Early on in the Rehabilitation of SCI, exercise takes on the role of maintenance and prevention. The individual, or the caregiver, is instructed in passive range-of-motion (ROM) exercises to maintain joint integrity. This form of exercise is purely preventative in nature and will not help the individual to become "stronger." Yet, it has an important role in decreasing the development of joint contractures, which would limit the potential use of that arm or leg for balance or movement as well as increase the risk of Skin Breakdown. Thus, passive ROM prevents joints from loosing range of movement and allows individuals to participate more fully in additional stages of rehabilitation, e.g., active-assisted ROM.
For a SCI survivor who have some/improving Motor control, he/she and the caregiver will begin active-assisted or active ROM exercises for any appropriate muscles above and below the level of injury. With these types of exercises, the survivor takes on an active role and can enhance physical strength. During active-assisted ROM, the survivor contracts the muscle and moves the limb through partial range then the caregiver will assist to complete the range. With active ROM, the some survivors may move the limb through the entirety of the muscle range without physical assist of the caregiver. Weights can be added for resistance training to further enhance muscle power. Increasing the number of repetitions and decreasing the number of rest periods between exercises will improve overall endurance.
The aerobic capacity of a spinal cord survivor is compromised by autonomic dysfunction and diminished cardiopulmonary responses. Lack of voluntary control leads to the reduction of muscle mass, which in turn promotes venous pooling. This decrease in the delivery of well-oxygenated blood to the exercising muscle results in a downward spiral of overall aerobic capacity and can plague these individuals with fatigue and hypotension. The higher the level of injury, the lower the exercise tolerance; thus, when exercising strenuously, the survivor or caregiver should closely monitor for any sudden onset of dizziness, headache, pain or discomfort, shortness of breath, or profuse sweating.
When developing an aerobic exercise program, the key is to activate large muscle mass so that a higher metabolic rate and maximal oxygen use can be accomplished. Just as importantly, varying the activity can help prevent overuse syndromes-as commonly seen in the shoulder pathology of chronic wheelchair users. Cycling, swimming, circuit weight training, rowing, standing, and Ambulation are just a few activities to consider when cross training. Though physical and economic barriers oftentimes limit access to flexible fitness programs, there are resources available and it is important for the SCI survivor to be proactive and assume personal responsibility for his health.
A healthy lifestyle is not achieved through exercise alone. Diet is the basis by which the physical demands of exercise can be accomplished. A healthy SCI survivor's dietary needs are similar to those of other healthy people. Some unique nutritional considerations can exist and are discussed below.
