How we treat spinal cord injury

Four to six hours of active therapy a day, five to six days a week. We describe the programme this way because dose is the part that can be verified — a list of named techniques tells you nothing about how much of each you will actually receive.

The first week is deliberately lighter while sitting tolerance and blood pressure control are established. Someone who has been lying flat for weeks cannot sit upright for six hours on day one, and pretending otherwise produces fainting, not progress.

The order is not arbitrary. Independent transfer between bed, chair, toilet and car changes daily life more than any other single skill, and it is achievable regardless of whether neurological recovery arrives. Walking work, where it is appropriate, is built on top of a stable transfer.

Wheelchair skills are taught as a skill and not as a defeat: propulsion over distance, kerbs, slopes, and getting back up after a fall. A person who can manage a kerb has a wider world than one who cannot.

Robotic gait training and body-weight-supported walking deliver a volume of stepping that two therapists cannot sustain by hand. In motor-incomplete injuries that volume is the point.

In complete injuries the same machines are used for upright loading — bone density, circulation, bowel function, spasticity. The equipment is identical and the goal is not, and the plan says which one applies to you.

Bladder management, bowel routine and skin protection take up a substantial part of the programme and appear in no brochure. They are also the three things that most often decide whether someone lives independently a year later.

We train these to independence — the patient's, or the companion's where the level of injury makes that necessary — and we do not sign a discharge until that training is done.