Occupational therapy for patients with spinal cord injury in early rehabilitation.

OBJECTIVE

To determine factors influencing the effectiveness of occupational therapy of patients with spinal cord injury in early rehabilitation.

MATERIAL AND METHODS

Data were obtained on 136 patients with spinal cord injury admitted to the Department of Rehabilitation, Kaunas University of Medicine Hospital in 1999-2005. The study population consisted of 97 (71.3%) males and 39 (28.7%) females. Complex rehabilitation was started after the stabilization of functional state in the Department of Neurosurgery and transfer to Department of Rehabilitation. The average duration of early rehabilitation in the Department of Rehabilitation was 68.3+/-22.5 days. According to the level of spinal cord injury patients were divided into two groups: patients with cervical lesions (C1-Th1 segments) and with thoracic-lumbar lesions (Th2-S1 segments). According to the level of spinal cord injury patients also were divided into two groups: complete (American Spinal Injury Association (ASIA-A)) and incomplete injury (ASIA-B, ASIA-C). The evaluation of the level of patients' independence was dependent on the level of injury: C4; C5; C6; C7-C8; Th1-Th9; Th10-L1; L2-S5 segments. Functional state and activity were evaluated by Functional Independence Measure (FIM). Effectiveness of occupational therapy was supposed to be good, if predicted independence level of final rehabilitation was achieved by a patient and it was supposed to be unsatisfactory if the same level of independence was not achieved.

RESULTS

The examination of patients has shown that 21 (15.4%) patients had complete injury (ASIA-A) in cervical level and 41 (30.2%) patients had complete injury in thoracic-lumbar level. Thirty-five (25.7%) patients had incomplete injury in cervical area and 39 (28.7%) patients in thoracic-lumbar level. At the end of early rehabilitation period in the case of complete spinal cord injury in cervical level (C4-C8) the expected level was achieved by 33.3-100% of patients. In the case of incomplete injury the expected level was achieved by 87.5-100% of patients. No patient with spinal cord injury in thoracic-lumbar (Th1-S5) level achieved the expected level of independence of final rehabilitation in early rehabilitation period.

CONCLUSIONS

Patients with spinal cord injury had disturbances of all activities according to FIM in early rehabilitation. The level of spinal cord injury had greater influence on the level of independence of patients with injury in cervical level rather than in thoracic-lumbar level. The level of independence in early rehabilitation period was achieved in 17.7% of complete spinal cord injury cases and in 45.9% of incomplete spinal cord injury cases.