Other Conditions Related to Spinal Cord Injury
The story of a typical patient with spinal cord injury (SCI) starts this way: “He was in a car accident and broke his neck, so now he is paralyzed from the neck-down.” Yet what most people do not realize is that there is more to SCI than being unable to move. As the spinal cord is the main highway through which the brain communicates with the rest of the body, other body systems are affected as well.
Skin, Sensation and Pressure
An SCI can render a person unable to sense deep pressure, pain or light touch. Coupled with the inability to move his muscles, this makes the person with SCI prone to skin breakdown and the formation of pressure ulcers. Wheelchairs with special cushions that distribute pressure more evenly may also be used in order to prevent skin breakdown. If possible, the individual with SCI should also taught to perform pressure-relief techniques like leaning forward while in the chair or shifting weight from side to side.
Bowel and Bladder
Control of bowel movements and urination can be a major issue in individuals with SCI. Some people fortunately regain full control of these body functions while others do not, and have to rely on medication or physical means of emptying the bowel and urinary bladder. Persons without full control of bowel movements usually start a bowel program during their inpatient rehabilitation stay. The goal of the bowel program is to have a consistent, predictable bowel movement daily or every other day so that the individual can go on with the rest of his or her day without having to worry about incontinence (“bowel accidents”). In the same way, the goal of a bladder management program is to avoid incontinence and have predictable times of emptying the urinary bladder. Some people opt for an indwelling catheter, permanently connected to their body, while others prefer intermittent catheterization, in which the catheter is placed in and taken out of the bladder several times during the day in order to eliminate the urine. Still others prefer surgical modification order to make it easier to void or perform catheterization. A person with SCI is also prone to vesicoureteral reflux (reverse flow of urine from the bladder to the kidneys), and should be seen at least yearly by a urologist to monitor the bladder function.
People with tetraplegia (injuries to the cervical portion of the spinal cord) also have respiratory problems. The chest wall and abdominal muscles used for breathing are effectively disconnected with the brain and spinal cord centers that move them. They are unable to take deep breaths or produce an effective cough, making them prone to pneumonia. Respiratory compensatory strategies such as assisted coughing may be used. More severe injuries may require the use of a mechanical ventilator. In some cases individuals with tetraplegia can use a portable mechanical ventilator which allows them to travel around the home and even outside in the community.
Spasticity (Muscle Stiffness)
Increased muscle tone or spasticity is also common among persons with SCI. Any injury to the brain or spinal cord can cause muscles to tighten and contract. These muscles are unable to provide feedback and regulate themselves (i.e., to adjust the tone to “normal”), causing them to permanently stay in a contracted state. This translates into the person’s inability to move his joints through the entire range of motion, interfering with gait, movement and sometimes speech. Treatments for spasticity include stretching, modalities (heat or ice), and oral medications. In more severe cases, the medication Lioresal (Baclofen) can also be administered within the spinal canal through an implanted pump, which delivers a small amount of the medication over several months. Botulinum toxin, a muscle relaxer, can also be injected directly into the muscle. Phenol, on the other hand, can be injected into individual nerves in order to relax the muscles affected by these nerves.
Autonomic Dysreflexia: an Emergency Condition
The autonomic nervous system is the part of the nervous system regulating blood pressure, breathing, heart rate and other bodily functions we do not consciously think of. As the spinal cord plays a part in transmitting neural signals for these functions, individuals with SCI whose injuries are at the cervical and upper thoracic levels are prone to a condition called autonomic dysreflexia (AD). AD is a potentially life-threatening condition little known outside the community of SCI patients and healthcare professionals familiar with SCI. Persons with AD should be treated emergently as sudden increases and blood pressure, causing a stroke, seizures or even death. The sudden increase in blood pressure coupled with a slow heart rate is caused by an irritating or noxious stimulus below the level of the SCI, such as an overfull bladder, impacted stool, pressure sore or even an ingrown toenail. Other symptoms may include flushing, profuse sweating, red blotches on the skin and restlessness. Recognizing the symptoms, treating and preventing autonomic dysreflexia are important in keeping the person with SCI healthy.
People with SCI are said to undergo an “accelerated aging”, as even chronologically young adults with SCI can exhibit diseases associated with advanced age such as osteoporosis, cardiac disease, increased cholesterol levels and diabetes. Monitoring for these conditions should be done periodically and vigilantly by a primary care physician.
There is more to having an SCI than the loss of movement. It also involves the different aspects of a person’s health, including skin integrity, bowel and bladder management, respiratory problems and monitoring for other medical complications. While there are healthcare professionals who can keep an eye on these issues, the empowered, educated patient is best advocate for his own health and quality of life.