Spinal cord injury

Firstly some statistics:
The number of new Spinal cord injuries (SCI) per year are 32 injuries per million population or 7800 injuries per year in the US.
Approx 250,000 Americans are spinal cord injured with 52% of spinal cord injured individuals are considered paraplegic and 47% quadriplegic.
82% of those injured are male and 56% of injuries occur between the ages of 16 and 30 with the average age of spinal cord injured person is 31.
SCI injuries are most commonly caused by:
Vehicular accidents 37%
Violence 28%
Falls 21%
Sports-related 6%
Other 8%
Finally 89% of all SCI individuals are discharged from hospitals to a private home, 4.3% are discharged to nursing homes.

Level of Spinal Cord Injury:
C4: Results in significant loss of function at the biceps and shoulders.
C5: Results in potential loss of function at the shoulders and biceps, and complete loss of function at the wrists and hands.
C6: Results in limited wrist control, and complete loss of hand function.
C7 and T1: Results in lack of dexterity in the hands and fingers, but allows for limited use of arms.
C7 is generally the threshold level for retaining functional independence.

There are two major classifications for SCI namely partial and incomplete SCI. Complete Spinal cord injury means that there is no propagation of sensory or motor signals up and down the spinal cord below the level of the injury. Incomplete SCI means that there is some propagation of nerve signals and information up and down the spinal cord over the level of the damage.

Most Frequent Neurological Category:
Quadriplegia (upper and lower limbs), incomplete 31.2%
Paraplegia (lower limb), complete 28.2%
Paraplegia, incomplete 23.1%
Quadriplegia, complete 17.5%

Following SCI patients undergo a prolonged period of physical rehabilitation designed to make them as independent in the functions of every day living and to increase there movement ability. Patients, who have suffered spinal cord injury, as well as other neurological or orthopedic injury, often have severe upper or lower extremity movement impairments. In short they have difficulty in doing the everyday living tasks that others take for granted.

This therefore introduces the topic of Quality of Life (HRQOL) in Individuals with Spinal Cord Injury (SCI)
In the December edition of Neuro rehabilitation http://bit.ly/g4Zvxk Dr. Arango-Lasprilla and her team from Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA assess health-related quality of life (HRQOL) in individuals with Spinal Cord Injury (SCI) in Neiva, Colombia. They conclude that individuals with SCI report having poorer quality of life across various domains, primarily in the area of physical functioning, compared to healthy controls. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve HRQOL in individuals with SCI.

Average hours for PT and OT in SCI Patients in Australia, Norway and the Netherlands:

Number of hours of inpatient physical and occupational therapy in SCI patients in Australia, Norway and the Netherlands:
The January edition of the Journal of American Physiotherapy presents a report by Dr. Langeveld of the Revalidatiecentrum De Hoogstraat in Holland http://bit.ly/i6G7IS on the number of hours per week of inpatient physical and occupational therapy of spinal cord injury (SCI) patients over four week time span. The report found that the number of hours was Holland 28 compared to Australia 43 hours and Norway 39 hours.

It is well documented in the literature that an important component in achieving optimal rehabilitation outcome is intensive active movement practice. Traditional Occupational and Physical therapy mainly provide the patient with task orientated training (TOT) also known as Task Specific Practice (TSP) or functional movement training. TSP is intensive repetition of everyday functional tasks or Active daily living tasks.
On a practical treatment aspect, many brain and spinal cord injury patients do not have sufficient movement ability to enable them to do repetitive active tasks or the active tasks can not be customized to work on their specific motor, sensory or cognitive impairment.

It is therefore an ongoing challenge for physical therapists and other health care professionals to find effective interventions that improve arm and hand function for patients with more severe paresis. Recently, additional rehabilitation tools such as the HandTutor have been developed that focus on evaluating and training isolated and co-ordinated movement parameters. Correct functional movement is dependent on normal kinematic movement parameters such as range, speed, and accuracy of movement. On a practical treatment level the HandTutor systems allows many patients that do not have sufficient movement ability to enable them to do repetitive active tasks, or the active tasks can not be customized to work on their specific motor, sensory or cognitive impairment.

The HandTutor system offers impairment oriented training and augmented feedback. The HandTutor encourages active repetitive customized isolated or inter joint coordinated finger and wrist hand exercises and rehabilitates fine movements of the hand and wrist and can be used by patients who have very limited finger movement ability.
The software is dedicated to rehabilitation and is easy to understand by both the patient and the therapist. This enables the exercises to be customized to the patients movement impairment so that they remain encouraged and motivated to continue intensive exercise practice. The HandTutor is used in hospitals and community hand therapy clinics as well as through tele rehabilitation. Examples of patients that are treated include Stroke, TBI, spinal cord injury CP, Orthopedic hand and arm surgery.