What is a spinal cord injury?

A spinal cord injury (SCI) is an acute traumatic injury that invades the spinal cord and nerves, resulting in motor, sensory and fecal dysfunction. The damage may be caused by large external forces, such as car accidents, falls, heavy objects crushing, sports injuries, etc., resulting in displacement or fracture of the spine, or minor injuries such as skidding or slipping.

Cervical spinal cord injuries will cause quadriplegia. If the injury involves the thoracic spinal cord, lumbar spinal cord or sacral spinal cord, it will cause paraplegia. In addition to motor and sensory dysfunction, SCI can also cause Voiding dysfunction, defecation and sexual dysfunction, as well as respiratory problems, autonomic nervous dysfunction. More worrying still are frustration and financial problems.

Symptoms

SCI deals a devastating blow to patients and their families. What they are most concerned about are the movement difficulties caused by limb paralysis.

Actually, nerve damage leads to the dysfunction of other internal organs. If not properly handled, it often brings more trouble and danger in the acute phase.

• Respiratory system: the patient may have paralysis of respiratory muscles, resulting in shallow breathing, difficulty in discharging respiratory secretions, and weakness in coughing.
• Gastrointestinal system: the peristalsis of the whole gastrointestinal system is poor, and it is easy to produce serious abdominal flatulence or constipation.
• Cardiovascular system: spinal cord injury may affect the function of autonomic nervous system (to control the contraction and relaxation of the heart and blood vessels), which will slow down the heart rate and reduce blood pressure. Postural hypotension occurs when blood vessels do not respond effectively to reflex contractions during postural changes. Because of poor vasoconstriction of the affected limb, it will cause dependent edema at the distal part of the affected limb. (e.g. the back of the hand, fingers, calves, instep, etc.).
• Urinary system: problems with the bladder's ability to relieve urine can lead to incontinence or inability to urinate.
• Skin system: loss of sensation below the injured area, combined with paralysis and immobility of the limbs, makes it difficult for the patient to turn over. If you sleep in the same posture for a long time, the skin under the protruding part of the bone will suffer from hypoxia, necrosis and ulceration of the tissue due to the flattening of its microvasculature and the lack of blood flow.
• Musculoskeletal joint system: paralyzed limbs are no longer able to move freely. Most of the time, they are placed in the same posture, which will cause muscle atrophy, fibrosis, contracture and deformation of joints and osteoporosis.
• Psychological adjustment: the patient is faced with major trauma, which can produce shock, anger, frustration, confusion, uncooperation, inability to face reality and other emotional reactions.

Rehabilitation training

Rehabilitation of patients with spinal cord injury requires the integration of many professionals and a patient-centered plan based on the patient’s injured site, severity of dysfunction, comorbidities, physical ability and willingness.

The rehabilitation team includes rehabilitation specialists, nurses, physical and occupational therapists, social workers, etc.

The contents of rehabilitation therapy include strengthening the muscle strength, endurance and physical strength training, as well as daily life skills such as washing, eating, wearing clothes and trousers, body washing, wheelchair use, urinating and defecating training, and the use of necessary auxiliary tools, all of which are preparation for the return to social life after returning home.

During hospitalization, the patient should consider while receiving training whether these skills are applicable to his/her post-discharge environment. If there are other difficulties in applying these skills, he/she should discuss with the medical staff whether there are other alternative compensatory skills, special aids support or environmental modifications needed. When necessary, he/she should return home to simulate home life during his/her stay in hospital.

Spinal cord injury is a severe disability, commonly found in young adults, which causes great losses to the patients themselves, their families and even society. They have run into many problems and difficulties, which require the coordination and cooperation of the members of the professional medical team, as well as the cooperation of the family, society and the government, in order to achieve satisfactory treatment results.