Definition and Symptoms
Spinal Cord Injury (SCI) damages the myelinated fibre tracts or white matter which carries signals to and from the brain. Depending on its classification and severity, this type of traumatic injury can also damage the grey matter in the central part of the cord, which can cause segmental loss of interneruons and motor neurons, both integral parts of the central nervous system. SCI can result from a variety of causes, including trauma, tumour, ischemia (restriction in blood supply or low blood circulation), developmental disorders, neurodegenerative diseases, demyelinative diseases, transverse myelitis and vascular malformations. (www.wikipedia.org)
Traumatic spinal cord injury is classified into five categories by the American Spinal Injury Association and the International Spinal Cord Injury Classification System:

• A = Complete lesion
• B = Incomplete lesion: sensory but not motor function below the neurological level.
• C = Incomplete lesion: sensory and motor function below the neurological level, with more than half of the key muscles below the neurological level able to be moved actively over full range of motion .
• D = Incomplete lesion: sensory and motor function below the neurological level, with more than half of the key muscles below the neurological level able to be moved actively over full range of motion against gravity.
• E = Normal: motor and sensory scores are normal.
  (http://www.asia-spinalinjury.org/publications/2006_Classif_worksheet.pdf)

The focus for spinal cord injury rehabilitation is to help the individual reach the highest level of independence possible. The exact nature of treatment depends on the classification of the individual’s SCI and their own needs. Most SCI rehabilitation programs combine physical therapy with skill-building activities and counselling for social and emotional support. Physical therapy includes exercise programsgeared towards muscle strengthening, while occupational therapy helps to redevelop fine motor skills to assist with coordination and dexterity.

Concerns for exercise
The ability of a patient with SCI to exercise is also very much dependent on their level of SCI according to the international classification system. If they are able to exercise, then this is an ideal way for them to improve their overall health and ability to carry out everyday activities. Most doctors recommend exercise as a way to improve health, but anyone planning to start or change their exercise program should always consult their own medical specialist first. (http://www.spinalcord.uab.edu/show.asp?durki=55969)
In the initial phase of rehabilitation, therapists will usually focus on a program that helps the patient to regain leg and arm strength, as mobility and communication are the two most important areas of function. For some, mobility will only be possible with the assistance of devices such as a walker, leg braces or a wheelchair. Communication skills, such as writing, typing or using the telephone may also require an adaptive device.
One of the main barriers to exercise for patients with SCI is spasticity, where certain muscles continually receive a message to tighten and contract. This can cause stiffness and tightness of the muscles, as well as interfering with gait, movement and sometimes speech. (www.wikipedia.org) Many patients with SCI have spasticity in one or both of their legs, which can affect both their ability to carry out everyday tasks and to exercise

Power Plate and Spinal Cord Injury
Power Plate® equipment is already used as an intervention in Project Walk in the USA and in Standing Start in the UK. Both these projects are focused on helping patients with varying levels of SCI regain as much function as possible. “Standing Start has integrated the Power Plate® machine into their standing program. Exercise on the machine results in the subconscious stimulation of the axons, activating muscles which would otherwise have remained unused.” Standing Start (www.standingstart.org)
Research into the effects of whole body vibration training on patients with SCI, suggest that it can help:

• Increase bone mineral density (Davis et al. 2008 poster presentation)
• Reduce body fat percentage (Davis et al. 2008 poster presentation)
• Improve walking function (Ness et al. 2009)

Anecdotal evidence from those patients with SCI who have used the Power Plate® machine also suggest that it may also be helpful in:

• Reducing spasticity
• Alleviating pain
• Increasing voluntary muscle contraction
• Allowing patients to have better control of the body

The main goal of rehabilitation for patients with SCI is to help improve their quality of life, and the results, both scientific and anecdotal, outlined above have the potential to improve quality of life.
Power Plate® equipment offers some advantages over other training machines. A patient with SCI can use the Power Plate® machine while sitting in his or her wheelchair, and results have been observed in those who have simply rested their feet on the vibrating platform. As and when a patient is able to stand, they can use the handlebars for additional support. The other advantage is that the load on the joints is minimal, as training on the Power Plate® machine increases acceleration, rather than mass (weights), to create the force needed to improve muscle strength.
Another possible advantage of the Power Plate® machine is that the reflexive muscle contractions caused by the external stimulation (the vibrations) activate the muscle spindles, which may help prevent paralysed muscles from atrophy. It is believed that this may also cause a sensory signal to the cortex, which could help patients to regain neurological functioning and motor control. Further research to help understand this effect and its potential to assist with SCI rehabilitation is being conducted.

Recommendations

• Patients with SCI often experience bladder problems, so they should be advised to void their bladder before using the Power Plate® machine.
• Always ensure there is support available in case of loss of balance, and avoid any exercises that may be unsafe if a patient does lose their balance.
• Start with a low intensity workout and progress slowly.
• Ensure the patient is well hydrated before the training session