When an individual becomes a quadriplegic or paraplegic either through illness or trauma, there is a lengthy rehabilitation process involved. The duration and frequency of the rehabilitative process depends on the severity of injury and disability. While in the hospital, therapy focuses on prevention of further illness. Usually this involves some respiratory therapy including deep-breathing exercises and chest percussions performed by the therapist to keep the lungs clear of mucus.
In addition a physical therapist is needed to help establish a routine for changing his/her position in bed to prevent skin breakdown, and teach family members how to assist with a positioning schedule. The physical therapist also instructs family members in how to stretch the paralyzed individual’s limbs to maintain flexibility and begin strengthening exercises for any muscles that may have movement. Also, an occupational therapist is needed to assess the potential for self-care. Physical and occupational therapists focus on increasing sitting tolerance and balance. Psychologists and psychiatrists are an important link in the rehabilitation process, helping in focusing the person on attainable goals and treating the depression that often occurs after spinal cord injury.
Once the paralyzed individual is medically stable, they will be transferred to a rehabilitation hospital for several weeks. This could be much longer if more intensive therapy is required. Physical therapists continue instruction in bed mobility, transferring to and from the wheelchair with a sliding board, and begin teaching wheelchair mobility. If the paralysis was from fractures in one of the first four cervical vertebrae, then they learn to utilize a mouth control system to propel the wheelchair, others may learn to use a joystick control. As wheelchair skills improve, the paralyzed learns to maneuver their wheelchairs outside and to perform certain activities. Sometimes a person with partial paralysis may be able to learn to stand using parallel bars for improved strength and balance, with a progression towards walking with forearm crutches through a combination of weight shifting and upper body momentum. For these individuals capable of this much mobility, therapists work on helping them safely transition into their communities.
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