From the Guidelines
Patients with complete spinal cord injuries can achieve improved sitting balance through specialized rehabilitation techniques focused on trunk stability and compensatory strategies, as recommended by recent guidelines 1. The impact of complete spinal cord injuries on sitting balance in patients is significant, and rehabilitation strategies are crucial to prevent complications and improve quality of life.
- The primary goal of rehabilitation is to prevent neuro-orthopaedic limb complications, pressure ulcers, and their functional consequences, as outlined in the French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury 1.
- Strategies for positioning and mobilizing patients with spinal cord injuries in the acute phase are essential to prevent pressure ulcers, which can occur in up to 26% of patients, with the sacrum, heels, ischium, and occiput being the most common locations 1.
- Rehabilitation techniques should focus on trunk stability and compensatory strategies, including weight shifting, reaching activities, and functional tasks performed while sitting, as well as core strengthening exercises targeting available musculature above the level of injury.
- Adaptive equipment, such as specialized wheelchair cushions, trunk supports, and custom-fitted wheelchairs, is also essential to improve sitting balance and prevent secondary complications like pressure ulcers and respiratory problems.
- The neurophysiological basis for improvement involves neuroplasticity of remaining neural pathways and development of compensatory strategies using intact muscle groups, particularly the latissimus dorsi, trapezius, and shoulder girdle muscles in higher-level injuries.
- Improved sitting balance enhances independence in activities of daily living, reduces caregiver burden, and decreases secondary complications, ultimately improving the patient's quality of life.
From the Research
Impact of Complete Spinal Cord Injuries on Sitting Balance
- Complete spinal cord injuries can result in severe motor and sensory functional impairments, affecting personal and social behaviors 2
- Deficits in motor function, including sitting balance, are a significant consequence of spinal cord injuries 2
Rehabilitation Approaches for Sitting Balance
- Game-based exercises, such as center-of-pressure-controlled video games, can improve dynamic short-sitting balance in individuals with complete spinal cord injuries 3
- These exercises can increase motivation, practice volume, and attention span during training, leading to substantial improvements in dynamic balance control 3
Comparison with Incomplete Spinal Cord Injuries
- Incomplete spinal cord injuries also result in impaired balance, and recovery of standing balance ability is an important aim of rehabilitative programs 4
- However, the impact of complete spinal cord injuries on sitting balance may be more severe due to the complete loss of motor and sensory function below the injury level 5
Importance of Early Rehabilitation
- Early rehabilitation is crucial to prevent joint contractures, loss of muscle strength, and other complications, and to ensure normal functioning of the respiratory and digestive system 5
- An interdisciplinary approach, including physiotherapy, occupational therapy, and other specialist care, is essential for effective rehabilitation of spinal cord injuries 5