Acute Phase of Rehabilitation

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Rehabilitation and management of the person with a SCI requires an interdisciplinary team approach during the acute phase of rehabilitation. The level and classification of the injury is determined and the goals of maintaining range of motion (ROM), improving strength, managing tone, spasticity, and the prevention of secondary complications in order to achieve the person’s maximum functional ability for independent transfers, ADL and mobility are developed (Drolet et al. 1999; Haisma et al. 2006; Sipski & Richards 2006). Clinicians must be knowledgeable about the change in physical capacity based on level of injury as a prerequisite to developing optimal rehabilitation programs and for setting realistic individual rehabilitation goals.

Table 1: Acute Phase of Rehabilitation


Rice et al. (2014) tested the efficacy of providing education of the PVA Clinical Practice Guidelines for Preservation of Upper Limb Function among manual wheelchair users. This RCT compared education to standard care among individuals with new SCI and found that receiving education resulted in better wheelchair skills including improved push frequency and length.

Rice et al. (2014) recommended further research in this area to:

  • Determine if differences in propulsion skills result in decreased pain and improved quality of life.
  • Determine if improvements are maintained over the long-term.


There is level 1b evidence (from one randomized controlled trial; Rice et al., 2014) that education improves wheelchair skills after 1- year post discharge.

  • Providing education to manual wheelchair users is effective in improving the push frequency and push length while using a wheelchair.