According to the National Spinal Cord Injury Statistical Center, more than ten thousand cases of spinal cord injuries occur each year.1 The figure is higher if the reported cases include those who succumb to spinal cord injuries or SCIs at the scene of the accident.1 Vehicular accidents account for at least 40 percent of the cause of injury. However, 27 percent of SCI cases are attributed to “accidental” falls.1 It is a good thing to know that the rise in the number of reported cases is met with research advancements, such as, body weight support, walking and functional electrical stimulation, and other techniques that significantly changes the capability of physical therapists in helping survivors of SCIs to improve walking function or other forms of locomotor recovery. It is important to continue the quest to discover effective intervention strategies to improve the locomotor activity of people with SCIs.
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Defining the Pathology and Its Manifestations
SCIs are the direct consequence of spinal fractures.2 Most of the time, the fractures occur at the 5th, 6th, and 7th cervical, the 12th thoracic and the 1st lumbar vertebrae.2 When it comes to symptoms and other manifestations, look for muscle spasms and back pain that worsen with movement.1 In minor injuries, the clinical effects may occur several days after the accident. However, in serious incidents, the SCI is manifested through mild paresthesia or quadriplegia.2
Describing the Etiology, Diagnosis, and Prognosis
As mentioned earlier, the etiological profile of SCI points to motor vehicle crashes as the cause of almost half of SCI cases. Accidental falls follow as the second major cause of the problem. This is followed by “acts of violence” such as gunshot wounds or assault. Thus, it is the application of excessive force or trauma that destroys the protective framework around the spinal cord causing serious injury. However, in some cases the accident results only in burst fracture that leads to an incomplete SCI.3 In the case of an incomplete SCI, it is imperative to apply necessary intervention strategies to lessen the extent of the injury. The absence of appropriate knowledge and skills cause mishandling and may aggravate the condition of the patient. In the case of vehicular accidents, it is of crucial importance to understand the mechanics behind a trauma to the spinal cord.3 After determining symptoms of SCI it is essential to apply immobilization techniques. For example, emergency responders must utilize a rigid collar and a spinal board to prevent unnecessary movements. It is also wise to use oxygen and relevant medication to prevent the swelling of the spinal cord.
Doctors must determine the seriousness of the injury and compelled to recommend surgery for serious cases. Most of the time, a pre-operative procedure requires the application of a technique that facilitates spinal alignment, spinal stability, and to prevent the deterioration of the spinal cord.3
Treatment Interventions or Physical Therapy Management
It is also of critical importance to master essential trauma care. For example, first responders must ensure open airways and support impaired breathing.3 It is also beneficial to relieve conditions labeled as pneumothorax and hemothorax. Surgery is also followed by appropriate measures of pain management and other treatments related to the accident or traumatic event.
Progression of Physical Therapy or Improvements of Therapy
Cutting-edge technology related to improvements in physical therapy is being studied for early deployment. For example, researchers are working on the idea that the spinal cord has the ability to learn complex motor skills, and therefore, suggested the use of task-dependent experience to facilitate skill acquisition to recover locomotor capability.4 In order to shed more light on these ideas, it is best to take an in-depth look at locomotor rehabilitation research that was conducted by E.C. Field-Fote.
In Field-Fote’s study, the researcher was trying to figure out how to train the spinal cord in order to restore locomotor capability. The proponent of the said study highlighted background research about the “spinal neural circuitry” and its reflex action that can be stimulated by an external input. However, Field-Fote went further when he said that the “training effects” remain even after spinal cord transection.5 Thus, it was discovered that this capability occurs at the level of the spinal cord.
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Field-Fote’s research had the potential to revolutionize the world of SCI treatment and Physical Therapy Assistants or PTA. However, at the time of the research Field-Fote was dealing with time constraints and other challenges. For example, he realized that although the use of tools and other implements caused a lot of improvements in locomotor capability, the researcher was unsure if the positive changes were the direct result of an intervention or part of the natural course of motor recovery There was also no time to figure out if the researcher’s proposed locomotor training method was effective enough to improve walking capability on solid ground.
The Role of the PTA
Almost two decades after the publication of Field-Fote’s work transformed the way people appreciate locomotor training, the said researcher must have been proud to know that scientists all over the world revolutionized SCI-related therapies using the locomotor training paradigm.6 For example, it is now an established fact that the use of bodyweight support or BWST was one of Field-Fote’s discovery. The injured person is encouraged to move his or her legs to mimic the act of walking. This process sends signals to the nervous system to learn locomotor patterns.6 The PTA not only assists with therapy sessions, but they also provide help when it comes to community ambulation training, especially when they teach and demonstrate principles that foster a safe and effective independent use of locomotor skills in the home or the community.6
Field-Fote utilized insights on how the nervous system works and established the initial framework for an intervention strategy called locomotor learning. The article in question did not provide enough information as to the extent of his progress regarding the quest to provide a radical intervention framework that makes it possible to regain significant locomotor capabilities. However, almost two decades after the publication of his initial research on locomotor training, he must have been pleased to know the value of his groundbreaking work. His research findings and others from like-minded researchers paved the way for the establishment of a more insightful and exciting work environment for future PTAs.
National Spinal Cord Injury Statistical Center. Spinal Cord Injury Facts and Figures at a Glance. 2017. Web.
Robinson J, Morris M, Kovach P. Professional Guide to Diseases. New York, NY: Lippincott Williams & Wilkins; 2013.
Goodman C, Fuller K. Pathology for the Physical Therapist Assistant. St. Louis, MO: Elsevier-Saunders; 2012.
Basso D. Neuroanatomical substrates of functional recovery after experimental spinal cord injury: Implications of basic science research for human spinal cord injury. Physical Therapy. 2000;80(8) : 807-817.
Field-Fote E. Spinal cord control of movement: Implications for locomotor rehabilitation following spinal cord injury. Physical Therapy, 2000;80(5) : 477-484.