# Spinal Cord Injury and Rehabilitation

> The spinal cord is a cylindrical structure that is part of the central nervous system (CNS) and runs through the center of the spine; from the base of the skull to the lower back.

## Introduction
In February 2023, a Blended Intensive Program in Neurological rehabilitation was conducted, involving over 30 physiotherapy students and teachers from Savonia University of Applied Sciences (Finland), the Third Faculty of Medicine at Charles University (Czech Republic), and the University of Thessaly (Greece). Students collaborated on articles covering stroke, multiple sclerosis, Parkinson’s disease, neurological disorders in children, spinal cord injury (SCI), and virtual reality in rehabilitation.

## Anatomy and Physiology of the Spinal Cord
The spinal cord is a cylindrical structure within the central nervous system (CNS) running from the base of the skull to the lower back. The vertebral column consists of 31 segments containing nerve bundles that transmit signals between the brain and the body. Its primary functions include controlling body movements, reporting sensory information to the brain, and managing reflexes. Traumatic spinal injury (TSI) encompasses injuries to the spinal cord and surrounding structures, such as nerve roots, discs, and ligaments.

## Symptoms and Levels of Injury
Symptoms vary based on the level of injury:
*   **Cervical spine:** The most severe, potentially causing life-threatening issues such as heart and breathing failure, diaphragm complications, and tetraplegia.
*   **Thoracic spine:** May affect chest muscles.
*   **Lumbar spine:** Can cause disruption to abdominal muscle innervation and bladder dysfunction, leading to paraplegia.

Beyond paralysis, SCI is a complex condition affecting multiple organ systems, including bladder, bowel, respiratory, cardiovascular, and sexual functions. It also carries significant social, financial, and psychological implications, increasing susceptibility to renal complications, musculoskeletal injuries, pain, and osteoporosis.

## Epidemiology and Etiology
Worldwide, there are 10.5 cases of TSI per 100,000 people, with mortality rates up to 60% and an average patient age of 40. Over 226,000 people are impacted annually. Primary causes include road traffic accidents (39.5%), falls (38.8%), sports injuries, violence, and medical/surgical complications.

## Stages of Spinal Cord Injury
1.  **Initial stage:** Mechanical injury caused by temporary compression leading to contusion.
2.  **Second phase:** Self-destructive biomechanical and biochemical changes leading to cell death, spreading rostrally and caudally.
3.  **Third phase:** Spread of secondary injury leading to structural and functional imbalance.

## Assessment and Physiotherapy Intervention
Assessment is critical for determining the best therapy. The **American Spinal Injury Association (ASIA) Impairment Scale (AIS)** is commonly used to evaluate motor and sensory functions.

Physiotherapy interventions focus on addressing weakness, contractures, and poor motor control through:
*   **Functional Electric Stimulation**
*   **Task-specific training**
*   **Resistance exercises:** Progressive resistance training helps patients with partial paralysis gain strength.
*   **Stretching:** Used daily to prevent and treat contractures.
*   **Gait training:** Robotic and overhead gait training show promise for patients with partial paralysis.

## Emerging Rehabilitation Methods
*   **Epidural Electrical Stimulation (EES):** Studies suggest it can help patients with lower limb paralysis stand, walk, swim, and cycle.
*   **Neuro-dance:** Uses rhythmic movement and music to provide social support and improve motor skills.
*   **Robot-assisted gait training (e.g., Lokomat):** Research indicates significant improvements in gait distance, speed, and balance compared to conventional overground training.

## Authors
*   **Kitixis Pavlos**, Physiotherapy student, University of Thessaly, Greece
*   **Vokacova Zuzana**, Physiotherapy student, Charles University, Czech Republic
*   **Hanurova Adela**, Physiotherapy student, Charles University, Czech Republic
*   **Hasu Emma**, Physiotherapy student, Savonia University of Applied Sciences, Finland
*   **Nurmiaine Riina**, Physiotherapy student, Savonia University of Applied Sciences, Finland
*   **Pliakas Christos**, Physiotherapy student, University of Thessaly, Greece
*   **Dr. Marja Äijö**, Principal lecturer, Savonia University of Applied Sciences, Finland
*   **Dr. Kamila Řasová**, Associate professor, Charles University, Czech Republic
*   **Dr. Thomas Besios**, Assistant Professor, University of Thessaly, Greece

## References
*   Alizadeh, A., et al. (2019). Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. *Frontiers in Neurology*.
*   Harvey, L. A. (2016). Physiotherapy rehabilitation for people with spinal cord injuries. *Journal of physiotherapy*.
*   Ki Yeun Nam, et al. (2017). Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. *Journal of NeuroEngineering and Rehabilitation*.
*   Kumar, R., et al. (2018). Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume. *World Neurosurgery*.
*   Quadri, S. A., et al. (2018). Recent update on basic mechanisms of spinal cord injury. *Neurosurgical Review*.
*   Rowald, A., et al. (2022). Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis. *Nature Medicine*.
*   Äijö, M., Řasová, K., & Besios, T. (2022). Neurological rehabilitation, Blended Intensive program has started. *Savonia Article*.