Controversies regarding mobilisation and rehabilitation following acute spinal cord injury

Spinal cord injury is a debilitating condition associated with significant physical and emotional burden for the patients and families involved. Despite advances in care of patients following spinal cord injury, rehabilitation following injury remains an underfunded area of research that is in need of significant change. Although bed rest has been suggested to improve spinal cord perfusion after acute cord injury, there is no data to suggest that long periods of bed rest following spinal cord injury (in the absence of haemodynamic or biomechanical instability) leads to better outcome. Despite paucity of evidence, prolonged flat bed rest is still practiced in many spinal cord injury rehabilitation units across United Kingdom with no consensus on timing of mobilisation. Here we review some of the controversies on mobilisation and rehabilitation following spinal cord injury with the aim to emphasise on the benefits of early mobilisation following spinal cord injury and to challenge the old practice of long periods of flat bed rest.