After a spinal cord injury, many people believe that any physiotherapy that takes place would be highly passive and limited in activity, especially when the client has a long history of moderate-severe osteoarthritis or other compounding injuries or conditions.
Other clinicians often assume that what goes on during in-patient care will continue to take place when the person has been discharged and is at home. In reality, this could not be further from the truth. In our professional experience, the client stands to make the best gains being pushed physically, within medical reason and taking into consideration medical precautions.
In this case study, the clinician and client set concrete goals and were determined to meet them by a certain time frame, despite the client reporting issues of fatigue, pain, soreness, or weakness.
Spinal Cord Injury Case Study
The Application of Active Physiotherapy to Clients with Severe SCI
Despite having a multitude of neurological and complex orthopaedic issues limiting this client’s mobility, Propel’s registered physiotherapist Alanna Holz was able to use salient goals to make his treatment sessions engaging and productive. Using her skillset, Alanna was able to motivate and push the client to complete portions of physical therapy that are highly active and quite difficult, despite the client reporting pain and soreness.
Using a multi-modal approach, Alanna was able to address the pain before and after the client’s active physiotherapy sessions, thereby fostering an environment of support. Therefore, by acknowledging the pain and soreness a client may be experiencing, it is possible to not let it take away from a session that would otherwise be very productive. Addressing his symptomology allowed the client to continue with meaningful movements and allowed the clinician to apply her skills more effectively. There was enough meaningful and appropriate repetitions of a given movement to ensure the client was moving in the right direction, and not remaining stagnant.
In addition, the physiotherapist made him accountable for his homework (re: home exercise program) and followed up routinely on whether they were being performed. There is nothing worse than being called out on not doing your physiotherapy homework, and the clinician made it clear that much of the gains in therapy are due to the work that you can put in outside of the sessions.
Alanna was able to create a home exercise program that involved the assistance and monitoring from caregivers to ensure safety. Items on the program included assisted standing and walking, and they were only progressed if the client was able to demonstrate safe abilities in-clinic with decreased therapeutic assistance. This helped to encourage adherence to the program and further made the client’s physical goals more achievable.
Physiotherapists Experienced in Treating Neurological Injury
For this particular client and for clients in similar situations, having a skilled physiotherapist with an understanding of physical and neurological limitations perform a comprehensive assessment is key in shaping physiotherapy sessions. It is encouraging to know and see that an active physiotherapy program can be applied to clients with severe injuries and complex histories, in order to push the client towards their optimal abilities.