Abstract
Neurorehabilitation constitutes to be the primary therapeutic approach to patients with spinal cord injury. Intense stimulation of the central nervous system is intended to maximize improvement in neurological function.
Besides the neurological development, every attempt is made to achieve the highest possible level of motor function, verticalization and locomotion with the goal to secure maximum self-sufficiency. The most serious motor impairment is the respiratory pattern disorder with limited ventilatory parameters.
This is due to impairment of motor functions caused by thoracic but primarily cervical lesions. Strength of the trunk muscles determines the ability of verticalization to the sitting or standing position and is also influenced by the upper and lower limb function.
Activity of the upper extremities predominantly determines the level of self-sufficiency but also the level of mobility. Ability to recruit lower extremity function is crucial for locomotion though residual mobility may be useful e.g. during transfers.
Rehabilitation is therefore focused on training the trunk as well as the limb muscles. The desired outcome is the return of muscle strength and inclusion of paretic muscles into functional movement patterns as well as respiratory pattern.
To meet these goals, several different physiotherapeutic methods may be utilized. These may be combined as needed and according to a therapist's creativity.
The treatment is based on neurophysiological principles including those based on motor ontogenesis. The objective is to utilize predetermined motor targets and recruit the damaged segments into their physiologic function.
To that end, it is possible to utilize methods that employ voluntary muscle control (e.g. Dynamic Neuromuscular Stabilization) as well as methods based on involuntary movement control (e.g.
Vojta's reflex locomotion).