In short, the sooner the person can begin appropriate therapy (even if it’s just passive range of motion exercises in the ICU), the better the chances of regaining the highest level of function. Another reason early rehab matters is psychological: it engages the patient in their recovery and gives a sense of progress during a difficult time. Lying in bed for too long can lead to depression and more complications. So, expect that as soon as you or your loved one is out of immediate danger, therapists will start coming by – even in the ICU – to move limbs, sit them up gradually, and work with them. On the following page we look at emerging therapies which are not yet standard care. They offer hope that future improvements are possible. Your healthcare team can inform you if any clinical trials are available for which you or your loved one might qualify. In the meantime,
E arly improvement vs. long-term Most neurological recovery tends to happen in the first 6 months post-injury. The fastest gains are often within 3 months as swelling subsides and the spinal cord heals to whatever extent it can. However, that doesn’t mean recovery stops at 6 months. People can make smaller improvements up to 1-2 years after the injury. For example, someone might regain some additional sensation or muscle flicker in the second year that wasn’t there initially. Generally, incomplete injuries continue to improve longer and more than complete injuries. With a complete SCI, if no improvement is seen after 6 months to 1 year, the functional level is likely to be permanent, though the patient will still get stronger and more skilful in using their abilities and equipment. Keep in mind that recovery can mean different things. It could be neurological recovery (the return of movement/sensation) or functional recovery (learning to do more despite paralysis, using equipment or new techniques). Rehabilitation focuses a lot on the latter – maximising independence even if the nerves don’t recover fully. Importance of early intervention and rehabilitation Early rehabilitation – starting as soon as medically stable – is crucial for the best outcomes. Studies show that starting rehab early can improve functional results. Early physical therapy helps prevent muscle wasting and joint stiffness, keeping circulation and skin health in better shape. Early occupational therapy can ensure the patient can participate in self-care to whatever degree possible, which improves morale and prevents learned non-use. In the UK, specialised Spinal Cord Injury Centres aim to admit patients for intensive rehab as soon as possible after injury. Early rehab also means educating the patient and family early about preventing complications (like chest infections and pressure sores), which can set back recovery.
the focus will be on proven rehabilitation strategies to maximise current abilities.
Remember, every injury is unique. The healthcare team might not be able to give a clear prognosis immediately. Often, they will say, “We need to wait and see.” This isn’t to be evasive – it’s simply that the extent of recovery can’t be known right away. Generally, complete injuries have a low likelihood of significant motor recovery, but incomplete injuries have a wide range of possible outcomes. No matter what, with prompt treatment, rehab, and support, people with SCI can lead fulfilling lives. Many return to work or school, engage in sports (like wheelchair basketball or hand cycling), and have families. The road is challenging, but there is a community of SCI survivors out there living a full life. Focus on potential and not just limits but also prepare and plan for living with the injury as it is.
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PROGNOSIS AND FACTORS AFFECTING RECOVERY
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