A diagnosis of spinal cord injury, including paraplegia and quadriplegia, often brings to mind an image of a person in a wheelchair. However, a spinal cord injury does not necessarily keep a person from walking. In fact, many people with spinal cord injuries are able to ambulate either part of the time or even exclusively.
Types of Spinal Cord Injury
There are several types of spinal cord injuries, and each affects the legs differently. While paraplegia and quadriplegia imply total paralysis of the legs, these injuries may be either complete or incomplete. A complete injury will cause complete loss of function below the level of spinal cord damage, while an incomplete spinal cord injury leaves some function intact. Someone with incomplete paraplegia or quadriplegia may retain enough strength in their legs for ambulation. Additionally, other spinal cord injuries such as central cord syndrome or spinal cord compression may also leave the lower extremities relatively unharmed.
Ambulation After an Incomplete Injury
According to the Walking Index for Spinal Cord Injury, or WISCI, more than half of all spinal cord injuries are incomplete. Of incomplete quadriplegics, it estimates around 86 percent have the ability to walk again, often with physical therapy training. Functional ambulation is described by the WISCI as community-distance mobility, or around 200 feet. While many people will require the use of an assistive walking device, such as a cane, walker or leg braces, some will be able to ambulate without holding on to anything.
Complete Injuries and Ambulation
While those with complete spinal cord injuries have a poor prognosis for ambulation, some may still benefit from walking training programs. According to the Christopher and Dana Reeve Foundation, these programs are called locomotor training, treadmill training or weight-supported ambulation. They are designed to "remind" the brain and body how to walk. This is an emerging -- and expensive -- technology that is currently only available at specialty spinal cord rehab centers, but it can be used by anyone with any type of spinal cord injury. Even if the person does not become a functional walker, locomotor training for someone with a complete spinal cord injury can help maintain muscle tone and postural control.
Rehabilitation for Ambulation
For a person to walk after a spinal cord injury requires rehabilitation with a physical therapist. Rehabilitation can take place in a specialized facility, outpatient therapy clinic or even at home, depending on the degree of injury and extent of paralysis. Physical therapy for spinal cord injury will consist of exercise and stretching, in addition to other modalities to improve ambulation, such as electrical stimulation of the muscles and treadmill training.
Considerations
Even someone who is a functional walker may still require the use of a wheelchair at home. Sometimes a person with an incomplete injury may receive a wheelchair early on during her rehabilitation; however, this does not mean that her prognosis for ambulation is poor: the wheelchair simply serves as a back-up method for community mobility, or in the case of fatigue or illness.
References
- Christopher and Dana Reeve Foundation: Paralysis Resource Center: Exercise and New Function
- Jacques, Erica. Occupational Therapist: Lucerne Spinal Center. Orlando, FL.
- Jefferson and Magee: Walking Index for Spinal Cord Injury.
