Principles of physical rehabilitation

Your care team have expert knowledge of the impact of SCI on movement and how to train and perfect movement skills. You will become an expert in the way your body moves and you are a crucial part in the physical rehabilitation process. Keep these things in mind when you are setting goals with your team.

Specific goals:

Setting specific, achievable goals is fundamental to rehabilitation. You need to have a clear picture of what you are aiming for to maintain motivation and to keep focus. Your care team can help you understand what is possible, what it will take to achieve certain goals and how long it is likely to take.

Assessment of improvement:

Using specific measurements to determine change is essential. Once you have set goals, it is easy to determine the best way to measure your performance against the goals you have set.

Teamwork:

While you are in inpatient rehabilitation, you will have a lot of people working with you. You are the most important and most consistent member of your rehab team and the one who the whole team is working for. Communication is essential for good teamwork. Make sure you talk regularly with your team about how you are progressing and what you are aiming for. If you are not sure what is happening, who is doing what, or how long something will take, make sure you ask.

Learning a skill:

Whether you are re-training your body to perform movements that it used to do with ease, or training to perform a movement you have never done before, learning a skill requires a lot of practice. In the early stages you will need a lot of guidance from others (external feedback) about what to do and how to do it. As you progress and improve, you will be able to evaluate your own performance and make adjustments to your technique without help from others (internal feedback). After you have learned the skill and can perform it independently, you need to spend even more time practising to further refine your technique and to get to the point where you can perform the skill without thinking (automation).

When training a skill, remember these 3 points:

Task specific and purposeful 

Train for movements that are useful for the tasks you need to (and want to) perform. While you are training, you will be able to see the outcome of your efforts because you are performing a real task and you can see the results. Research evidence shows that task specific training provides better results than isolated muscle training or part practice. This is what we would expect as it seems only logical that if you practice a specific task many times then you will be better at performing that task. After you have mastered the basic skill, move on to practice in the context you will be using the skill.

Correct pattern of movement 

Your body will become very skilled at performing the movement that you practice so make sure you are practising the right thing. Sometimes people find ways to achieve a certain task that are initially quick and easy. They keep performing the task that way because they can do it easily and independently. If you start performing movements in this way without advice and feedback about the correct movement pattern then you may face problems in the future as a result of your technique. Some problems people encounter are: damage to joints from excessive strain without the protection of muscles, increased spasticity, increased energy cost (this causes fatigue), overuse injuries like carpal tunnel syndrome, tennis elbow, and tendonitis in the shoulder muscles. Your therapy team can provide information about the most efficient ways to perform specific movements and what is required for you to be able to perform the task in that way. They can also provide physical assistance and specific feedback while you work with them on your technique. It may take a bit longer before you are able to perform the task independently but think of this time as an investment in your long term health and independence.

Repetition

You need to repeat the skill many times to master it. Make the most of your therapy sessions and also talk to your therapy team about what you can practise on your own so you can get in more training. Be careful about how many times you repeat a skill in one session and work within your fatigue limits. Once you fatigue you are at risk of injury and you are also likely to be practising the wrong technique. Your therapy team can help you determine what signs of fatigue to look for and how to know when you are too fatigued to perform any more practise. You will get to know the signs from your body and eventually you will be able to know how hard to push yourself and when to take a break.