Acute Spinal Cord Injury and Rehabilitation

Interviewer: For a patient or a loved one of a patient who has suffered an acute spinal cord injury, they may have a lot of questions about what they can expect with their treatment and rehabilitation.

Now, to answer some of these questions and give us an overview of acute spinal cord injuries, we're joined by Dr. Jeffrey Rosenbluth, the Medical Director of the Spinal Cord Injury Acute Rehabilitation Program with University of Utah Health.

Now, Dr. Rosenbluth, let's start with the basics.

What is an Acute Spinal Cord Injury?

Dr. Rosenbluth: Well, an acute spinal cord injury can happen in a number of ways, traumatically or non-traumatically. Typically, traumatically, we're talking about an accident, a motor vehicle accident, motorcycle accident, could be a ski accident, an ATV accident.

And then, many times, there's also the potential for a non-traumatic spinal cord injury, which may be a result of a lack of oxygen, an issue with the blood vessels delivering oxygen to the spinal cord. This is typically like a stroke of the spinal cord, so to speak.

Causes and Severity of Acute Spinal Cord Injuries

Interviewer: Oh, wow. I guess how serious are these types of injuries?

Dr. Rosenbluth: A spinal cord injury can have a range of potential damage from what they call incomplete to complete. So an incomplete spinal cord injury may be just a subtle weakness, and a complete spinal cord injury may be the loss of function that's more significant anywhere from the arms, to the trunk, to the legs, or all of the above.

Early Treatment for Acute Spinal Cord Injuries

Interviewer: After a patient has sustained one of these injuries, been in one of these scenarios, what are some of the initial treatment steps or the kind of critical things that happen after that type of injury?

Dr. Rosenbluth: Well, in traumatic spinal cord injury, there's typically a rush to get someone to an appropriate medical center that has the technology, the skill set, and the clinicians to take care of that.

Many individuals who have had a spinal cord injury have had some type of bony injury, some type of fracture that needs to be repaired. So you'll find a lot of these individuals end up in trauma centers and are receiving typically same-day, or even within hours, some type of stabilization procedure to restore the alignment of their spine.

Interviewer: And how important is this kind of early intervention for some of the potential outcomes of a spinal cord injury?

Dr. Rosenbluth: So it's super important. Sometimes after the injury, there's ongoing pressure and swelling involved with the spinal cord that has the potential to add more injury. So the sooner that you can get into an acute care center, restore that alignment, and leave some room for that swelling to not continue to press on the spinal cord injury, all of those things can help to facilitate faster and better recovery.

Rehabilitation for Acute Spinal Cord Injuries

Interviewer: After patients have this injury, they're at a trauma center or wherever emergent care they've received, they're stabilized. What do you do next?

Dr. Rosenbluth: So typically, we're involved very early on in seeing some of our acute patients in the acute part of the hospital and determining when they're ready for rehabilitation.

So after individuals are stabilized, we're bringing them to another part of the hospital where we're really starting that journey towards additional recovery and return of function and neurological return.

Interviewer: What does some of that rehabilitation look like? I mean, is it just physical therapy? What does the neurological aspect look like?

Dr. Rosenbluth: So at the Craig H. Neilsen Rehab Center at the University of Utah, we have a team of individuals and clinicians, other folks, that are really wrapped around this diagnosis of spinal cord injury.

So someone would be coming to the spinal cord injury team. This is doctors and nurses and physical and occupational therapists and psychologists and social workers all wrapped around really trying to understand the needs of that individual. How do we work on maximizing their recovery? How do we work on adaptations and technology to facilitate their return to home, and return to activities that they've previously enjoyed?

Interviewer: At the Neilsen Rehabilitation Center, it sounds like we have a lot of different moving pieces and parts. What are some of the major concerns that we are trying to address here? My understanding is neurological, getting motion back. I also heard about social workers. What aspects are each of these individuals trying to help with during the rehabilitation process?

Dr. Rosenbluth: So there's a really holistic approach to spinal cord injury, especially with the large team that we have. A lot of times, especially with complete spinal cord injuries, many organ systems are affected. So having physicians that are very familiar with the types of issues that come up with spinal cord injury is important.

And having a social work team and a psychology team that really understands some of the emotional needs of an individual that's gone through such a catastrophic process is really important.

Neurological Rehabilitation and Recovery

Interviewer: Sure. When I think of rehabilitation, I think of physical therapy. You're doing stretching bands. You're walking with supporting your weight on two beams, etc. What does the neurological rehabilitation look like?

Dr. Rosenbluth: As much as we can, we really try to facilitate and help along with the neurological recovery, which is really the body's recovery. Sometimes it recovers to a great extent, and sometimes it doesn't. So not everyone is walking out of rehabilitation.

There's a team of individuals to help with the types of equipment you would need to still be independent even if you weren't able to walk. There's a team of occupational therapists who really understand technology and the technology you need to control your environment and control your life in ways that maybe you're not used to doing.

And so that team is really thinking about anything technology-wise, program-wise, exercise/rehabilitation-wise that really can facilitate the best possible neurological recovery and the greatest amount of function that we can augment with technology.

Interviewer: Now, understanding there have been a lot of advancements in care and we see a lot of really good outcomes with this holistic kind of approach to treatment, for someone who may be on their road to recovery from a spinal cord injury or a loved one who is maybe listening to learn a little bit more about the condition, what do you say to a patient or the loved one of a patient to reassure them about what kinds of outcomes they can expect after this sometimes long recovery?

Dr. Rosenbluth: Well, I think most of what I would say anyway is about hope. I think most of our spinal cord injuries, more so now than ever, are more incomplete. There's a greater chance of recovery than there ever has been before. This may be because we get people to hospitals earlier, we provide better care, and we have better protection equipment for when we do crash or have some type of accident. And so people are, again, doing better than ever.

And rehabilitation is not just what happens inside of the rehabilitation hospital. There's a really long, sometimes many months or longer, period of time where we take the same resources, the same therapists, the same technology, and apply that until we've really maximized someone's recovery.

And I think that commitment to people after a spinal cord injury to take them as far as they can go towards getting back to the activities they would like to participate in, to get back to their lives, their work, their families, these are things that are very important to us.