Serious spinal cord injury (SCI) can be life changing and traumatic—physically, emotionally, and psychologically. However, a good team of health care providers can help patients adjust to new ways of accomplishing everyday activities and assist them in moving forward with their lives.
Although some spinal cold injuries can be due to birth defects. Tumors, degenerative disease, and aging, Chihyung Kevin Park, MD, an assistant professor in the Department of Physical Medicine and Rehabilitation at University of Utah Health, says most of his patients are victims of serious motor vehicle accidents, gunshot wounds, violence, or sport accidents.
There are many changes to the body and emotions a person will experience after a SCI. Here are a few:
After the initial neurosurgery, mental health is the primary concern for these patients. Understandably, patients sink into depression, Park says, which is accompanied by anxiety, loss of motivation, and negative thoughts.
“When I first meet a patient, I tell them mental health is actually half of the battle, because for most of the patients, their life has been flipped upside down in a split second,” Park says. “If we don’t have mental health in check, it is very difficult to move on to other aspects of physical recovery.”
Park and the team at University of Utah Health set patients up with a psychologist right away. But that is only the beginning of helping patients adjust to post-injury life.
The higher the injury on the spinal cord, the greater the possibility for complications. Injuries to the C3, C4, and C5 vertebrae can result in the loss of diaphragm function and may require a ventilator for breathing, as well as loss of function in hands, arms, torso, and legs. Park says that patients with injuries to those vertebrae tend to get pneumonia because their coughs are so weak—meaning they cannot effectively remove the mucus and bacteria. Pneumonia is a leading cause of death for SCI patients.
“When I see a patient come in with a higher-level cervical injury, that’s my number one concern,” Park says. “I ask, ‘How are you breathing?’ ‘How are you coughing?’ ‘Are you getting too tired?’”
Low Blood Pressure
One of the main roles of the nervous system is to control blood flow. When that ceases to function effectively, low blood pressure becomes another concern for SCI patients. According to Park, it may take three to four months for patients to get accustomed to having a lower blood pressure, especially if they had high blood pressure previously. It can cause dizziness and falls. Medications can help increase blood pressure, but these are not a permanent solution. Other advice is to move more and stay hydrated.
Urinary and Bowel Issues
Depending on where along the spinal cord the injury occurred, some patients may walk again. But many are tetraplegic or quadriplegic and will need to use a wheelchair. These patients often suffer other health consequences, most commonly bladder and/or bowel incontinence. Many patients lose the sensation of needing to urinate or have a bowel movement.
In the cases of urinary problems, patients must learn to use an intermittent catheter. If their hand function has been impaired, then family members or caretakers must help. Park says they try to mimic what is natural—urinating every four to six hours but with the use of the catheter. In some cases, surgery is needed and an “indwelling” Foley catheter is placed, which drains into an external bag.
For bowel problems, Park says the team trains patients to have a bowel movement at the same time every day, which often means using a stool softener or laxative nightly. This helps prepare them for the day and minimize accidents, which is a dignity issue as well.
Skin Harmed by Lack of Circulation
Skin is the largest organ of our bodies. It is crucial to protecting us from bacteria, maintaining water balance, and providing us with sensory information such as temperature and texture. The loss of nerve impulses can change our skin color and temperature and cause skin to become thinner, drier, and more prone to injury and wounds.
Park says there are concerns about patients not feeling skin injuries as well as a major concern with wounds worsening due to lack of movement and limited blood circulation. The latter is a huge problem, costing millions of dollars in health care spending and resulting in reduced independence and potentially life-threatening infections.
Park advises clients to set a timer on their phone to remind them to shift positions or have caregivers move them as necessary. Pressure injuries due to sitting or lying in one position too long may first look like benign red spots but can turn into a serious issue. They may even start under the skin and not be apparent for some time. Lack of circulation can cause blood and lymph fluid to pool, fluid to collect in the legs and feet, and result in other conditions such as deep vein thrombosis.
New Advances in SCI Care
As serious as all the conditions related to SCI sound, new advances in SCI care have been made over the past two decades. Research has shown that self-management is linked to reduced secondary health complications and a better quality of life.
Park advises that working with your health care team long term can make a difference. “Patients can live to ages 65, 70, or 80 if they take care of themselves,” Park says. “Our knowledge has increased, and we treat our spinal cord injury patients better. We continue to follow our patients until the end of life.”