Spinal Cord Injury – Early days
For the first few weeks after a spinal cord injury no-one can really tell how severe the injury is going to be. The difficulty is that something called spinal shock develops immediately after a spinal injury. This involves all nervous system communication between the spinal cord and the rest of the body, temporarily shutting off below the level of the injury.
Some patients may recover a lot of sensation and movement when the spinal shock phase ends, others may not. There are no tests that can be done during the spinal shock phase to predict the degree of recovery. So, if you are getting frustrated by the inability of doctors or nurses to give you straight answers to some of your questions, please try to understand that they are genuinely unable to give definite information at this early stage. They don’t want to make you too optimistic about the future but, at the same time, they don’t want you to give up hope.
Once the spinal shock phase is over, the true extent of the injury can be assessed and future abilities can start to be predicted more reliably. Careful assessment of the remaining movement and sensation around the body is needed to determine the likely outcome of SCI in a particular individual.
For high level SCI, meaning injury to the neck or upper back, the effects are always likely to be more serious than with lower level injuries, regardless of how extensive the actual damage is. It’s very likely, for example, that the arms, as well as the legs, will be affected. However, people may regain some sensation or movement in their legs and arms, if their spinal cord has only been partially (incompletely) damaged. Some higher level injuries will require assistance with breathing.
With lower level injuries, meaning injury to the chest and lower back, the legs but not the arms, will be affected. Again, people may regain some sensation or movement in their legs, depending on the completeness of their injury. Retaining full use of the hands and arms makes it much easier to manage the everyday tasks involved in daily life. As such, many of the individuals affected will be able to lead an independent life once they have completed the healing and rehabilitation phases.
Aside from the most obvious effects of SCI – the reduced ability to move and feel things below the level of injury – there are a range of additional complications that a person with SCI can expect to face. Perhaps one of the most difficult to come to terms with is reduced ability to control the bowel and bladder function. During the initial spinal shock phase, this control may be totally lost. Over the next few weeks or months, various degrees of control may return, according to the level and severity of the injury. With the right training and good motivation, new routines for dealing with these essential functions can be learned and put into practice. People with lower level injuries or incomplete injuries may retain enough sensation and mobility to completely manage these routines by themselves, while for those whose hand and arm function remains limited or absent, a carer may have to assist with or carry out these routines.
Rehabilitation
Rehabilitation is a continuous process that begins as soon as possible after the injury. The aim is to restore as much long-term independence as possible. A wide range of activities are involved in the rehabilitation process. These may involve medical and nursing staff preventing long-term complications, and physiotherapists and occupational therapists developing personalised exercise programmes, functional training and the supply and fitting of any personal aids that may be found to be useful.
Active and passive movement programmes are started as soon as possible after the injury, to avoid the development of stiffness in limbs and joints that could limit the future ability to perform basic but important tasks, like eating, washing, dressing and transfers from bed to wheelchair. As the rehabilitation process continues, every person with SCI will be shown techniques and activities specific to their own abilities, to help them manage better the tasks they will need to be able to carry out their daily lives.
With any level of injury, whichever muscles are still working, however weakly, increasing their strength through exercise programmes will go a long way towards achieving independent living. At first, the pain from the initial injury may limit activity, but as the initial healing phase continues, the individual’s ability to exercise should noticeably improve.
Restoring independence to a person with SCI in this way, encourages the development of an active social life and helps to promote a positive attitude to life. This benefits not only the individual affected but also the members of his or her social circle, including family, friends, colleagues and the healthcare professionals who continue to be involved in their lives
Your Role
Whatever the injury, every individual with an SCI will make progress afterwards. How much progress depends upon them and those around them, as much as it does on the injury. Even if someone loses the ability to walk, they still have the ability to think, to plan, to care, to love, to have fun, to work and to want the best out of life. Improvements in technology mean that more and more opportunities are opening up to people with SCI and most people with SCI go on to lead rewarding and active lives.
Supportive family and friends can make a real difference, especially if they can take an active part in therapy programmes. Families and friends must try to remain supportive throughout the difficult months or even years after the injury, as their loved ones go through the various stages involved in coming to terms with their new situation.
Going through periods of depression and anger can reduce the motivation that the injured person needs to improve. These feelings are part of the normal reaction to such a severe injury and it often takes the combined efforts of family, friends, nursing and medical staff to help them through these difficult periods, to a more positive, independent state of mind.
In addition to the adjustments that your injured friend or relative must face, you will need to adjust to many changes yourself, such as possibly becoming a caregiver or helping more with family finances. This adjustment process is much the same for you as it is for your loved one. You can help to make this as easy as possible by replacing unrealistic ideas and beliefs with information based on fact.