long term management and rehabilitation

Last reviewed 01/2018

Disbelief and anger are common emotional sequelae as the patient realizes the extent and permanence of the disability. These often turn to depression and lack of enthusiasm for learning how to cope with their condition.

A realistic target should be set appropriate to each patient. Since the brain is rarely affected, a return to work may be feasible.

Active physical rehabilitation must wait until the bony injury is stable.

Spinal instrumentation may be used to stabilise the fracture and to prevent or correct deformity arising at the fracture site. The patient should be encouraged to gradually sit up in bed in order to reduce the chances of postural hypotension. Paraplegics should be given the opportunity to strengthen the muscles in the upper part of the body in preparation for using a wheelchair.

Tetraplegics may achieve mobility only by use of an electric wheelchair. Rehabilitation for these patients should be directed at maximising the function of their hands.

Post-traumatic syringomyelia affects about 2% of all patients with spinal injury. Cavitation in the spine ascends several segments above the level of the traumatic lesion, causing pain, dissociated sensory loss, and muscle weakness at a higher level. The cavity should be drained to relieve pain, but generally, has little effect on motor disability.