Acute Management
Maintain spinal stability, monitor respiratory function (C3-C5), prevent DVT/pressure injuries/UTIs, manage neurogenic shock (hypotension, bradycardia, hypothermia) above T6.
Rehab Goals
Maximize independence by level. C1-C4: ventilator, total care. C5: feed with devices. C6-C7: transfer, dress. T1-T12: wheelchair independent. L1-L5: may ambulate with braces.
Lifelong Care
Manage neurogenic bowel/bladder, monitor for autonomic dysreflexia (T6+), prevent pressure injuries (reposition q2h), address spasticity, support psychological adjustment.
Important Notes
- Autonomic dysreflexia is life-threatening above T6 — check for bladder distension or bowel impaction.
- DVT prophylaxis is mandatory for first 3 months post-injury.
Clinical Tips
- Teach patients to recognize autonomic dysreflexia: SBP >200, pounding headache, sweating above injury.
- Bowel and bladder programs should be established early.
Summary
SCI rehabilitation focuses on maximizing independence, preventing complications, and managing lifelong physiological changes.
