F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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Adaptation therapy of normal parts of the body
General principles of compensatory training
These are carried out, from the early stages, in conjunction with passive movements,
proper positioning, electrotherapy, etc., with a view to overdevelopment of those muscles,
which are essential for a patient's upright position and readjustment of postural and
vasomotor control of these cases.
Overdevelopment of arm, trunk and abdominal muscles
The most important muscles to be exercised in spinal cord lesions above Ty are the
latissimus dorsi, trapezius, rhomboidei, teres major, serratus anterior, pectorals, and last
but by no means least, the triceps—and, for distal cord lesions, also the abdominal and
long back muscles. Compensatory training of these muscle groups is important for the
following reasons:
a
the combined operation of these muscle groups will greatly improve the balance and
mobility of the trunk;
b
the combined operation of these muscle groups will restore the paraplegic's capability
to walk between parallel bars on crutches, by means of pelvic tilting or by promoting
swinging movements of the trunk. The knees are fixed with light bivalved walking plasters
and, later on, with calipers, keeping the feet at the correct angle by means of simple
toe-raising springs; thus, the paralysed legs are used as stilts;
c
training of the abdominal muscles is also of great importance for the re-conditioning
of the bladder and for the restoration of the sexual function of the paraplegic.
Techniques
The following are special methods which have been developed at Stoke Mandeville to
achieve compensatory training effects:
Resistance and suspension exercises
Auto-assisted, resistance exercises of the upper limbs are introduced in the early stages,
while the patient is still in bed, with the aid of simple springs unit (chest expanders) and
ten pulls or more are made by the patient every half an hour to an hour. This immediately
encourages the paraplegic to activity, and it is the co-operation of the nursing staff and
physiotherapist to ensure that these chest-expander exercises are carried out regularly
by the patient.
Later on, exercises in suspension and against resistance by means of pulleys and
weights are added, as introduced and developed by Mrs Guthrie-Smith (1943). These
have been an important contribution to physical readjustment in certain stages, and the
Guthrie-Smith apparatus has proved invaluable for these exercises. Fig. 227 shows a
patient with a complete lesion below T3, conveniently suspended in such a position as to
allow movements unhampered by friction or weight of the paralysed body, doing
