Spinal Cord Injury
Spinal cord injury is a sudden, life changing event that often transforms a healthy individual into someone unable to move or function independently. According to the National Spinal Cord Injury Statistical Center, there are approximately 12,000 new SCI cases each year in the U.S. These injuries are very complex and tenuous due to the injured person’s highly fragile condition. They typically involve multiple body systems and require a great deal of expertise to manage toward an optimal outcome.
The spinal cord is a bundle of nerves that carries information from the brain to the rest of the body. Damage to the spinal cord can occur by such mechanisms as compression, stretch, crush or contusion, and can result in any severity of neurological deficit from total (complete) to subtotal (incomplete). In both instances, spinal cord injury can cause paralysis, sensory loss and bladder and bowel dysfunction, and affect virtually every organ in the body including skin, respiratory, cardiovascular, gastrointestinal, urinary, metabolic and hormonal systems among others.
Treatment and Complications
Primary spinal cord damage is the effect of trauma on the spinal cord, potentially resulting in immediate paralysis. Secondary damage is a very complex, progressive mechanism of spinal cord injury that evolves over the next two days and includes programmed cell death (also called apoptosis). Early treatment in the secondary injury phase can result in less or limited cord damage. In fact, with vigilant therapy, approximately 10% of initially complete cord injuries experience recovery of some lower extremity movement. Whether this additional recovery is enough to contribute to functional improvement takes time to manifest.
Because spinal cord injury cases result in an altered physiologic state typically involving multiple body systems (e.g. spine, respiratory, skin, bladder, bowel, autonomic instability, malnutrition, etc.), they require ongoing management and care protocol surveillance for the best possible medical outcomes. Complications may include neurogenic shock, bradycardia, pressure ulcers, various infections, malnutrition, and an inability to wean from a ventilator.
Properly preventing risks and managing medical complications will require treatments in a variety of settings, including:
- Emergency response team (medical, transportation, etc.)
- Emergency trauma unit (surgeries, medications, anesthesia, etc.)
- Intensive care unit (medical, specialists, pharmaceuticals, etc.)
- Inpatient rehabilitation (for acute and post-acute needs)
- Outpatient rehabilitation, medical care and life-time follow up
- Assisted living or outpatient services in the home
The goals of rehabilitation are to increase the injured worker’s level of function for everyday tasks such dressing, bathing, use of a wheelchair and accessing the community, or to teach the person what care is needed and how to direct that care from others. Living and aging with spinal cord injury poses numerous lifelong physical, medical and psychosocial challenges that evolve over time. The journal Spinal Cord reported in 2006 that 62% of patients with work-related tetraplegia required rehospitalization. Since many of the causes for rehospitalization are preventable, it is very important to establish an appropriate, long-term care configuration to reduce the risk of complications.