The patient begins to take more of an active role in their rehabilitation at this stage and works with the team to develop reasonable functional goals.
[5] In the acute phase physical and occupational therapists focus on the patient's respiratory status, prevention of indirect complications (such as pressure sores), maintaining range of motion, and keeping available musculature active.
[5] Depending on the Neurological Level of Impairment (NLI), the muscles responsible for expanding the thorax, which facilitate inhalation, may be affected.
Physical therapists can assist immobilized patients with effective cough techniques, secretion clearance, stretching of the thoracic wall, and suggest abdominal support belts when necessary.
Other complications that arise from immobilization include muscle atrophy and osteoporosis, especially to the lower limbs, increasing the risk of fractures to the femur and tibia.
[7] While passive weight bearing of paralyzed lower extremities appears to be ineffective, stressing the bones through muscular contractions initiated by functional electrical stimulation (FES) has yielded positive results in some cases.
[1] A 2012 systematic review found insufficient evidence to conclude which locomotor training strategy improves walking function most for people with spinal cord injury.
[1] Applying spinal cord stimulation (transcutaneous or epidurally) during weight supported walking have been shown to improve locomotor output.
Literature has shown that participants with spinal cord injuries that had massage therapy added into their rehabilitation had significant improvement observed by physical therapist in functional living activities and limb range of motion.
This could be due to the decrease in H-Reflex amplitudes measured by EMG that is critical for the comfort of spinal cord injury patients for reducing cramps and spasms.
[18] Independence in daily activities like eating, bowel and bladder management, and mobility is the goal, as obtaining competency in self-care tasks contributes significantly to an individual's sense of self-confidence[4] and reduces the burden on caregivers.
[4] In addition to acquiring skills such as wheelchair transfers, individuals with a spinal cord injury can greatly benefit from exercise reconditioning.
In the majority of cases, spinal cord injury leaves the lower limbs either entirely paralyzed, or with insufficient strength, endurance, or motor control to support safe and effective physical training.
Exercisers also reported less stress, fewer depressive symptoms, greater satisfaction with physical functioning, less pain, and better quality of life.
Adapted physical activity equipment can also be used to allow for sport participation: for example, sit-skiis can be used by individuals with a spinal cord injury for cross-country or downhill skiing.
For example, ramps or lifts can be added to a patient's home, and part of rehabilitation involves investigating options for returning to previous interests as well as developing new pursuits.
Body weight supported treadmill training has been researched in an attempt to prevent bone loss in the lower extremities in individuals with spinal cord injury.