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Spinal Cord Injury

Effects from Spinal Cord Injury:

The physical and emotional consequences from a spinal cord injury (SCI) can be devastating. Loss of spinal cord function can affect activities that are autonomous (e.g. breathing) as well as thought-driven actions (e.g. driving). Both motor and sensory functions may be lost.

According to the National Spinal Cord Injury Association (NSCIA), not every spinal cord injury results from a motor vehicle accident (42%), violence (24%), falling (22%), or sports (8%). Occasionally SCIs are caused by diseases such as polio. Spinal cord injuries are usually described using the following terms:

• Paraparesis: A slight degree of paralysis affecting the lower extremities
• Paraplegia: Complete paralysis of both lower extremities and usually the lower trunk. The upper extremities are not involved.
• Quadriparesis: Partial paralysis of all four limbs (arms, legs)
• Quadriplegia (or Tetraplegia: Complete paralysis of all four limbs

• Contusions, or bruising of the spinal cord.
• Compression injuries that place pressure on the cord.
• Lacerations or tearing (e.g., from a bullet).
• Central Cord Syndrome.
• Complete severing (rare).

Symptoms

When injury occurs and for a time period following, the spinal cord swells. Loss of function occurs below the level of the injury and may be permanent or temporary. Much depends on the severity of the injury.

Symptoms may include loss of motor function, sensation or proprioception. The nerves responsible for these functions transmit their messages through the muscles, tendons, joints and other organs.

Destruction of sensory nerve fibers may lead to loss of sensation such as touch, pressure, and temperature. Reflexes may become exaggerated, bladder and bowel control may be lost, even the ability to breath normally may be compromised.

Treatment

Treatment begins with the emergency medical personnel who make an initial evaluation and immobilize the patient for transport. Immediate medical care within the first 8 hours following injury is critical to the patient's recovery.
When injury occurs and for a period of time thereafter, the spinal cord responds by swelling. Treatment starts with steroid drugs such as methylprednisolone. These drugs reduce inflammation in the injured area and help to prevent further damage to cellular membranes that can cause nerve death. Sparing nerves from further damage and death is crucial.

Surgery

Depending on the circumstances, when surgery is required, it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. The surgeon decides the procedure that will provide the greatest benefit for the patient.
Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated intervertebral disc, or a hematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.
Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. These procedures correct, join, and solidify the level where a spinal element has been damaged or removed (e.g., intervertebral disc).

Recovery

Once the patient is stabilized, care and treatment focuses on supportive care and rehabilitation. Family members, nurses, or specially trained aids give supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores, and other assistance. Rehabilitation often includes physical therapy, occupational therapy, and counseling for emotional support. Each program is designed to meet the patient's unique needs.
The services may be initially provided while the patient is hospitalized. Following hospitalization, some patient's are admitted to a rehabilitation facility. Other patients can continue rehab on an outpatient basis and/or at home.
A physical therapy (PT) program can facilitate the restoration of muscle strength, flexibility, improve mobility, coordination, and maintain body functions through exercise. Massage, hydrotherapy, and other modalities can relieve pain.
Gait training may be taught to patients with difficulty walking, which could include teaching the patient how to use assistive devices (e.g., walker, cane). Physical therapy benefits the patient be preventing complications from surgery or illness.
Occupational therapy (OT) teaches the patient how to cope with everyday life. OT encourages independence by helping the patient with daily tasks such as dressing, bathing, food preparation, going to the toilet, and other activities of daily living (ADLs).
Speech and language therapy may be included. These skills cross over to the workplace, helping the patient develop their full potential. This might include teaching the patient how to use different muscles to complete tasks such as writing.