How soon after a spinal cord injury should occupational therapy begin?

I think occupational therapy, especially in cases of spinal cord injury, should begin immediately. It’s important to have input even in the intensive care unit because there are lots of things that can happen as you’re healing.  In the intensive care unit, the goal is for people to survive, to live, but there are also issues with your skin, with perhaps in the positioning of your arms and your hands. And, if you’re in the ICU a long time, it’s important to have occupational therapy there making sure that certain things are preserved so that you don’t develop contractures, or pressure ulcers, or any other of a number of things that can go wrong. A contracture happens—it’s a tightening of muscles and joints, and the primary cause is because people have lost motion in that joint. There are other more complicated reasons for why those contractures happen. If you can’t move the joint yourself, it’s very important to have someone do that for you, or have your occupational therapist teach you ways that you can still do passive range of motion to those joints on your own to prevent that tightening. It’s very functionally limiting. 

Occupational therapy should begin as soon as possible after a spinal cord injury. Generally once a person has a spinal cord injury, the physician will put in a consult or an order for an occupational therapist to come in and evaluate the person who is newly injured. Those first couple days in the hospital, as an occupational therapist, I’m looking at what this person can functionally do and how much activity they can tolerate. So we’re look at basic things like being able to sit up, getting into a chair, maybe looking at if they can feed themselves. And then once they’re medically stable, we generally recommend, in collaboration with the rest of the team, that they continue on in an intensive therapy program somewhere where they can get an integrative rehab team working with them. From that point, that’s where we get into the nitty-gritty of what we do. We’re really focusing on people’s self-care, what equipment they’re going to need and getting them ready to go back home or into the community.