Spinal Cord Injury

The spinal cord carries every signal between the brain and the body below the neck: the instruction to move a leg, the sensation of a hand touching something hot, and the automatic controls for bladder, bowel, blood pressure and temperature. When the cord is damaged, the signals below the damaged point are reduced or lost.

This is why spinal cord injury is not only a walking problem. The functions people rarely think about — emptying the bladder, feeling that you have been sitting too long, sweating to cool down — are carried by the same cord. A rehabilitation programme that only trains legs has addressed the visible part of the injury and left the part that decides daily independence.

Two facts shape everything that follows. The level is the lowest segment of the cord still working normally — cervical injuries affect the arms as well as the legs, thoracic and lumbar injuries usually do not. Completeness is whether any signal is still crossing the damaged point.

These are recorded with the international ASIA classification, from A (no motor or sensory function below the injury) to E (normal). The grade is not fixed at the moment of injury: it can improve over the first weeks and months, which is one reason the first assessment is repeated rather than trusted once.

When you contact us, the single most useful document is the ASIA classification and the imaging. With those, a rehabilitation physician can say something specific. Without them, any answer would be a guess dressed as a plan.

Some neurological recovery happens on its own — most of it in the first three months, with smaller gains continuing for up to eighteen months — and it is greater in incomplete injuries 5. Rehabilitation does not replace that process. What it does is make sure the body is able to use whatever return arrives, and build function that does not depend on neurological recovery at all.

That second part is the one families underestimate. A person who transfers independently from bed to wheelchair has gained a great deal of freedom without a single nerve recovering. Much of the programme is built on that logic.

After spinal cord injury the bladder no longer empties on command. Left unmanaged this causes infections and, over years, kidney damage — which is why bladder management is not a comfort issue but a survival one. Most people are taught intermittent catheterisation on a fixed schedule, and the training continues until it can be done independently or by the companion reliably.

Bowel management works on the same principle: a routine performed at the same time of day, rather than waiting for a signal that no longer arrives. It is unglamorous and it is one of the strongest predictors of whether someone can live outside an institution.

We teach this during the stay rather than describing it at discharge. A family that has done it for three weeks under supervision goes home differently from one that has been handed a leaflet.

Where sensation is lost, the warning that normally makes a person shift position is gone. Sitting in one posture long enough damages the skin over the bone beneath it, and once that damage opens, it can take months to close — months spent lying down, which undoes the mobility the programme has just built.

Prevention is a schedule: pressure relief at set intervals, a cushion matched to the person rather than to the chair, and a daily skin check with a mirror for the areas that cannot be seen. The companion learns the check as well, because the patient cannot see everything.

If the injury is at or above the sixth thoracic vertebra (T6), the body can respond to a problem below the injury — most often a full bladder, sometimes a blocked catheter, constipation or a skin injury — with a sudden and dangerous rise in blood pressure 2. The person feels a pounding headache, sweats above the injury level, and may have a flushed face and blurred vision.

A systolic rise of 20 mmHg or more above the person's own baseline is the threshold 2. Untreated it can lead to seizures, retinal haemorrhage and cerebral haemorrhage. It is a medical emergency and it is treated by sitting the person upright, loosening anything tight, and finding and removing the cause — usually draining the bladder.

Every patient with an injury at or above T6, and every companion, leaves our programme able to recognise this and act on it. It is the single most important thing we teach, because it happens at home, months after discharge, with no clinician in the room.

We use robotic gait training and body-weight-supported walking where the injury is motor-incomplete — ASIA C and D. In that group the evidence supports improvement in walking distance and speed, measured with the six-minute walk test, the ten-metre walk test and the Walking Index for Spinal Cord Injury.

In complete injuries the same equipment is used for a different purpose: upright loading for bone density, circulation, bowel function and spasticity. That is a real benefit and we offer it. It is not a walking programme, and we will not describe it as one.

If a centre offers you walking after a complete injury without qualifying it, ask which classification they are working from. The difference is not marketing language; it is the difference between a goal and a false hope.

Almost every patient who travels for spinal cord rehabilitation travels with someone. That person will be doing transfers, skin checks, catheterisation support and the bowel routine within days of getting home, usually without a nurse nearby.

So the companion is scheduled into the programme rather than allowed to watch it. A bed for one companion is provided in the patient's room, and the discharge criteria include what the companion can do, not only what the patient can do.

Four to eight weeks as an inpatient, four to six hours of active therapy a day, five to six days a week. Physiotherapy for strength, balance and transfers; occupational therapy for dressing, washing and the equipment that makes them possible; wheelchair skills including kerbs and slopes; bladder, bowel and skin training; and robotic or hydrotherapy sessions where they fit the plan.

A rehabilitation physician reviews the plan through the stay, and the discharge document is written to be usable by clinicians in your own country — because the programme continues there.