The use of occupational therapy in the rehabilitation of patients with spinal cord injuries

  • Kardatos A.
  • Evangelopoulos ME
  • Vlamis J.
Keywords: Occupational therapy, Rehabilitation, Spinal cord injuries


Introduction: Occupational therapy addresses physical and psychomotor disorders through specially selected activities in order to help individuals achieve the maximum level of functionality and independence in all aspects of their lives. The role of the occupational therapy in the rehabilitation of patients with spinal cord injuries (SCI) is complex. Its main goal is to compose and intertwine all the skills so that the SCI patient is able to have an independent, happy and productive life. The purpose of this study is to review the role of occupational therapy in the rehabilitation of SCI patients.

Material and methods: In the PUBMED database the following search was done with the following keywords: “occupational therapy”, “spinal cord injuries”. The search results showed 413 papers. After checking titles, abstracts and accessibility to full texts, 297 articles were rejected. Of the 116 publications evaluated, 35 were rejected for various reasons. So there are 81 studies left for this literature review.

Results: Occupational therapy has been proven to have a significant role in the rehabilitation of SCI patients as it facilitates motor retraining, basic functional movements, home alterations, gait training, wheelchair use, personal independence, entertainment and return to work to SCI patients. Occupational therapy is an important parameter of SCI patients rehabilitation, as it helps them to regain the skills they possessed before his injury, to be re-trained in the roles of daily life and to learn ways to repair shortcomings. Moreover, it helps SCI patients to fulfilldaily activities, such as clothing, nutrition and personal hygiene, and to improve memory, attention, perception and concentration. Ongoing research gives us hope for further improvement in the care and treatment of SCI, but even when new developments are used in practice on a daily basis, the neurological rehabilitation team is fundamental to tackling these patients, so that they can have a productive life.


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Author Biographies

Kardatos A.

Emergency Department, KAT Hospital, Athens, Greece

Evangelopoulos ME

Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece

Vlamis J.

3rd Department of Orthopaedic Surgery, University of Athens, KAT Hospital, Athens, Greece


1. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014; 6:309-31.
2. Burns AS, Marino RJ, Flanders AE, Flett H. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol. 2012; 109:47-62.
3. Sadowsky CL, McDonald JW. Activity-based restorative therapies: concepts and applications in spinal cord injury-related neurorehabilitation. Dev Disabil Res Rev. 2009; 15(2):112-6.
4. van Langeveld SA, Post MW, van Asbeck FW, Postma K, Ten Dam D, Pons K. Development of a classification of physical, occupational, and sports therapy interventions to document mobility and self-care in spinal cord injury rehabilitation. J Neurol Phys Ther. 2008; 32(1):2-7.
5. Smith EM, Boucher N, Miller WC. Caregiving services in spinal cord injury: a systematic review of the literature. Spinal Cord. 2016; 54(8):562-9.
6. Vining RD, Gosselin DM, Thurmond J, Case K, Bruch FR. Interdisciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity: A case report. Medicine (Baltimore). 2017; 96(34):e7837.
7. Mingaila S, Krisciunas A. Occupational therapy for patients with spinal cord injury in early rehabilitation. Medicina (Kaunas). 2005; 41(10):852-6.
8. Henshaw J, Grundy D, Russell J. ABC of spinal cord injury. Occupational therapy. Br Med J (Clin Res Ed). 1986; 292(6518):473-5.
9. Cohen ME, Schemm RL. Client-centered occupational therapy for individuals with spinal cord injury. Occup Ther Health Care. 2007; 21(3):1-15.
10. Arsh A, Anwar Z, Zeb A, Ilyas SM. Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study. Pak J Med Sci. 2020; 36(2):96-99.
11. Myburg M, Allan E, Nalder E, Schuurs S, Amsters D. Environmental control systems - the experiences of people with spinal cord injury and the implications for prescribers. Disabil Rehabil Assist Technol. 2017; 12(2):128-36.
12. Frye SK, Geigle PR, York HS, Sweatman WM. Functional passive range of motion of individuals with chronic cervical spinal cord injury. J Spinal Cord Med. 2020; 43(2):257-63.
13. Isaksson G, Josephsson S, Lexell J, Skar L. To regain participation in occupations through human encounters--narratives from women with spinal cord injury. Disabil Rehabil. 2007; 29(22):1679-88.
14. Watson AH, Kanny EM, White DM, Anson DK. Use of standardized activities of daily living rating scales in spinal cord injury and disease services. Am J Occup Ther. 1995; 49(3):229-34.
15. Pillastrini P, Mugnai R, Bonfiglioli R, Curti S, Mattioli S, Maioli MG, et al. Evaluation of an occupational therapy program for patients with spinal cord injury. Spinal Cord. 2008; 46(1):78-81.
16. Alve YA, Bontje P. Factors Influencing Participation in Daily Activities by Persons With Spinal Cord Injury: Lessons Learned From an International Scoping Review. Top Spinal Cord Inj Rehabil. 2019; 25(1):41-61.
17. Derakhshanrad N, Vosoughi F, Yekaninejad MS, Moshayedi P, Saberi H. Functional impact of multidisciplinary outpatient program on patients with chronic complete spinal cord injury. Spinal Cord. 2015; 53(12):860-5.
18. Rice LA, Smith I, Kelleher AR, Greenwald K, Hoelmer C, Boninger ML. Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury. Arch Phys Med Rehabil. 2013; 94(7):1230-46.
19. Isaksson G, Hellman A. The influence of social support on the rehabilitation of women with spinal cord injury: experiences recounted by occupational therapists. Scand J Occup Ther. 2012; 19(5):395-403.
20. Whiteneck GG, Gassaway J, Dijkers MP, Lammertse DP, Hammond F, Heinemann AW, et al. Inpatient and postdischarge rehabilitation services provided in the first year after spinal cord injury: findings from the SCIRehab Study. Arch Phys Med Rehabil. 2011; 92(3):361-8.
21. Ghaisas S, Pyatak EA, Blanche E, Blanchard J, Clark F. Lifestyle changes and pressure ulcer prevention in adults with spinal cord injury in the pressure ulcer prevention study lifestyle intervention. Am J Occup Ther. 2015; 69(1):6901290020p1-10.
22. Glass K, Hall K. Occupational therapists’ views about the use of robotic aids for people with disabilities. Am J Occup Ther. 1987; 41(11):745-7.
23. Creighton C, Dijkers M, Bennett N, Brown K. Reasoning and the art of therapy for spinal cord injury. Am J Occup Ther. 1995; 49(4):311-7.
24. Ozelie R, Gassaway J, Buchman E, Thimmaiah D, Heisler L, Cantoni K, et al. Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med. 2012; 35(6):527-46.
25. Argetsinger LC, Singh G, Bickel SG, Calvery ML, Behrman AL. Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury. Spinal Cord Ser Cases. 2020; 6(1):13.
26. van Langeveld SA, Post MW, van Asbeck FW, ter Horst P, Leenders J, Postma K, et al. Contents of physical therapy, occupational therapy, and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres. Disabil Rehabil. 2011; 33(5):412-22.
27. Foy T, Perritt G, Thimmaiah D, Heisler L, Offutt JL, Cantoni K, et al. The SCIRehab project: treatment time spent in SCI rehabilitation. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation. J Spinal Cord Med. 2011; 34(2):162-75.
28. Mahmoud H, Qannam H, Zbogar D, Mortenson B. Spinal cord injury rehabilitation in Riyadh, Saudi Arabia: time to rehabilitation admission, length of stay and functional independence. Spinal Cord. 2017; 55(5):509-14.
29. Carlson M, Vigen CLP, Rubayi S, Blanche EI, Blanchard J, Atkins M, et al. Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study. J Spinal Cord Med. 2019; 42(1):2-19.
30. Hsieh CH, DeJong G, Groah S, Ballard PH, Horn SD, Tian W. Comparing rehabilitation services and outcomes between older and younger people with spinal cord injury. Arch Phys Med Rehabil. 2013; 94(4 Suppl):S175-86.
31. Burns AS, Marino RJ, Kalsi-Ryan S, Middleton JW, Tetreault LA, Dettori JR, et al. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017; 7(3 Suppl):175S-94S.
32. Lathem PA, Gregorio TL, Garber SL. High-level quadriplegia: an occupational therapy challenge. Am J Occup Ther. 1985; 39(11):705-14.
33. Unger J, Chan K, Scovil CY, Craven BC, Mansfield A, Masani K, et al. Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. Phys Ther. 2019; 99(4):420-27.
34. Park MO, Lee SH. Effects of seating education and cushion management for adaptive sitting posture in spinal cord injury: Two case reports. Medicine (Baltimore). 2019; 98(4):e14231.
35. Zbogar D, Eng JJ, Miller WC, Krassioukov AV, Verrier MC. Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation. Spinal Cord. 2017; 55(2):172-79.
36. Verran AG, Baumgarten JM, Paris K. Occupational therapy management of tendon transfers in persons with spinal cord injury quadriplegia. Occup Ther Health Care. 1988; 4(3-4):155-69.
37. Mulcahey MJ, Smith BT, Betz RR, Weiss AA. Outcomes of tendon transfer surgery and occupational therapy in a child with tetraplegia secondary to spinal cord injury. Am J Occup Ther. 1995; 49(7):607-17.
38. Kim DI, Lee H, Lee BS, Kim J, Jeon JY. Effects of a 6-Week Indoor Hand-Bike Exercise Program on Health and Fitness Levels in People With Spinal Cord Injury: A Randomized Controlled Trial Study. Arch Phys Med Rehabil. 2015; 96(11):2033-40 e1.
39. Floris L, Dif C, Le Mouel M. The tetraplegic patient and the environment. Surgical Rehabilitation of the Upper Limb in Tetraplegia: WB Saunders Co Ltd; 2002. p. 45-55.
40. Sleight AG, Cogan AM, Hill VA, Pyatak EA, Diaz J, Florindez LI, et al. Factors Protecting Against Pressure Injuries in Medically Underserved Adults With Spinal Cord Injury: A Qualitative Study. Top Spinal Cord Inj Rehabil. 2019; 25(1):31-40.
41. Guidetti S, Tham K. Therapeutic strategies used by occupational therapists in self-care training: a qualitative study. Occup Ther Int. 2002; 9(4):257-76.
42. Norin L, Slaug B, Haak M, Jorgensen S, Lexell J, Iwarsson S. Housing accessibility and its associations with participation among older adults living with long-standing spinal cord injury. J Spinal Cord Med. 2017; 40(2):230-40.
43. Hayes SC, James Wilcox CR, Forbes White HS, Vanicek N. The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: A systematic review. J Spinal Cord Med. 2018; 41(5):529-43.
44. Nam KY, Kim HJ, Kwon BS, Park JW, Lee HJ, Yoo A. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017; 14(1):24.
45. Bayley MT, Kirby RL, Farahani F, Titus L, Smith C, Routhier F, et al. Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med. 2019; 42(sup1):130-40.
46. Marszalek J PhD PT, Kosmol AP, Mroz AP, Wiszomirska I PhD PT, Fiok KP, Molik B PhD PT. Physiological parameters depending on two different types of manual wheelchair propulsion. Assist Technol. 2018:1-7.
47. Bolin I, Bodin P, Kreuter M. Sitting position - posture and performance in C5 - C6 tetraplegia. Spinal Cord. 2000; 38(7):425-34.
48. Mendes PVB, Gradim LCC, Silva NS, Allegretti ALC, Carrijo DCM, Cruz D. Pressure distribution analysis in three wheelchairs cushions of subjects with spinal cord injury. Disabil Rehabil Assist Technol. 2019; 14(6):555-60.
49. Garber SL, Dyerly LR. Wheelchair cushions for persons with spinal cord injury: an update. Am J Occup Ther. 1991; 45(6):550-4.
50. Murata J, Murata S, Yamagata S, Ohyama M, Kogo H, Umeki N. The attenuating effect of a dynamic cushion on the development of leg edema in wheelchair users with spinal cord injuries. Technol Health Care. 2020.
51. Giesbrecht EM, Ethans KD, Staley D. Measuring the effect of incremental angles of wheelchair tilt on interface pressure among individuals with spinal cord injury. Spinal Cord. 2011; 49(7):827-31.
52. Yuen HK, Garrett D. Comparison of three wheelchair cushions for effectiveness of pressure relief. Am J Occup Ther. 2001; 55(4):470-5.
53. Fogelberg D, Atkins M, Blanche EI, Carlson M, Clark F. Decisions and Dilemmas in Everyday Life: Daily Use of Wheelchairs by Individuals with Spinal Cord Injury and the Impact on Pressure Ulcer Risk. Top Spinal Cord Inj Rehabil. 2009; 15(2):16-32.
54. Herzog T, Swanenburg J, Hupp M, Mittaz Hager AG. Effect of indoor wheelchair curling training on trunk control of person with chronic spinal cord injury: a randomised controlled trial. Spinal Cord Ser Cases. 2018; 4:26.
55. Lukersmith S, Radbron L, Hopman K. Development of clinical guidelines for the prescription of a seated wheelchair or mobility scooter for people with traumatic brain injury or spinal cord injury. Aust Occup Ther J. 2013; 60(6):378-86.
56. Singh H, Scovil CY, Yoshida K, Oosman S, Kaiser A, Jaglal SB, et al. Capturing the psychosocial impacts of falls from the perspectives of wheelchair users with spinal cord injury through photo-elicitation. Disabil Rehabil. 2020:1-10.
57. Rice LA, Sung JH, Keane K, Peterson E, Sosnoff JJ. A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study. J Spinal Cord Med. 2019:1-9.
58. Kirby RL, Worobey LA, Cowan R, Pedersen JP, Heinemann AW, Dyson-Hudson TA, et al. Wheelchair Skills Capacity and Performance of Manual Wheelchair Users With Spinal Cord Injury. Arch Phys Med Rehabil. 2016; 97(10):1761-9.
59. Bergstrom AL, Samuelsson K. Evaluation of manual wheelchairs by individuals with spinal cord injuries. Disabil Rehabil Assist Technol. 2006; 1(3):175-82.
60. Singh H, Scovil CY, Yoshida K, Oosman S, Kaiser A, Craven C, et al. Factors that influence the risk of falling after spinal cord injury: a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility. BMJ Open. 2020; 10(2):e034279.
61. Pham HN, Noble CN, Hentz VR. Rubber band as external assist device to provide simple grip for quadriplegic patients. Ann Plast Surg. 1988; 21(2):180-2.
62. Seplowitz C. Technology and occupational therapy in the rehabilitation of the bedridden quadriplegic. Am J Occup Ther. 1984; 38(11):743-7.
63. Sargant C, Braun MA. Occupational therapy management of the acute spinal cord-injured patient. Am J Occup Ther. 1986; 40(5):333-7.
64. Ozelie R, Sipple C, Foy T, Cantoni K, Kellogg K, Lookingbill J, et al. SCIRehab Project series: the occupational therapy taxonomy. J Spinal Cord Med. 2009; 32(3):283-97.
65. Gallagher G, Bell A. Combining Adult Learning Theory with Occupational Therapy Intervention for Bladder and Bowel Management after Spinal Cord Injury: A Case Report. Occup Ther Health Care. 2016; 30(2):202-9.
66. Rigby P, Ryan SE, Campbell KA. Electronic aids to daily living and quality of life for persons with tetraplegia. Disabil Rehabil Assist Technol. 2011; 6(3):260-7.
67. Gottlieb A, Plotnik M, Kizony R, Katsarou Z, Bostantjopoulou S, Zeilig G. Identification of clinically related requirements of a novel assistive device for people with a high spinal cord injury. PLoS One. 2019; 14(6):e0218393.
68. Holme SA, Kanny EM, Guthrie MR, Johnson KL. The use of environmental control units by occupational therapists in spinal cord injury and disease services. Am J Occup Ther. 1997; 51(1):42-8.
69. Sorensen L, Manum G. A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury. Spinal Cord Ser Cases. 2019; 5(1):29.
70. Jung JH, Lee HJ, Cho DY, Lim JE, Lee BS, Kwon SH, et al. Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury. Ann Rehabil Med. 2019; 43(4):445-57.
71. Cheung EYY, Ng TKW, Yu KKK, Kwan RLC, Cheing GLY. Robot-Assisted Training for People With Spinal Cord Injury: A Meta-Analysis. Arch Phys Med Rehabil. 2017; 98(11):2320-31 e12.
72. Runge M. Self-dressing techniques for patients with spinal cord injury. Am J Occup Ther. 1967; 21(6):367-75.
73. Krajnik SR, Bridle MJ. Hand splinting in quadriplegia: current practice. Am J Occup Ther. 1992; 46(2):149-56.
74. Peters B. Driving performance and workload assessment of drivers with tetraplegia: an adaptation evaluation framework. J Rehabil Res Dev. 2001; 38(2):215-24.
75. Kiyono Y, Hashizume C, Matsui N, Ohtsuka K, Takaoka K. Car-driving abilities of people with tetraplegia. Arch Phys Med Rehabil. 2001; 82(10):1389-92.
76. Hanson CS, Nabavi D, Yuen HK. The effect of sports on level of community integration as reported by persons with spinal cord injury. Am J Occup Ther. 2001; 55(3):332-8.
77. Magnani PE, Marques NR, Junior AC, de Abreu DC. Adapted sport effect on postural control after spinal cord injury. Spinal Cord. 2016; 54(12):1188-96.
78. Li C, Khoo S, Adnan A. Effects of aquatic exercise on physical function and fitness among people with spinal cord injury: A systematic review. Medicine (Baltimore). 2017; 96(11):e6328.
79. Reid MJ. Activity in water based on the Halliwick method. Child Care Health Dev. 1975; 1(4):217-23.
80. Guttmann L, Mehra NC. Experimental studies on the value of archery in paraplegia. Paraplegia. 1973; 11(2):159-65.
81. Taktak DM. An adjustable table tennis bat and grip system for tetraplegics. Spinal Cord. 1997; 35(1):61-3.
82. Valent LJ, Dallmeijer AJ, Houdijk H, Slootman HJ, Janssen TW, Post MW, et al. Effects of hand cycle training on physical capacity in individuals with tetraplegia: a clinical trial. Phys Ther. 2009; 89(10):1051-60.
83. Lee B, Nantais T. Use of electronic music as an occupational therapy modality in spinal cord injury rehabilitation: an occupational performance model. Am J Occup Ther. 1996; 50(5):362-9.
84. Ullah MM, Fossey E, Stuckey R. The meaning of work after spinal cord injury: a scoping review. Spinal Cord. 2018; 56(2):92-105.
85. Alve YA, Bontje P, Begum S. Intra- and interpersonal agency: Resuming occupational participation among persons with spinal cord injury after discharge from in-patient rehabilitation. Scand J Occup Ther. 2020; 27(1):66-79.
86. Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil. 2018; 40(15):1745-53.
87. Trenaman LM, Miller WC, Escorpizo R. Interventions for improving employment outcomes among individuals with spinal cord injury: a systematic review. Spinal Cord. 2014; 52(11):788-94.
88. van Velzen JM, de Groot S, Post MW, Slootman JH, van Bennekom CA, van der Woude LH. Return to work after spinal cord injury: is it related to wheelchair capacity at discharge from clinical rehabilitation? Am J Phys Med Rehabil. 2009; 88(1):47-56.
89. Miller WT. An occupational therapist as a sexual health clinician in the management of spinal cord injuries. Can J Occup Ther. 1984; 51(4):172-5.
90. Taylor SM, Cheung EO, Sun R, Grote V, Marchlewski A, Addington EL. Applications of complementary therapies during rehabilitation for individuals with traumatic Spinal Cord Injury: Findings from the SCIRehab Project. J Spinal Cord Med. 2019; 42(5):571-78.