Treatment/Rehabilitation for Spinal Cord Injury
Treatment for spinal cord injuries begins in the emergency room and continues long after the patient is released from the hospital. The very first procedure for treatment occurs even before the injury is diagnosed. The goals of treatment are to help the patient live the most satisfying life possible and to prevent additional injuries.
Initial Treatment for Spinal Cord Injury
When a spinal cord injury is suspected, medical personnel immobilize the spine using rigid collars and boards. It is important to move patient as little as possible, since the level of recovery depends in part on preventing additional damage and inflammation.
Emergency room physicians take steps to stabilize blood pressure, breathing, bladder and bowel functions, and prevent blood clots. Many patients then move to the intensive care unit or a special spinal cord injury treatment center.
In some cases, the drug methylprednisolone (Medrol) is given. While the full benefits of this medication have not been determined, it may help control damage to nerve cells if it is administered within 8 hours of the injury.
Following spinal cord injury, it is important to keep the spine still and properly aligned. In many cases, this requires using traction and a rigid neck collar. Traction involves using metal braces or a body harness to keep the skull immobile.
Surgery may be performed to remove elements that are bearing down on the spine, such as bone fragments and foreign objects. In some cases, surgery can also be used to stabilize the spine, although this procedure may be too risky at this point.
Once a neurological exam and other tests are completed and the extent of injury has been determined, a team of physicians and other specialists (e.g., social workers, physical therapists, vocational counselors, nutritionists) begin working on a long-term treatment plan.
Patients often are frightened, confused, and unsure about the future. A supportive team of qualified health care providers, family, and friends, can help the patient set achievable goals. In many cases, the greater the patient's ability to adapt, the more successful recovery will be.
Long-term Treatment for Spinal Cord Injury
Following spinal cord injury, the first priority often is to help the patient develop as much strength as possible in the arms and legs, since these limbs are crucial for movement and communication. Patients may need to learn to use devices like walkers, wheelchairs, or leg braces, as well as devices to help them write, type, and talk on the phone.
Physical therapists work with patients to build muscle strength and occupational therapists can help patients develop skills required for day-to-day activities, such as dressing, grooming, and going to the toilet. Patients also learn how to cope with other issues, including pain and spasticity.
Vocational rehabilitation specialists can help patients determine employment options. They assess how work skills and dexterity have been affected by the injury, find job sites that complement the patient's expertise and abilities, and help secure adaptive devices. For patients who are unable to work, vocational specialists help find opportunities for meaningful projects to keep them active and build self-esteem.
Specialists also can provide recreational therapy, which helps patients participate in athletic and recreational activities. In this way, patients can get out with other people, have fun, and lead as normal a lifestyle as possible.
Modern technology also can help patients manage their treatment. For example, computers can help with a number of functions, such as communication, bathing, cleaning the house, and reading. Wheelchairs are lighter and easier for patients to work with. Some wheelchairs can go up stairs or lift a patient to eye level. Electrical stimulation devices can help patients achieve greater movement.
In August 2011, the U.S. Food and Drug Administration (FDA) approved onabotulinumtoxin A (BOTOX) injections to treat urinary incontinence caused by spinal cord injury. This treatment may improve bladder relaxation, increase storage capacity of the bladder and decrease incontinence. The injection is performed using cystoscopy, a procedure in which the health care provider is able to visualize the bladder, and may help reduce incontinence for about 9 months. Adverse reactions include urinary tract infection (UTI) and urinary retention.
Spinal Cord Injury Prognosis
Prognosis for patients with spinal cord injuries varies and depends largely on the degree of damage. The first year following injury is critical, as more patients die of the injuries within that time period than any other. Kidney (renal) failure and pneumonia are frequent causes of death.
In many cases, physicians cannot be certain of the extent of immobility until a few months have passed since the injury. Some patients will have more mobility than others. Most function that is going to return does so within 2 years and after that, physicians usually agree that the remaining damage is permanent.
Patients often develop a number of secondary conditions following spinal cord injury. Managing these conditions through a network of qualified health care providers, therapists, family, and friends plays a large role in the patient's quality of life. Staying emotionally healthy and maintaining good eating and exercise habits are important.
There is hope for spinal cord injury patients. With technological advances, further studies on the horizon, and adaptability on the part of patient, people with spinal cord injuries are often able to do many activities that keep them independent, productive, and satisfied with their lives.