Introduction

Imagine waking up one day only to realise that your body no longer moved or responded as you are supposed to. Such is the rather unfortunate reality when one has to live with spinal cord injuries (SCI). Physical and emotional trauma can be overwhelming. Yet, there is a glimmer of hope. 

Rehabilitation, especially with occupational therapy (OT), has become very instrumental in enabling victims of spinal cord injury to get their lives back together. The purpose of this article is to address the occupational therapy approach in SCI rehabilitation, how therapists assess the patients, plan for interventions, and apply various techniques to aid the patients in regaining independence and improving the quality of their lives. Being a continuously changing field, and as you will learn in just a bit, it's a very promising branch of health service for people suffering from a spinal cord injury. In the end, you will also get to know how occupational therapy helps them cope with living-injured.

Overview of spinal cord injury

Spinal cord injury (SCI) is a destructive neurological and pathobiological condition that leads to the dysfunction of the sensory, autonomic, and motor systems of the nervous system.¹ It arises from damage to the spinal cord, leading to communication impairment between the spinal cord and the brain. This impaired communication may cause the body not to move or feel sensations, and a loss of control of bodily functions below the site of injury. 

SCIs have been categorised into complete or incomplete injuries. Complete injury in general is defined as total loss of motor and sensory function. Incomplete injury, on the other hand, is defined as the retention of some function.² Traumatic actions like road accidents, falls, or even sports accidents, may cause an SCI.³ The impact of SCI does not end with impairment in the physical capability of an individual but also extends into his or her emotional and mental state.⁴ 

Many have to learn to live with feelings of grief, anxiety, or depression while adjusting to the cruel realities of their condition. According to the World Health Organisation (WHO), every year, about 500,000 people fall victim to spinal cord injury.⁵ Hence, there is an urgent need for effective and extended rehabilitation.

Occupational therapy's role in SCI

Occupational therapy plays a vital role in the rehabilitation process for patients who have suffered damage to their spinal cord. In general, occupational therapy would help the patient regain a normal life and become independent enough to carry out all the daily routines and activities.⁶ Therapies help the individual with SCI in physical recuperation, restoration of functions, and improvement of the quality of life.⁷ Apart from that, physical therapy tries to develop the physics of movement and muscles of a patient,⁸ while occupational therapy deals with function.

Assessment in occupational therapy for SCI

Occupational therapists must understand the nature of the injury and the specifics of how it affects the patient's abilities. In this context, a review of the medical background of the patient, his physical and cognitive examination, and discussions with the patient about his goals and problems have to be conducted.⁹ Probably, the most widely used tool is the Spinal Cord Independence Measure, a measure of the patient's ability to perform essential tasks like breathing, mobility, and self-care.¹⁰ Other generally applied assessment tools include the Functional Independence Measure, a tool that allows tracking of the patient's ability to perform activities of daily living.¹¹

Occupational therapy interventions for SCI

Occupational therapy treatments for spinal injuries are numerous. Each is specially projected for the specific needs of the patient to maximise functionality, independence, and quality of life. The following are occupational therapy interventions for patients with spinal cord injuries:

Activities of daily living (ADLs) training

Activities of daily living are those life roles that refer to basic self-care through dressing, bathing, eating, grooming, etc.¹² All these day-to-day activities will be hugely challenging after having an SCI. The main focus in occupational therapy is to enable the person to regain the ability to perform their previous normal daily routine, by teaching adapted techniques or introducing available assistive tools.

For example, patients who have lost significant hand function may find it difficult to button their shirts themselves, if not impossible. Occupational therapists teach the use of adaptive devices like buttonhooks that make it easier for such people to button their shirts.¹³ Suppose the patient's mobility remains limited in the upper body, the therapist might recommend using long-handled sponges to bathe or using eating utensils that have larger grips, making it easier to grasp. If the limitations are more severe, the therapist may adapt the performance of some activities that the patient already performs, such as using voice-controlled gadgets to carry out certain tasks.¹⁴ It targets the training of patients to be independent in their personal care. Thus, it is very effective in improving the self-esteem and quality of life of the patient.

Upper limb function and hand therapy

This occupational therapy is aimed at enabling the patient to restore the function of the upper limbs and hands, especially in those patients whose injury is higher on the spinal cord and thus affects the arms and hands.¹⁵ A person's independence in activities of daily living is considerably compromised by the loss or use of their hands, although good interventions might often make a considerable difference.

Mobility and transfers

To most people with an SCI, such a seemingly basic act as transferring from bed to wheelchair, or from wheelchair to car, for example, is a Herculean feat. Occupational therapists show people how to do transfers without hurting themselves, thus facilitating independent locomotion.¹⁶

Environmental changes

The spinal injury patient requires some home environmental modifications to make the environment more accessible and friendly for the patient. The occupational therapists, after assessing the patient and the patient's family living space, will recommend the type of modification that would guarantee safety and independence.¹⁷

Assistive technology and devices

Assisted technology helps persons with SCI become independent once again. An occupational therapist is a professional who seeks to identify various devices that the patient may be trained to use to facilitate the easier performance of daily tasks. Examples of such technologies are adaptive spoons or keyboards for complex systems, voice-activated computers, or robotic arms that help them feed or groom themselves.¹⁸

Psychosocial support

Psychosocial support in occupational therapy addresses not only different challenges but also reaches into the patient's psyche, emotional, and social aspects. Most often, patients with injuries to the spinal cord may go through a gamut of feelings, ranging from frustration and anger to sadness and grief. Occupational therapists provide patients with some very effective coping strategies to deal with feelings such as these and are sometimes consulted along with psychologists or social workers for comprehensive treatment.¹⁹

Advances in occupational therapy for SCI

Nowadays, occupational therapy is a branch of medical science that has developed one of the fastest due to new technologies and research that changed the point of view on SCI rehabilitation. These novelties opened new hopes for people with spinal cord injuries and allowed them to restore more to their lives. But probably the most fascinating development in recent years has to do with the integration of robotics and exoskeletons into occupational therapy.^20,21 

As these innovations finally reach development, occupational therapists will be instrumental in the integration of new technologies and techniques into rehabilitation programs.

Conclusion

SCI is traumatic and affects an individual's ability to mobilise, carry out daily routine activities, and engage in valued life activities. In occupational therapy, though, many with SCI work through such issues and lead normal, independent lives. The occupational therapist is prepared through appropriately tailored personal assessments, specific interventions, and integrating advanced technologies that allow the patient to rise above their new circumstances and achieve what they strive for.

While much remains to be conquered between accessibility to rehabilitative care and limitations placed on the severity of injury, occupational therapy remains a very important modality in the recovery process for the SCI patient. But as research continues to forge ahead, and as new technologies are being developed, the outlook for the future in spinal cord injury rehabilitation is starting to brighten.