Rehabilitation of Walking and Psychosocial Wellbeing in People with Severe Spinal Cord Injury

Abstract

The aim of this research was to investigate what factors, apart from the neurophysiological impairment of the spinal cord, might be of critical importance for improved rehabilitation of people with severe spinal cord injury. The research used qualitative and quantitative analysis. In current rehabilitation practice walking disability status is often considered as final. In Study 1, a survey was conducted with two hundred and ninety participants with severe spinal cord injury, in order to determine their own attitudes towards their injury and their experience of treatment. The factors contributing to improved rehabilitation outcomes were further investigated in respect to biological, psychological and social aspects of participants' functioning and their rehabilitation outcome. Firstly, participants' willingness to regain normal walking was analysed and then their willingness to participate in current rehabilitation practice that typically involves passive movements or brace walking. Several reported factors were found to have influence on changes in the participants' exercise behaviour and their life quality. They maintained great willingness to regain walking ability while their willingness to exercise brace walking waned over time. The reasons reported were mainly: brace gait being difficult, uncomfortable, unsafe and useless. The exercise behaviour was further influenced by severity of other impairments, such as: bowel and bladder control; sexual functioning; loss of job; lack of employment opportunities; deterioration or loss of intimate relationships as well as absence of exercises relevant to the normal-gait reacquisition. Two more studies were designed for further investigation. Study 2 investigated how significantly different might normal gait be from the brace gait. It involved 20 able-walking participants. The nature of the participants' emotional, cognitive, physical and behavioural responses was investigated as well in relation to their brace walking experience. The data showed that brace gait is significantly different from normal gait. It was reported as awkward, difficult, uncomfortable and unsafe. Study 3 was designed as a case study aiming to investigate the impact that normal gait exercises might have on rehabilitation outcome for persons with severe spinal injury. It involved a male participant of age 32 with severe incomplete spinal injury who presented with great walking difficulties and has never achieved normal walking pattern since his injury occurred. It was found that walking knowledge might be available and accessible after a severe spinal cord injury but that it should be accessed indirectly through carefully structured exercises where the tasks involved should be simple, achievable and consistent with normal gait properties. Several psychological, social and kinematical factors were identified as being of critical importance for improved rehabilitation for people with severe SCI. The research findings emphasised the critical importance of the participants' desire to be involved in the decision-making process related to their prospective rehabilitation. An integrative rehabilitation system was proposed, called Integrative Meta Learning. This facilitates learning in people with severe spinal cord injury in how to guide their further learning and rehabilitation processes. The aim of this approach is to improve their functioning and cope more successfully with multiple changes following their SCI. It followed The Ripple-Effect Model that promoted sensitive and client-centred assessment of participants' complex emotional, cognitive, physical, environmental and behavioural experiences. It was found that through a collaborative, supportive and respectful therapy relationships, people with a spinal injury would be able to grow from the stage where they lacked understanding of their problems towards achievement of improved voluntary control and independent daily functioning. For this to happen, a person with a severe spinal injury, as well as their families, would need professional help to support them in assisting each other towards optimal physical as well as psychosocial recovery. Further research in psychology needs to be designed to integrate relevant areas of biomechanics, physiology, neuropsychology and social sciences.