Physiotherapy Management for Spinal Cord Injuries: A Comprehensive review

Abstract

Spinal cord injury (SCI) has far-reaching consequences beyond paralysis, affecting various bodily functions and leading to significant social, financial, and psychological repercussions. Physiotherapy plays a pivotal role in the rehabilitation of individuals with SCI, addressing key challenges such as weakness, contractures, and impaired motor control. While many physiotherapy interventions rely on established motor learning principles and techniques like strength training and repetitive practice, evidence for their effectiveness in SCI-specific contexts remains limited. For neurologically intact muscles, progressive resistance training with systematically increasing loads is recommended. However, the optimal training protocol for partially paralyzed muscles affected by SCI is less clear, with mixed evidence supporting the efficacy of progressive resistance training, high-repetition low-resistance approaches, or electrical stimulation. Stretching and passive movements are commonly used to prevent and manage contractures, but their long-term efficacy is uncertain. Emerging approaches such as activity-based therapy, exoskeleton-assisted walking, and neural recovery interventions hold promise, yet their integration into standard practice must be supported by high-quality evidence. Future advancements in technology, stem cell therapies, and neuroplasticity offer hope for enhanced recovery, but continued emphasis on evidence-based practices and rigorous clinical trials remains crucial. Physiotherapists must develop skills to predict outcomes, prioritize interventions, and strike a balance between embracing innovation and resisting premature adoption of unverified techniques. Ultimately, the physiotherapy management of SCI must prioritize patient-centered care and leverage innovative interventions judiciously to optimize functional independence and foster realistic expectations for recovery.