19/07/2025
🔹 ROM, Positioning and Selective Strengthening after Spinal Cord Injuries (SCIs)
✅ Range of Motion (ROM) Exercises
While the patient is immobilized in bed or on a turning frame, full ROM exercises should be completed daily except in those areas that are contraindicated or require selective stretching.
🚫 Paraplegia ROM Contraindications
With paraplegia, motion of the trunk and some motions of the hip are contraindicated.
Generally, straight leg raising more than 60 degrees and hip flexion beyond 90 degrees (during combined hip and knee flexion) should be avoided.
This will avert strain on the lower thoracic and lumbar spine.
🔄 ROM Positions
If possible, ROM exercises should be completed in both the prone and supine positions.
Prone positioning may be contraindicated for some patients owing to fracture and/or respiratory compromise in this position.
🎯 Prone ROM Focus
In the prone position, attention should be directed toward shoulder and hip extension and knee flexion.
🚫 Tetraplegia Contraindications
With tetraplegia, motion of the head and neck is contraindicated pending orthopedic clearance.
Stretching of the shoulders should be avoided during the acute period.
🧍 Positioning Consideration in Tetraplegia
The patient should be positioned out of the usual position of comfort, in which there is internal rotation, adduction and extension of the shoulders, elbow flexion, forearm pronation, and wrist flexion.
🦵 Lower Extremity ROM in Tetraplegia
Full ROM exercises are generally included for both lower extremities.
🧠 ROM Strategy in SCI
Patients with SCIs do not require full ROM in all joints.
Some joints benefit from allowing tightness to develop in certain muscles to enhance function.
📐 Functional Tightness Benefits
With tetraplegia, tightness of the lower trunk musculature will improve sitting posture by increasing trunk stability.
Tightness in the long finger flexors will provide an improved tenodesis grasp.
📏 Full Stretching Needs
After the acute phase, the hamstrings will require stretching to achieve a straight leg raise of approximately 100 degrees.
This ROM is required for many functional activities such as sitting, transfers, lower extremity dressing, and self-ROM exercises.
🎯 Selective Stretching
This process of understretching some muscles and full stretching of others to improve function is referred to as selective stretching.
🖐️ Positioning Splints for Upper Limb
Positioning splints for the wrist, hands, and fingers are an important early consideration.
Alignment of the fingers, thumb, and wrist must be maintained for functional activities or future dynamic splinting.
For high-level lesions the wrist is positioned in neutral, the web space is maintained, and the fingers are flexed.
If the wrist extensors are functional (fair muscle grade), a C-bar or short-opponens splint is usually sufficient.
🦶 Ankle Alignment & Pressure Sore Prevention
Ankle boots or splints are indicated to maintain alignment and to prevent heel cord tightness and pressure sores.
Ankle boots designed to suspend the heel in space and distribute pressure evenly along the lower leg are available commercially.
📦 Additional Positioning Aids
Sandbags or towel rolls also may be required to maintain a position of neutral hip rotation.
🛏️ Proning Schedule
Following orthopedic clearance, the patient typically is placed on a schedule to increase tolerance to the prone position.
For patients wearing a halo device, one or two pillows under the chest will allow assumption of the prone position.
The ankles should be positioned at a 90-degree angle.
Tolerance to the prone position should be increased gradually until the patient is able to sleep all, or at least part, of the night in this position.
🛡️ Proning Benefits
This routine will assist with prevention of pressure sores on posterior aspects of the body and development of flexor tightness at the hips and knees.
Proning schedules also are considered to promote improved bladder drainage.
🔵 SELECTIVE STRENGTHENING
During the course of rehabilitation, all remaining musculature will be strengthened maximally.
⚠️ However, during the acute phase certain muscles must be strengthened very cautiously to avoid stress at the fracture site.
🚫 During the first few weeks following injury, application of resistance may be contraindicated to:
1️⃣ musculature of the scapula and shoulders in tetraplegia
2️⃣ musculature of the hips and trunk in paraplegia
🧠 An important consideration in planning exercise programs during the acute phase is to emphasize bilateral upper extremity activities because these will avoid asymmetric, rotational stresses on the spine.
💪 Several forms of strengthening exercises are appropriate during this early phase:
✅ bilateral manually resisted motions in straight planes
✅ bilateral upper extremity proprioceptive neuromuscular facilitation (PNF) patterns
✅ progressive resistive exercises using cuff weights or dumbbells
📈 Biofeedback training also may be a useful adjunct during early exercise programs.
👤 With tetraplegia, emphasis should be placed on strengthening the:
anterior deltoid
shoulder extensors
biceps
lower trapezius
👉 If present, the radial wrist extensors, triceps, and pectorals should also be emphasized because they will be of key importance in improving functional capacity.
👤 With paraplegia, all upper extremity musculature should be strengthened, with emphasis on:
shoulder depressors
triceps
latissimus dorsi
👉 which are required for transfers and ambulation.
🏃 Early involvement in functional activities should be stressed.
💡 In addition to their intrinsic value, many activities afford the important benefit of progressive strengthening.
🍽️ For example, self-feeding and involvement in limited personal care activities will assist with strengthening the shoulder and elbow flexors.
♿ Another example of a functional activity (although not appropriate during the acute phase) with important strengthening benefits is wheelchair propulsion (deltoids, biceps, and shoulder rotators).
📃📝 AAYU Health Care Dr.VIJAY YADAV
