Physiotherapy management of T12 incomplete cord injury

S. Hariharan*

Physiotherapist, Kauvery Rehabilitation Centre, Trichy, Tamil Nadu

*Correspondence

Abstract

This case presentation describes the physiotherapy management of a 51-year-old male with a T12 incomplete cord injury following a domestic fall. The patient presented with bilateral lower-limb weakness, impaired sensation below T12, poor sitting and standing balance, difficulty with activities of daily living, and inability to stand or ambulate independently. At admission, the patient was classified as ASIA Grade C. Physiotherapy management focused on maintaining joint range and muscle properties, improving muscle strength, trunk and sitting balance, lower-limb weight bearing, standing stability, transfers, and functional ambulation. Treatment included active exercises, stretching, strengthening with dumbbells and weight cuffs, weight-bearing exercises, high sitting, trunk mobility exercises, therapeutic standing, suspension-based training, and progressive ambulation with walker support. On reassessment, improvement was noted in upper- and lower-limb muscle power, sitting and standing balance, transfers, and functional gait. The patient’s high sitting and long sitting balance progressed from poor to good, standing balance progressed from poor to fair, and gait progressed from non-ambulatory status to ambulation with walker support. ASIA pre- and post-treatment values will be added after final data collection.

Key words: ASIA Grade C; Spinal cord injury (SCI); Physiotherapy management

Introduction

Spinal cord injury (SCI) can result in motor, sensory, balance, mobility, and functional limitations depending on the level and completeness of the lesion. Incomplete thoracic cord injury may preserve some motor or sensory function below the neurological level while still causing significant impairment in lower-limb control and functional mobility. Early and progressive physiotherapy is important to maintain musculoskeletal function, develop postural control, improve strength, facilitate weight bearing, and progress functional mobility. This case presents a rehabilitation approach for a patient with T12 incomplete cord injury who initially had poor sitting and standing balance and was unable to ambulate, followed by progression to walker-assisted ambulation.

Study Design: Single-case descriptive case study / case report with pre-treatment and post-treatment assessment.

Study Setting: The patient was admitted to Kauvery Hospital and subsequently received physiotherapy rehabilitation at the rehabilitation unit. Initial assessment was performed on 21-04-2026 following admission on 20-04-2026.

Patient Profile

Age / Sex	51 years / Male
Diagnosis	T12 Incomplete Cord Injury
ASIA Classification	Grade C at admission
Chief functional problems	Unable to sit independently, unable to stand, difficulty in ADL, difficulty moving both legs
Sensation	Impaired below T12
Balance at admission	High sitting – Poor; Long sitting – Poor; Standing – Poor
Gait at admission	Not applicable / non-ambulatory
Associated conditions	Hypertension, Diabetes Mellitus
Tightness	Bilateral hamstring tightness

Outcome Measures

ASIA / ISNCSCI neurological assessment – used to document neurological status and grade of spinal cord injury.
Manual Muscle Testing (MRC scale) – used to document changes in muscle strength of the upper and lower limbs.
Functional balance assessment – high sitting, long sitting, and standing balance were clinically graded.
Functional mobility – transfer ability and gait status with/without assistive support were documented.

Note: The final ASIA pre-test and post-test numerical data will be inserted after the data are provided.

Treatment Techniques

Active exercises	Active limb exercises were encouraged and progressed according to the patient's tolerance.
Stretching	Bilateral lower-limb stretching, particularly hamstring stretching, was used to reduce stiffness and maintain flexibility.
Strengthening exercises	Upper- and lower-limb strengthening was performed using dumbbells and weight cuffs to improve muscle power.
Weight-bearing exercises	Progressive weight bearing was used to improve hip, trunk, and lower-limb stability.
Sitting and trunk training	High sitting and trunk mobility exercises were used to improve postural control and sitting balance.
Therapeutic standing and gait training	Standing was progressed for knee stability, followed by ambulation using walker support and manual assistance.

Procedure

Initial assessment: neurological status, ASIA grade, sensation, range of motion, muscle strength, tightness, balance, transfers, and gait status were documented.
The initial treatment phase emphasized active exercises, stretching, and maintenance of joint range and muscle properties.
Strengthening was progressed using dumbbells and weight cuffs for the upper and lower limbs.
High sitting and trunk mobility exercises were introduced to improve sitting balance and trunk stability.
Progressive weight-bearing activities were performed to improve hip and trunk stability.
Therapeutic standing was introduced to improve lower-limb and knee stability.
The patient was progressed to ambulation using walker support with manual assistance as required.
Post-treatment reassessment documented changes in muscle power, balance, transfers, and gait.

Data Analysis

Pre-test and post-test ASIA/ISNCSCI scores will be entered after the final data are supplied. For this single-case presentation, descriptive comparison of pre- and post-treatment values will be used. The change score will be calculated as: Post-test score − pre-test score. Percentage change may be reported where appropriate.

ASIA Measure	Pre-test	Post-test
Motor score	UEMS -26 & LEMS-20	UEMS -40 & LEMS-30
Sensory score	LT -92 & PP -92	LT -96 & PP -96
Neurological/ASIA grade	C	D

Pre-test vs Post-test Bar Graph

Results / Clinical Outcome

The available case data show functional improvement following rehabilitation. Muscle power improved from approximately 3/5 to 4/5 in the upper limbs; hip strength improved from 2+/5 to 3/5; knee strength improved from 3−/5 to 4/5; and ankle strength improved from 3/5 to approximately 4/5. High sitting and long sitting balance improved from poor to good, while standing balance improved from poor to fair. Transfer ability improved from poor to good, and gait progressed from non-ambulatory status to ambulation with walker support.

Conclusion

A structured, progressive physiotherapy programme consisting of active exercise, stretching, strengthening, weight bearing, trunk and sitting balance training, therapeutic standing, and gait training was associated with meaningful functional improvement in this patient with T12 incomplete cord injury. The case demonstrates the importance of progressive rehabilitation aimed at strength, postural control, transfers, weight acceptance, and functional ambulation. Final ASIA pre- and post-treatment data should be added before presentation to quantify neurological change.

References

American Spinal Injury Association. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). ASIA/ISNCSCI reference materials.
Kirshblum SC, Burns SP, Biering-Sørensen F, et al. International standards for neurological classification of spinal cord injury (revised 2019). Journal of Spinal Cord Medicine. 2019.
Somers MF. Spinal Cord Injury: Functional Rehabilitation. 3rd ed. Pearson.
Harvey LA. Physiotherapy rehabilitation for people with spinal cord injuries. Journal of Physiotherapy.

Physiotherapy management of T12 incomplete cord injury

Physiotherapy management of T12 incomplete cord injury

S. Hariharan*

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