Just near the space being used by the woman learning to walk again, inside the building of Spinal Injury Rehabilitation Centre, in Sanga, Kavre, is a lean, wiry man who is learning to get more comfortable with his new wheelchair. The man feels no sensations below his feet and he will have to learn to depend on the wheelchair to get around from now on. Even if he tries, he will probably not be able to walk again.

By the first week of June the centre was already working with 120 such patients, most of whom had suffered spinal injuries during the recent quakes. The spinal cord is a long connecting wire that is encased inside the rugged bony structures of the vertebral column and it helps transmit messages from the brain to the muscles and nerves in the body. It is because of this soft, squelchy material that we can sense and differentiate heat from cold and help the body react instantly to various stimuli, through movements called reflex actions. When the spinal cord is crushed by heavy objects, (falling debris chunks in the case of earthquakes) the pressure on the cord can rupture it and render it unable to signal information to the muscles and nerves. Spinal injuries can thus affect a whole host of muscular and nerve functions in the human body.

Most earthquake victims with spinal injuries suffer either an ‘incomplete’ or ‘complete’ injury of the spine. For people with an incomplete injury, therapy regimens ensure that they regain their normal body functioning, as with the woman taking baby steps, mentioned earlier; for those who have suffered complete injuries, the patients, such as the man in the wheelchair, have to be taught to not exacerbate their injury, and with the help of assistive equipment such as wheelchairs, gain some measure of mobility. At the Spinal Injury Rehabilitation Centre, the patients will have to learn these new ways of getting around, mostly over the course of three to six months.

Sashi Shrestha is a physiotherapist at the centre and she works with many spinal injury patients every day. Shrestha says she has seen all levels of injury at the centre—from people who are able to move only their heads and have lost mobility in the rest of their body to those who cannot move either the upper or lower regions of their body.

 “For patients with incomplete injuries, we primarily help them recover the strength of the limbs,” says Shrestha. The movements they work with include passive movements and stretching and other procedures that patients here are asked to work through each day. “For those with complete injuries, we try to figure out new ways for them to conduct their daily tasks. For example, if someone has completely lost the use of his legs, we focus on strengthening their arms and muscle groups in other parts of the body.”

The ground floor of the centre’s building houses a spacious room in which these exercises are conducted. Although no visible demarcation has been made, most of the space in this room constitutes the physiotherapy section, while the rest of the space is used by the occupational therapists. The physiotherapists help the patients regain body strength, while the occupational therapists teach the patients how to perform basic everyday tasks such as brushing their teeth, combing their hair and feeding themselves through muscle movements that they can still produce despite their injury.

Biraj Bhatta, 19, of Fipuri-8 in Nuwakot, was buried in the rubble of his house after the April 25 quake. The whole house collapsed instantly over him, crushing his spine. He faintly remembers how he tried to move his legs after he had been taken to Bir Hospital but it came to no avail. He hoped they would get back to normal again, but after weeks without seeing any improvement, he resigned himself to his fate. After a spinal surgery, he was brought to the rehabilitation centre.

After undergoing an initial assessment, the physiotherapists started working with him. In accordance with the regimen prescribed, a therapist asks him to clench his fists, lift his arms and push against the therapist’s palms with his fists. The therapist then slowly pushes Bhatta’s hands to the sides of his chest, one at a time, and asks him to push it forward. This to-and-fro motion continues for a while. He then asks Bhatta to keep his arms up but relaxed, and asks him to try to sit. What looks like a straightforward process for a normal person makes for a complex and difficult task for the injured such as Bhatta: the physiotherapists take them through the new techniques they need to learn again to move their hands to perform the simplest tasks and to use their legs to support their bodies.

Depending on the muscle groups that have been affected by the spinal injury, the therapists prescribe different exercise regimens.  Sulekha Patel, 30, from Rautahat, who suffered a spinal injury when her house collapsed on her, is being made to work with dumbbells. The injury she suffered affected her upper arm movement and her regimen comprises standing in front of a mirror, maintaining form, slowly raising dumbbells with both her hands and keeping them aloft in order to work her biceps’ muscles.

In the recent quakes, thousands of Nepalis have suffered spinal injuries. The 51-bed Spinal Injury Centre is making arrangements to provide care for at least 200 of those patients. Deepesh Pradhan, the administrative director of the centre, says that post-quake care for most patients is all about rehabilitation of the sort carried out at the centre, but because many of the poorer patient families are afraid to invest in long-term therapy, they are still languishing in despair in their homes.  “The centre provides free care right now, but the government needs to help subsidise costs for many of the poorer patients in the long run, and they need to come to centres such as ours, where we will teach them how to live fruitful lives, even with disability,” says Pradhan.