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What’s It Like To Be is a regular online column in which New Zealanders from all walks of life share first-hand experiences. Here, physiotherapist Maree Walters talks about helping people to make the most of life after a spinal cord injury. As told to Paulette Crowley.
I came to physiotherapy from the neurological rehab angle, which includes things like stroke, Parkinson’s and spinal cord injuries. My dad had Parkinson’s disease and when I was a kid, I went with him to see his physiotherapist at Middlemore Hospital. I remember thinking, “That’s a cool job”.
I did my rotational training at Middlemore Hospital, including at the Auckland Spinal Rehabilitation Unit. I worked for a year in the UK before coming back to the spinal unit. I’ve been here for about 16 years and I’m now working in outpatients.
In the spinal rehab unit, we see anyone who’s had an injury to their spinal cord. This is about not just broken bones in the back; it needs to involve nerve damage. This could be anyone from a young person in a car accident or someone coming off their mountain bike, breaking their neck. Injuries can also be caused through spinal cord stroke or getting an infection in the spinal cord.
Once the patient has had surgery, they are stabilised, which might include going to an intensive care unit for a while. Once they’re medically stable, they can come to the rehab unit. How long they stay varies but normally it’s for around two to three months.
For a patient who’s lost movement in their legs, we would start them off with spending time in a wheelchair and getting them comfortable with that. We sometimes use electrical stimulation to help strengthen weak muscles. We might need to start hoisting people with an electric hoist and sling. If they get a return of strength in their legs, they could start standing in a supportive frame and can try standing and balancing. We can train them for walking by using a harness system to hold their weight, so if they fall, they’re safe. We might then start them using a walking frame or crutches, or whatever else is needed. They could also exercise in a swimming pool.
A lot of the people who come through here have had a severe injury and won’t be able to walk again, which means their rehab is focused on learning skills needed to live a full and active life using a wheelchair. For them, it’s about how to negotiate the world in a wheelchair. Physiotherapists and occupational therapists continue helping them after they get home.
Stem-cell therapy is another treatment. There’s been a lot of research done on this and it was brought into the public eye by people like Christopher Reeve – the actor who played Superman – who had a spinal cord injury. The theory is that stem cells can become other types of cells, such as nerve cells, that can be put into the damaged spinal cord in the hope that they will bridge the gap of the damage.
Results from stem-cell therapy are a mixed bag. Some people who’ve found it beneficial already had what we call “incomplete” injuries, so they already had potential to improve. This means it’s very hard to tell whether it was the stem-cell therapy that helped, or whether they were going to improve anyway. Overall, it hasn’t been as much of an instant cure as we hoped but there is still a lot of ongoing research.
In a lot of ways, regaining hand function after a spinal cord injury can be even more important than walking. Your independence really depends on your hands. New Zealand is one of the world leaders in reconstructive hand surgery. It’s been going on here for 40 years at Burwood Spinal Unit (in Christchurch) and at Middlemore (Auckland) in the last 10 years.
Now, we’re doing a lot of nerve reconstructive surgery. You can get some really amazing results – it’s really exciting to see someone who had no hand function regain it over a couple of years. The fascinating thing is that if you cut or squash nerves in the brain and the spinal cord, they can’t regrow – they’re dead. However, our brain has a lot of neuroplasticity, so other parts of the brain can take over to help improve function. Also, nerves in other parts of the body (peripheral nerves) can regrow. We use this ability in hand-nerve surgery.
Although this work can be great, it can be daunting as well. Not everyone’s going to regain full feeling and movement after a spinal cord injury. It’s a huge adjustment and a grief. If muscles haven’t recovered after about six months, you can reasonably say that the leg or hand might never be strong enough to use.
We always say the first two years are the most important when it comes to rehab and figuring out the extent of recovery from an injury. Being able to walk again is really celebrated in the media but people who don’t get to walk again can go on to live flourishing lives. They really need to be celebrated, too.
What I love about working in rehab is that you have time to really get to know your patients and form relationships. You’re potentially in and out of their lives for a long time. I’ve worked with some patients across 25 years. It’s a wonderful feeling that you are making a contribution to someone’s life and helping them navigate a huge change.
