes. Your first step is made in a pool or with a bodyweight support device –special equipment that holds a part of your body weight to make it easier for your muscles to support you. These devices can be used on the ground or combined with a treadmill.
Gait training will first be done indoors. When you’ve gained security, you’ll start training outdoors, eventually dropping the body weight support system. Once you can stand or walk independently (with the use of canes or crutches) then, the training will aim toward improving coordination and balance.
The goal is for you to be more secure, less prone to falling, and increase walking speed. In other words, to be able to get around in the safest way possible.
Your doctors and therapists will guide you throughout the process, and it is essential to trust them, accept every advice you get, be persistent and patient, and always do your best.
Will I walk again?
It is hard to say. The outcome depends on many factors such as the level and severity of the injury, your age, other health problems, level of pain, etc. People with ‘incomplete’ lesions have a better prognosis than those with ‘complete’ lesions, and so do those with the better AIS score. However, it is impossible to predict the outcome for every particular case.
Give all of yourself to the training and hope for the best. Never ask yourself the ‘what if’ questions. Some improvement will happen, and you’ll see how much better you’ll feel with every skill you regain or learn. Remember not to feel hopeless and helpless – you can live a happy life despite your injury. And the most important of all, remember that you’re not alone.
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