Spinal Cord Injury, Complications, & Functionality
The spinal cord is the central nerve pathway from the brain to rest of the body, and is encapsulated primarily by 3 sections of articulating vertebrae (cervical, thoracic, and lumbar). If any trauma occurs to the spinal cord, partial to complete paralysis or loss of sensation can occur below the level of injury. Injuries in the thoracic or lumbar region often result in paraplegia – paralysis in the trunk and lower extremities. However, cervical injuries can lead to quadriplegia, with all portions of the body below the neck at least partially paralyzed.
A spinal cord injury (SCI) entails much more difficulty than the simple loss of ambulatory movement, as multiple complications arise that further limit physical and psychological abilities. As a result, a spinal cord injured person (SCIP) requires additional rehabilitation in order to overcome these issues independently of the physical rehabilitation for paralysis. “Rehabilitation” refers to learning how to fully accommodate a limitation if it cannot be removed.
Bladder Incontinence. The bladder will continue to store urine from the kidneys but the SCIP may not be able to control the bladder. This increases the risk of urinary tract infections, kidney infections and kidney or bladder stones. Bladder catheterization is usually required.
Bowel Incontinence. Although the stomach and intestines work much like they did before the injury, control of bowel movements is often altered. An SCIP must learn how to manually evacuate the bowels on a consistent schedule and often requires an assistant at first
Skin Breakdown.Prolonged pressure, heat, or cold can make an SCIP susceptible to pressure sores, which if unnoticed and untreated can prove deadly. Proper wheelchair sitting, cushioning, and movement strategies are necessary to prevent complications.
High/Low Blood Pressure. The sympathetic nervous system becomes hyperactive in the absence of skin sensation, registering pain as extremely high blood pressure. An SCIP is also prone to low blood pressure and swelling of extremities if they do not remain physically active.
Respiratory Weakness. It becomes more difficult to breathe and cough if the abdominal and chest muscles are affected. Cervical and thoracic SCI are often accompanied by an increased risk of pneumonia or other lung problems.
Muscle Atrophy & Spasticity.If muscles are not used, they begin to deteriorate naturally. Muscles may then become either permanently tense or flaccid, creating further obstacles for natural body movement.
Weight Gain.Limited mobility may lead to a more sedentary lifestyle, placing SCIPs at risk of obesity, cardiovascular disease and diabetes. Weight gain is difficult to counteract once it occurs, and must be mitigated by proper eating habits
Osteoporosis.In the absence of walking or standing, bone density in the lower extremities decreases, increasing the risk of breakage. Standing exercises are necessary in order to prevent serious injuries when an SCIP falls down from a bed, wheelchair, or is simply carried.
Sexual Stigma. Fertility and sexual function is not completely impaired, and the degree varies from individual to individual. The majority of SCIPs remain able to raise natural families with limited intervention
Depression.The amount of time it takes to manage physical changes after an SCI leaves little room for vocational or social habits and often results in isolation and self-deprecatio
A Diagnosis of “Quadriplegia” does not mean that a person cannot move anything below their neck; this is only the case for certain types of quadriplegics with high-level spinal cord injuries (see chart below). High-level quadriplegics are completely dependent for most of their volitional body functions. Low-level quadriplegics may seem to have a similar functional range as high-level quadriplegics due to extended bed-rest periods that result in muscle atrophy. With exceptional therapy and carefully targeted exercise, however, these individuals can emerge from a seemingly therapeutic plateau and gain a level of independence similar to that of paraplegics. The overall strategy of ESCIP’s mentoring program is to help these people toward this very important level of independence.
High-Level Quadriplegia Functionality
As shown in the table below, a c5/c6 quadriplegic can breathe and speak normally and has some triceps and wrist motion. With these abilities such a person can be independent not only in eating, bathing and driving, but also can turn over in bed and get dressed, and push a manual wheelchair. Such skills allow a person to remain physically fit, hold a job, and live fully independently with the help of some low-tech assistive technology.