power in partially paralyzed muscles and are therefore important in preventing certain SCI impairments from progressing to functional limitations. In addition, recent studies (Ditunno et al., 1987, 1989a, 1989b) have shown sufficient recovery of motor power in the arms of quadriplegic patients to enable significant improvement in function during rehabilitation and at the time of one-year follow-up.
Recently reported research (Bracken et al., 1990) has demonstrated that treatment with methylprednisolone within 8 hours of spinal cord injury significantly improved the recovery of motor and sensory function. Because most people with acute SCI are admitted to a hospital within the critical 8-hour period, this intervention has great potential for reducing disabling conditions. The study, however, did not measure functional improvement.
Improved cardiovascular conditioning of paraplegic individuals is an important part of rehabilitation and can be achieved through aerobic exercises, especially in young people. Such conditioning enables many to participate in wheelchair sports and to walk in braces with crutches.
Functional electrical stimulation (FES) has been promoted as having several potential applications. These include increasing strength and endurance and preventing osteoporosis in paraplegic and quadriplegic individuals, although these claims have not been evaluated rigorously (Ragnarsson et al., 1988). Another application of FES is in implantable electrodes to enable upper extremity grasping and thus self-feeding by persons with high-level quadriplegia (Peckham et al., 1986). Applications of FES in ambulation (Marsolais and Kobetic, 1988) and prevention of pressure sores (Davidoff et al., 1988) show early promise but require further development and evaluation.
Individuals with complete paralysis of leg muscles can learn to get in and out of bed, bathe, dress, use the toilet, and dress without assistance by learning certain skillful maneuvers and using adaptive equipment. A high level of independence can be achieved with the aid of adaptive equipment and training in feeding, dressing, bathing, using a wheelchair, and driving a car. Even people with paralysis in all limbs can reduce dependency through the use of technology that permits such individuals to unlock doors, turn on lights, and operate a phone or a computer. The opportunity for enhancing functional capacity and independence in people with paralysis is great, meriting an expanded research and development effort on new assistive technologies.
Educational programs that help individuals perform self-care activities are an integral part of the rehabilitation process, which begins in the acute phase of injury and continues throughout the life course. Modification of procedures, tasks, and schedules according to the needs of the individual facilitates functioning on the job and in other social contexts. Eventually, these modifications should become the exclusive responsibility of the person with the potentially disabling condition. Another example is learning to