ENAfter a spinal injury or spinal cord surgery, the next step is rehabilitation in a specialist centre, yet the family is left with one question: what happens next? Doctors speak carefully, nobody names a timeline, and the weeks pass.
Paraplegia rehabilitation in Germany takes place in spinal cord injury centres. This page covers how they work, what is trained, who looks after bladder and skin, and when travelling makes sense. Put plainly, nobody promises that walking will return; the aim is as much independence as possible. See also rehabilitation in Germany.
What paraplegia is, and what rehabilitation really changes
Paraplegia is paralysis of the legs and part of the trunk caused by damage to the spinal cord in the thoracic or lumbar region; rehabilitation decides how independently a person lives with it. Unlike tetraplegia, which also affects the arms, it leaves the arms strong, and independence is built on them.
Doctors distinguish complete injuries, with no movement or sensation below the damage, from incomplete ones, where some signals get through and more may return; the plan follows from this. Most recovery happens in the first months, so rehabilitation starts once the patient is stable, not “once it has healed”. The World Health Organization calls timely rehabilitation essential for restoring function.
A result is what changes daily life: moving from bed to wheelchair unaided, managing bladder and bowel, returning to study or work. Whether and when someone will take steps again, nobody can say in advance.
How a German spinal cord injury centre works
In Germany, people with spinal cord injuries are usually treated not on a general ward but in a specialist centre with one team: spine surgeon, neuro-urologist, physiotherapist, occupational therapist, psychologist and specially trained nurses. This field, paraplegiology, is a medical specialisation of its own. General principles are covered under neurological rehabilitation in Germany.
One example is the Centre for Spinal Cord Injury at the Werner Wicker Clinic in Bad Wildungen. Paraplegiology, the treatment of spinal cord injuries, is led there by Dr Axel Hempfing and neuro-urology by Dr Marcus Nehiba, both head physicians. Heidelberg University Hospital has a Centre for Orthopaedics, Trauma Surgery and Paraplegiology with its own paraplegiology clinic. More centres are listed under rehabilitation clinics in Germany.
A day is a full timetable, not one procedure: several therapy sessions, gym work, self-care lessons. Goals are set with the patient and reviewed by the team regularly. A course is counted in weeks and refined as it goes.
What is actually trained
Training starts with what independence depends on: tolerating being upright, transferring, handling a wheelchair. After long bed rest, blood pressure drops on sitting up, so sitting and standing are reintroduced gradually on a tilt table or standing frame. Arm and shoulder strength is built alongside: every transfer needs it.
Transfers are learned step by step: bed to wheelchair, into a car, into the shower. Wheelchair skills are practised outdoors too, on uneven ground, kerbs and steps. Chair and cushion are fitted to the person, not taken from stock; the right cushion also protects the skin.
Extras are added as needed: gait training with body-weight support or an exoskeleton, electrical muscle stimulation, treatment of pain and spasticity (involuntary muscle tightening). The occupational therapist selects home aids and trains the family to use them. Robotic trainers are a tool, not a guarantee: their benefit for walking depends on whether signals still pass below the injury.
Bladder, bowel and skin — the things patients ask about least
After a spinal cord injury the bladder stops obeying, and the goal is not comfort but protecting the kidneys from retained urine and high pressure. In German centres a dedicated neuro-urologist runs urodynamic tests, showing how the bladder fills and empties, and sets a catheterisation routine with a thin tube at fixed times. At the Werner Wicker Clinic this is led by urologist Dr Marcus Nehiba, whose department specialises in diagnosing and treating neurogenic, nerve-related bladder dysfunction. See also urinary incontinence treatment in Germany.
The bowel is managed by routine: emptying at a regular time, suitable food and fluids, family training. Pressure sores are far easier to prevent than to treat: below the injury a person cannot feel prolonged pressure, and a neglected wound may need surgery. Prevention is daily: changing position, the right cushion, checking the skin.
The psychologist is part of the programme, not a pleasant extra: accepting what happened can be harder than learning to transfer, and many centres arrange meetings with people long used to living with such an injury. The companion is trained too: the patient goes home, not to a clinic.
Frequently asked questions
Will a person with paraplegia walk again?
That depends on whether the injury is complete or incomplete. With an incomplete injury some movement often returns, and some patients walk again, with or without support. After a complete injury walking usually does not return, and the programme aims at an independent life in a wheelchair. The first months tell doctors more.
Is rehabilitation worthwhile years after the injury?
Yes, a course can still help years later, though its goals differ. Heidelberg’s paraplegiology clinic, for example, also admits patients with long-standing injuries to rebuild fitness and tackle problems such as pressure sores, bladder trouble, pain or spasticity. It advises its patients to have a check-up once a year.
When can a patient travel to Germany for rehabilitation?
A patient can travel once the condition is stable and the centre’s doctor has reviewed the reports and images and agreed to the admission. Nobody needs to wait until the patient can sit: they can travel lying down with a medical escort. Starting early makes the best use of the crucial first months.
How AlenMed arranges rehabilitation
AlenMed first chooses the centre by level of injury, present condition and whether neuro-urology or repeat spinal surgery is also needed. The company has 86 partner hospitals in 38 cities and 345 doctors, with its office in Munich. From reports, images and current findings we prepare a request; the centre replies whether it takes the patient and with what programme.
We translate records, agree the date, help with the visa invitation, arrange transport for a patient who cannot sit up and a place for the companion, and provide a medical interpreter. The estimate and invoice come from the clinic itself; on costs, see cost of neurological rehabilitation in Germany.
This material is for information only and is not an offer: the programme and its length are set by the centre’s doctor after an in-person examination.