Immediate (acute) treatment
At the accident scene, emergency personnel will put a rigid collar around the neck and carefully place the person on a rigid backboard to prevent further damage to the spinal cord. Sometimes the person may be sedated to relax and prevent movement. A breathing tube may be inserted if the person has problems breathing and the body isn’t receiving enough oxygen from the lungs.
Immediate treatment at the trauma center may include:
- Realigning the spine using a rigid brace or mechanical force, which is usually done as soon as possible to stabilize the spine and prevent additional damage.
- Surgery to remove any fractured vertebrae, bone fragments, herniated discs, or other objects that are pressing on the spinal column. Spinal decompression surgery to relieve pressure within the spinal column also may be necessary in the days after injury. Results of a neurosurgical study show that, in some cases, earlier surgery is associated with better functional recovery.
Possible Complications of SCI and treatment
- Breathing. About one-third of those with a neck injury will need temporary or permanent help with breathing and may require an inserted artificial breathing tube. Any injury to the spinal cord between the C1-C4 segments (see Appendix) can stop breathing, as the nerves in this region cause the diaphragm to move and the lungs to expand. Special training regarding breathing and swallowing may be needed.
- Pneumonia. Respiratory complications are the leading cause of death in people with SCI, commonly as a result of pneumonia. People who have an inserted breathing tube and are placed on a ventilator to assist with breathing (called intubation) are at increased risk of developing pneumonia. They must be carefully monitored and treated with antibiotics if symptoms of pneumonia appear. Clearing secretions from the throat and preventing food and liquids from being sucked into the lungs (called aspiration) can prevent pneumonia.
- Circulatory problems. Changes in circulation, including blood pressure instability, abnormal heart rhythms (arrhythmias), and blood clots may appear days after the injury. Blood pressure needs to be closely monitored to keep blood and oxygen flowing through the spinal cord tissue. Because the brain’s control of the cardiac nerves can be cut off, the heart can beat at a dangerously slow pace, or it can pound rapidly and irregularly. Changes in the control of blood vessels can cause them to widen and allow blood to pool in the small arteries far away from the heart. People with spinal cord injuries are at increased risk for blood clots due to stagnation of blood flow in the large veins in the legs. Treatment includes anticoagulant drugs and compression stockings to increase blood flow in the lower legs and feet.
- Spasticity and muscle tone. Reflexes may become exaggerated over time, causing muscle spasticity that may require special treatment. Muscles may waste away due to underuse.
- Autonomic dysreflexia. Autonomic dysreflexia is a life-threatening reflex action that primarily affects those with injuries to the neck or upper back. Symptoms may include flushing or sweating, a pounding headache, anxiety, sudden increase in blood pressure, vision changes, or goose bumps on the arms and legs. If possible, the person should be kept in a sitting position, rather than lying flat, to keep blood flowing to the legs and feet and help reduce blood pressure.
- Pressure sores (or pressure ulcers). Pressure sores are areas of skin that have broken down because of continuous pressure on the skin and reduced blood flow to the area. People with paraplegia and tetraplegia are susceptible to pressure sores because they may lose all or part of skin sensations and cannot shift their weight. As a result, individuals must be shifted periodically by a caregiver if they cannot shift positions themselves. Special motorized rotating beds may be used to prevent and treat sores.
- Pain. Some people who have spinal cord nerve damage develop neurogenic pain—pain or an intense burning or stinging sensation that may be constant due to extreme physical sensitivity (called hypersensitivity) in some parts of the body. It can either be spontaneous or triggered by a variety of factors and can occur even in parts of the body that have lost normal sensation. Treatments for chronic pain include medications, acupuncture, spinal or brain electrical stimulation, and surgery. However, none of these treatments are completely effective at relieving neurogenic pain.
- Bladder and bowel problems. Some people may need to use a catheter to empty their bladder or learn ways to empty their bowels. A change in diet may be needed to help with control.
- Sexual function. Depending on the level of injury and recovery from the trauma, sexual function and fertility may be affected. A urologist and other specialists can suggest different options for sexual functioning and health.
- Depression. Many people living with a spinal cord injury may develop depression due to lifestyle changes. Therapy and medicine may help treat depression.
Once someone has survived the injury and begins to cope psychologically and emotionally, the next concern is how to live with disabilities. Doctors are now able to predict with reasonable accuracy the likely long-term outcome of spinal cord injuries. This helps people experiencing SCI set achievable goals for themselves and gives families and loved ones a realistic set of expectations for the future.
Rehabilitation
Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support, as well as to increase independence and quality of life.
A rehabilitation team is usually led by a doctor specializing in physical medicine and rehabilitation (called a physiatrist) and often includes social workers, physical and occupational therapists, recreational therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists, a case worker, and other specialists.
In the initial phase of rehabilitation, therapists emphasize regaining communication skills and leg and arm strength. For some individuals, mobility will only be possible with assistive devices such as a walker, leg braces, or a wheelchair. Communication skills such as writing, typing, and using the telephone may also require adaptive devices for some people with tetraplegia.
- Physical therapy includes exercise programs geared toward strengthening muscles.
- Occupational therapy helps redevelop fine motor skills, particularly those needed to perform activities of daily living such as getting in and out of a bed, self-grooming, eating, and using a toilet. People may learn how to cope with spasticity, autonomic dysreflexia, and neurogenic pain.
- Vocational rehabilitation includes identifying basic work skills and physical and cognitive capabilities to determine the likelihood for employment; identifying potential workplaces and any assistive equipment that will be needed; and arranging for a user-friendly workplace.
- Educational training can help people develop skills for a new line of work that may be less dependent upon physical abilities and more dependent upon computer or communication skills. People with SCI or other disabilities are encouraged to participate in activities that provide a sense of satisfaction and self-esteem, such as educational classes, hobbies, joining special interest groups, and participating in family and community events.
- Recreation therapy encourages people with SCI to participate in sports or activities at their level of mobility, as well as achieve a more balanced and normal lifestyle that provides opportunities for socialization and self-expression.
Adaptive devices also may help people with spinal cord injury to regain independence and improve mobility and quality of life. Such devices may include a wheelchair, electronic stimulators, assisted training with walking, neural prostheses (assistive devices that may stimulate the nerves to restore lost functions), computer adaptations, and other computer-assisted technology.