1.11 Spinal cord injuries

Spinal cord injuries usually result in paralysis or par­tial paralysis of the arms, trunk, legs, or any particular combination thereof depending on the locus of the damage. The spinal cord is housed in the spinal or vertebral column. Nerves from the spinal cord pass down into the segments of the spinal column. Injury to the spinal cord affects innervation of muscle. The higher up the vertebral column the level of injury, the greater the restriction of body movement. Per­sons with spinal cord injuries are usually referred to as paraplegics or quadriplegics. A paraplegic is one who has the legs paralyzed. The quadriplegic has both the arms and legs affected.

The physical fitness characteristics of persons with spinal cord injury have been suspected as being re­lated to the level of their lesion. Kofsky et al found significant differences between the aerobic power as predicted by submaximal ergometer tests between classifications of spinal column lesions at levels 2, 3, and 4. However, Winnick and Short, who studied children aged 10 to 17 who are classified as levels 2 to 5, found that when comparing skinfold measures, grip strength, arm-hand pullups, speed in the 50-yard dash and shuttle run, and distance in the Softball throw, significant differences were not found among levels nor ages. Collectively, the physical characteris­tics are as follows:

1. Inappropriate control of the bladder and diges­tive organs

2. Contractures (abnormal shortening of muscles)

3. Heterotopic bone formation, or laying down of new bone in soft tissue around joints (during this process the area may become inflamed and swollen)

4. Urinary infections

5. Difficulty in defecation

6. Spasms of the muscles

7. Spasticity of muscles that prevent effective movement

8. Overweight because of low energy expendi­tures

Therapeutic Treatment. Therapeutic treatment should be based on a well-rounded program of exercises for all the usable body parts, including activities to develop strength, flexibil­ity, muscular endurance, cardiovascular endurance, and coordination. Cardiovascular development may be attained through arm pedaling of a bicycle ergo­meter, pushing of a wheelchair over considerable distances, and agility maneuvers with the wheelchair. Paraplegics can perform a considerable number of physical activities.

Movement and dance therapies have been used successfully in rehabilitation programs for persons who have spinal cord injuries. Berrol and Katz indi­cate that the focus of outcomes was goal oriented and there was considerable similarity between dance therapy, movement therapy, and those activitites that traditionally are included in adapted physical educa­tion programs. Once treatment goals are established, the disciplines appear to conduct their programs in a very similar manner.

Paraplegics can perform most physical education ac­tivities from a wheelchair. For younger children, fundamental motor skills such as throwing, hitting, and catching are appropriate. Once these skills are mas­tered, games that incorporate these skills may be played. Modifications of games that have been previ­ously described are appropriate for children in wheelchairs. Children in wheelchairs can participate in parachute games and target games without accom­modation. They can maintain fitness of the upper body through the same type of regimens as do the nonhandicapped. Strengthening of the arms and shoulder girdle is important for propulsion of the wheelchair and for changing body positions when moving in and out of the wheelchair. Swimming is a particularly good activity for the development of total physical fitness.

Several organizations promote competition for persons in wheelchairs. These include archery, bowl­ing, basketball, table tennis, wheelchair racing, and track events. Classification systems based on the levels of injury and physical functioning ability have been developed for equitable competition.