Spinal Cord Injury Treatment and Rehabilitation

Treatment of spinal cord injuries begins the moment the injury occurs.  The first considerations are ABC—airway, breathing, and circulation.  In addition, the spine must be immobilized to prevent further injury.  Once these things are completed, the person should be transported immediately to the nearest hospital, preferably a trauma center.  Depending on the injury, the patient may need blood pressure therapy (via medicines and fluids) or may even need a ventilator to assist in breathing. 


Initial Treatment

Once the injured person is stabilized, steps must be taken to reduce swelling in the spinal cord and prevent any further tissue damage.  Methylprednisone is a high-dose steroid that, when administered within eight hours of injury, can greatly improve chances of recovery.  Methylprednisone works to reduce inflammation at the site of the injury and in doing so can prevent nerve death.

Some patients may require surgery soon after the injury in order to decompress and stabilize the spine.  Every spinal cord injury is different, so the surgeon must assess each situation and decide what type of surgery is necessary.  An unstable spine can be treated with “instrumentation”—using specially designed hardware such as rods, bars, and screws—and “fusion.”  Fusion involved grafting bone in order to permanently join two or more vertebrae.

Initial treatment of the spinal cord injury focuses on stabilizing the patient and ensuring that breathing, circulation, and spinal column stability are established.  After hospital physicians have accomplished these tasks, the patient is either sent home (with the possibility of participating in outpatient rehabilitation services) or admitted into a rehabilitation facility in order to experience additional recovery and learn to live with a spinal cord injury.

Most spinal cord injury patients experience some degree recovery after the injury.  For example, most patients recover function 1-2 vertebral segments below the injury site.  This is called segmental recovery.  Methylprednisone also contributes to recovery.  Patients often find they are initially unable to control their trunk muscles, but most will recover more control months or even years later.  Many patients will also recover standing or walking, especially if their injuries were “incomplete.” 


Rehabilitation

Thirty-nine days is the average amount of time a spinal cord injury patients stays at a rehabilitation center.  A variety of therapies are used at rehabilitation centers to help patients recover and adjust to spinal cord injuries.  Rehab often includes physical therapy, occupational therapy, counseling, and other services depending on the patient’s particular needs.  Physical therapy works to restore muscle strength, coordination, flexibility, and mobility.  Patients with difficulty walking may participate in “gait therapy” to help them walk using a walker or cane.  Occupational therapy provides the patient with tools to cope with the everyday activities, like getting dressed, taking a bath, or going to the bathroom.  Counseling can help spinal cord injury patients adjust to their new life and grieve the loss of their old life. 

The quality and character of the rehabilitation center have a great impact on the patient’s recovery, so it is important to pick the right one.  Here are some questions to consider when selecting a rehabilitation center:

Spinal Cord Injury Experience – Is the spinal cord injury center accredited?  Has it been designated as a Model Spinal Cord Injury Center?  Is the facility state-operated or privately run?  Are there physicians who specialize in spinal cord injuries, and if so, do they speak the primary language of the injured person?  How many spinal cord injury patients are admitted to the program each year?

Facility Operations – Is the lead physician a Physiatrist (a doctor who specializes in physical medicine and rehabilitation)?  Is there around-the-clock physician coverage?  Do nursing staff receive special training in treating spinal cord injuries?  Are consultants such as urologists and neurologists available nearby?

The Treatment Program – Does the facility offer long-term planning for the injured person?  How often will the injured person receive occupational and physical therapy?  Does the center plan evening and weekend recreational activities for patients?

Other Patients – Are the other patients of the same age and sex as the injured person?  Do they have similar injuries?


Experimental Treatments

Experimental therapies are tested for both new and ongoing spinal cord injuries.  Activated microphage transplants, alternating current electrical stimulation, Neotrofin, and GM1 injections are all examples of experimental therapies that have been tested in injuries that are a few days or weeks old.  For spinal cord injuries that have been stabilized for one or more years, 4-AP and fetal porcine stem cell transplants are examples of experimental therapies.


Living with a Spinal Cord Injury

A spinal cord injury affects not only the injured person’s ability to move or feel—it also contributes to a variety of physical health problems.  In addition, the injured person must make a psychological adjustment to their condition.

There are several common complications of spinal cord injuries that can be detrimental to the injured person’s health:

Skin breakdown – Also referred to as “pressure sores” or “decubitus ulcers,” skin breakdown results from too much pressure on the skin.  Patients with spinal cord injuries often sit for long periods of time, and this combined with changes in blood supply and skin elasticity that occur after injury can result in skin breakdown.  Treating a single pressure sore can cost anywhere from $10,000 to $50,000.  Pressure-relieving cushions can help prevent skin breakdown.

Osteoporosis – Most people with spinal cord injuries will develop osteoporosis.  This is because bones weaken if they are not subject to regular weight-bearing activity.  Although osteoporosis cannot be cured, standing and walking therapies can help strengthen bones and therefore decrease the risk of osteoporosis.

Respiratory problems – Breathing problems are likely if the person’s injury occurred at the T-4 level or above.  Proper maintenance of pulmonary function is a key component in the long-term care plan of a person with a spinal cord injury.

Spasticity –  The disconnect between the brain and parts of the spinal cord that occurs due to spinal cord injury can cause spasticity.  This term refers to an exaggeration of the body’s normal reflexes.  Violent spasms may be treated with medication, and spasms can also be reduced by maintaining good general health (i.e., avoiding skin breakdowns and bladder infections).  Spasms can be beneficial in that they warn of underlying health problems and help maintain muscle strength.


Spinal Cord Injury Support

A spinal cord injury is a devastating event, often made worse by the related health problems mentioned above.  The newly injured patient will likely go through a grieving process similar to that following the death of a loved one, instead grieving the loss of her mobility, sense of touch, or independence.  The final stage in this grieving process is acceptance, where the patient develops a realistic view of her life and sets future goals. 

Counseling and support groups are tools that spinal cord injury patients can use to help with the psychological adjustment to their new condition.  Internet message boards and online communities can also help patients adjust.

 

Read the next article:  Advice for Caregivers of Spinal Cord Injury 

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