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Spinal Cord Injuries

Any mechanism that causes injury or damage to the vertebral column or the bones of the spine can result in damage to the spinal cord. Think of the spinal cord as an electrical or telephone cable composed of millions of wires, or nerves. The nerves carry the messages between the brain and the muscles, skin and joints of the arms, legs and trunk. If the nerves or wires are disrupted, there is reduced, or no communication, between the brain and the body below the level of the interruption or injury. This results in no/poor movement, and no/poor feeling in the trunk and limbs below the level of the injury i.e: paralysis.
Causes
Damage to the spinal cord is either caused by trauma eg; motor vehicle accident, a fall, a gunshot wound; or by non-traumatic causes eg: a tumour, illness, disc herniation, or vascular problems.
Types of spinal cord injury
Incomplete

This is when only part of the spinal cord is injured. This is when some of the messages for moving and feeling can still be passed between the brain and the limbs, but not all of them. The person will have some movement and feeling below the level of their injury. The number of nerves that are damaged will depend on the person’s injury and the damage caused at the time of the accident/or the disease process, and is different for everyone.

People who have damaged their spinal cords can be broadly divided into two categories – quadriplegia/tetraplegia and paraplegia.

Tetraplegia / Quadriplegia

Tetraplegia occurs because of a spinal cord injury, in the neck region (C1 – T1). Such an injury to the spinal cord disrupts the messages that are transmitted between the brain and all four of the limbs and thus the person will have difficulty moving all four of their limbs (arms and legs).

The trunk muscles help a person to move and balance, and to breathe and cough, so if they are paralysed, a person may find that they are breathless and cannot cough properly. A Physiotherapist, and the Nursing staff, will assist with coughing and clearing the chest.

Paraplegia

Paraplegia occurs when the spinal cord is damaged in the thoracic, lumbar or even sacral regions of the spine. People with paraplegia can use their arms normally, but their trunk and legs are affected. A person with a low paraplegia will be able to move and feel their trunk, but their legs will still be affected/paralysed.

The effects of SCI on the Body

  • paralysis (loss of movement) below the level of the injury
  • loss of feeling below the level including the ability to:
    • feel touch on the skin
    • feel painful sensations
    • tell the difference between hot and cold
    • know what body parts are doing and what position they are in without looking at them (called proprioception)
  • altered bladder and bowel function
  • altered sexual function
  • fertility may be affected (in males)

Depending on the level of injury:

  • temperature control and sweating may be altered
  • breathing may be affected
  • blood pressure and circulation may be altered
  • autonomic dysreflexia may occur

Often people with tetraplegia and high paraplegia, develop stiffness in certain muscles and involuntary movements (spasms). These movements are caused by the damage to the spinal cord and cannot be controlled by the individual. The therapists and nursing staff are aware of these issues, and will work with the patient and the doctor to overcome these challenges.

Possible complications
Spinal Cord Injury not only causes major trauma to your spinal cord but also affects the way the whole body functions. Other injuries can also complicate the problems. Because of this, the period after the injury is very important and there are many things that must be done after the injury to ensure that you do not develop other complications.

Some of these include:

  • Regular blood tests to check your blood count and blood chemistry.
  • X-rays of the fracture, chest and other injuries.
  • Skin: Special care must be taken of the skin because of loss of feeling, especially when you are in bed. Initially you shall need to be turned every 2-3 hours to prevent pressure sores.
  • Joints: If you are not able to move your limbs they can become stiff and could eventually freeze in one position (a contracture). You will be taught to move your joints regularly to prevent this from happening.
  • Circulation: Inability to move your limbs also means that the blood does not circulate as well as usual. This can lead to blood clots in the legs called Deep Vein Thrombosis or DVT. This can cause swelling and discomfort in the leg. The Physiotherapist will also help to prevent this. You will also receive medication to help prevent blood clots.
  • Breathing and chest: The ability to breathe may also be affected after spinal cord injuries. This applies to all people with injuries above T12 due to paralysis of the abdominal (stomach) and intercostal (between the ribs) muscles. The higher the injury above T12 the more severe the breathing difficulty will be. Your ability to cough adequately may also be affected. Your Physiotherapist will assist you with this.
  • Bladder: All activity in the bladder stops during the “spinal shock” phase of SCI and the bladder will not empty by itself. To allow the bladder to drain, an Indwelling Catheter (IDC) is put into the bladder. This will remain in place until further investigation of the bladder can occur from 6 weeks after your injury·
  • Bowel: The activity in the lower bowel and rectum may also be affected immediately after the injury. This means that you will need tablets, suppositories or an enema to help your bowel to work. The nurses will help you with this in bed as you will be restricted to the bed initially.
Rehabilitation
Rehabilitation is a very important part of your recovery. It is, however, important to know that changes and improvements in function will not happen all at once. Rehabilitation is a lifelong process…it does not end when you leave the rehabilitation facility. To master your life after a spinal cord injury, you will need courage, commitment, and be willing to be challenged. It is important to stay motivated and positive. Never give up! Celebrate your achievements along the way, no matter how small you think they are – every goal achieved is a step in the right direction.

The rehabilitation process starts in hospital. This is the most crucial time where you learn how to cope with various aspects of your injury. The team in the rehabilitation facility will assist you.

Rehabilitation is aimed at helping people with spinal cord damage to become as independent as possible.

Weak muscles will be strengthened, paralysed limbs will be moved on a regular basis to prevent stiffness and joint contractures.

Balance will be re-trained and exercise endurance will be improved.

Splints and other assistive devices that help perform activities will be trialed, as will various wheelchairs, including power (electrical) wheelchairs.

Equipment recommendations will be discussed with the individual and their family, and the agreed- upon equipment will then be ordered from the appropriate supplier.

Whatever level of recovery you make, you are surrounded by a team of knowledgeable and caring professionals who will help you make the changes you’ll need to return to a more normal daily routine.

What about recovery?
It is impossible to predict how many nerves will/will not recover, and how severe the remaining paralysis will be. There are no special investigations or tests that can be done to predict, with certainty, if you will have neural recovery or not. We take each day as it comes, and work hard to provide an environment that facilitates/promotes neural recovery. You need to learn to work with what you have, and learn to compensate, where possible, for muscles that are not working.

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