F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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hundred contractions were followed by a short period of rest. Nine months after injury,
there was a first faint flicker of function in the posterior portion of the deltoid. The
patient gradually improved, and 14 months after injury there was a weak faradic response
in the anterior and middle portions of this muscle. One month later, he was able to
abduct his left arm to 70°, with his forearm in flexed position. Seventeen months after
injury, he could lift the whole extended arm above the horizontal and maintain it there
for i or 2 sec. He gradually improved, until he was finally able to lift the whole extended
arm above the horizontal against resistance and keep it in this position for a very long
time. The profound atrophy of the deltoid muscle gradually improved, but there remained
a definite difference in its size as compared with the normal side. However, throughout
the stage of denervation, the deltoid retained a good contractile power, in response to
galvanic stimulation (Guttmann, 1949).
In conus-cauda equina lesions, electrotherapy is given in selected cases only and
mainly to restore or improve the function of partially denervated muscles, in particular
those which are important for standing and walking—i.e. quadriceps and glutaei. This
is given, especially to the quadriceps in cauda equina lesions below L2-L4. It has been
our experience with these injuries that if they are complete below L4, the paralysis of
the extensors and plantar flexors of the feet and toes as a rule remains permanent, and
it is, therefore, a waste of time to apply electrical stimulation to these muscles, as the
paralysis of these muscles can easily be compensated by simple toe-raising springs. Only
in partial root lesions of L4/L5 should electrotherapy be tried.
(c)
Management of respiratory disturbances in higher dorsal and cervical lesions.
The higher
the cord lesion the greater the patient's dependence upon the action of the diaphragm
and accessory muscles for his major respiratory function. This applies, in particular, to
cervical lesions above Cy. In order to increase the vital capacity of the lungs, the patient
must be taught to exercise at short intervals the remaining respiratory muscles, especi
ally sternomastoid and trapezius, to the fullest possible capacity, and maximal apical
inspiration must always be encouraged, as well as diaphragmatic breathing. As has been
mentioned before these patients are particularly endangered, if they develop congestion
of the lungs. The physiotherapist's main role in these cases is basically the same as that
for any other acute chest condition, in that she helps the patient to cough and expectorate
mucus accumulated in the larynx, trachea and lungs. The importance of a close co-opera
tion between nursing and physiotherapy staff in these acute cases cannot be over
emphasized, as each is dependent on the good will of the other. As the patient is turned
by the nursing staff at regular intervals, the physiotherapist must know the time of these
turns and must fit in her work accordingly—the more so as the respiratory treatment in
these cases has to be carried out frequently.
Technique
It is better to treat such a patient for short periods but often, rather than give him two
or three long sessions, which may be too tiring for the patient. It is necessary to elevate
the foot end of the bed and tilt the patient's head down which greatly facilitates draining
