Life after a spinal cord injury
A spinal cord injury (SCI) affects movement, sensation and body systems below the level of injury. The effects depend on the level and completeness of the injury. Someone with a low incomplete injury may walk with an aid, while someone with a high complete injury may use a power wheelchair and need support for most personal care.
Whatever the level, people with SCI face some common long-term challenges:
- Much lower daily activity than before injury, which raises the risk of heart disease, type 2 diabetes and weight gain
- Shoulder pain and overuse from wheelchair propulsion and transfers
- Pressure injury risk, bone density loss and spasticity
- Changes to blood pressure control and temperature regulation
- Barriers at home, at work, in the car and in the community
The SCI exercise guidelines
International evidence-based guidelines (Martin Ginis et al., 2018) give clear targets for adults with chronic SCI:
- For fitness and strength: at least 20 minutes of moderate to vigorous aerobic exercise twice a week, plus 3 sets of strength exercises for each major functioning muscle group twice a week
- For cardiometabolic health: at least 30 minutes of moderate to vigorous aerobic exercise 3 times a week
Meeting those targets safely takes more than a gym membership. That is where an exercise physiologist helps.
What the exercise physiologist focuses on
- Arm-crank, wheelchair and seated aerobic training to meet the SCI guidelines
- Shoulder-protective strength programs (rotator cuff, scapular and posterior muscles)
- Trunk control and balance for safer transfers and reaching
- Monitoring for autonomic dysreflexia and blood pressure changes
- Managing heat, since sweating may be reduced below the injury
- Standing or walking programs for incomplete injuries where appropriate
What the occupational therapist focuses on
- Wheelchair and seating assessment, including pressure care
- Transfer techniques and equipment such as boards and hoists
- Hand function, splinting and adaptive equipment for tetraplegia
- Home modifications: ramps, bathrooms, kitchens and access
- Personal care routines and support worker training
- Driving assessments and vehicle modification recommendations
Protecting the shoulders
For a manual wheelchair user, the shoulders do the work that legs used to do. Shoulder pain is very common after SCI and can threaten independence. OT and EP tackle it from both ends. The OT makes sure the wheelchair is set up correctly, the transfer technique is efficient and the home layout reduces unnecessary reaching and lifting. The EP builds the muscles that stabilise the shoulder and balances out the pushing muscles that get overused. Getting both right is one of the best investments a person with SCI can make.
Safety considerations your EP will manage
Autonomic dysreflexia: people with injuries at T6 or above can have sudden, dangerous rises in blood pressure, often triggered by a full bladder, tight clothing or a pressure area. Your EP checks blood pressure, knows the warning signs and has a plan in place before exercise starts. Exercise is also adjusted for low resting blood pressure, a lower heart rate response and reduced sweating in higher injuries.
Driving and getting around
Returning to driving is a major step towards independence after SCI. An OT driving assessment identifies what vehicle modifications are needed, such as hand controls, a spinner knob or wheelchair loading systems and what training is required. Exercare doesn't currently offer driving assessments, but we can point you to accredited OT driving assessors and help you prepare. The EP supports the physical side, including the upper body strength and trunk control needed to transfer in and out of the car and load a wheelchair.
One team for strength, access and independence
Exercare comes to you across Melbourne: exercise physiology in the south-east and east and occupational therapy in the north-east, east and inner suburbs. Complete one NDIS intake form for either or both services.
NDIS funding for SCI
Most people with an SCI that causes permanent disability are eligible for the NDIS if they apply before age 65. Both are usually funded from your Capacity Building budget, most often under Improved Daily Living Skills (Category 15). Exercise physiology can also be funded under Improved Health and Wellbeing (Category 12). Equipment and home modification recommendations from your OT are funded from your Capital budget. Wheelchairs, hoists, shower commodes and vehicle modifications are high-cost assistive technology and usually need an OT assessment and report before the NDIS will fund them.
If your injury came from a transport accident in Victoria, the TAC may fund your supports instead. If it happened at work, WorkSafe may be responsible. Your support coordinator can help clarify which scheme applies.
Evidence referenced in this article
- Martin Ginis KA, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord, 2018.
- Exercise guidelines for adults with spinal cord injury. SCIRE Community.
Written by the Exercare allied health team. This article is general information only and is not a substitute for individual medical advice. Exercare provides mobile exercise physiology and NDIS occupational therapy across south-east and eastern Melbourne.
OT services mentioned in this article:
Assistive technology → · Home modifications →
Frequently asked questions
How much exercise should someone with a spinal cord injury do?
The international SCI guidelines recommend at least 20 minutes of moderate to vigorous aerobic exercise twice a week plus strength training twice a week for fitness and 30 minutes of aerobic exercise 3 times a week for heart and metabolic health.
Can an OT help me get a wheelchair or hoist through the NDIS?
Yes. OTs assess your needs, trial equipment and write the report the NDIS needs to fund assistive technology such as wheelchairs, hoists, shower commodes and pressure cushions.
Is exercise safe with autonomic dysreflexia?
It can be, with the right precautions. Your exercise physiologist will check blood pressure, make sure bladder and skin are managed before sessions and know how to respond if symptoms appear.
Do you offer driving assessments for people with SCI?
Not at the moment. Exercare doesn't currently offer driving assessments, but we can point you to accredited OT driving assessors and help you prepare.