About Physiatry

Traumatic Spinal Cord Injury: Treatment and Practice Concepts

Condition: Traumatic spinal cord injury (SCI) means there is damage to spinal cord or nerves that run through the backbone (spine). Depending where the injury is and how severe it is, partial or complete loss of feeling and control in just the arms (paraplegia) or both the arms and legs (tetraplegia) may be present.

Background: Over 12,000 SCIs occur each year, mostly from auto accidents. Other common causes of SCI include acts of violence, falls, and sports injuries..

Risk Factors: Men between the ages of 15 and 35 are most likely to have an SCI. The number of SCIs in persons over 65 years of age is increasing because of falls.

History and Symptoms: Details about how the injury occurred may help to determine injury severity and if there are other associated injuries.  The paralysis that follows an SCI is usually sudden. There may also be breathing, blood pressure problems, or problems controlling the bladder and bowel.

Physical Exam: Your physician will perform a thorough examination including checking strength, reflexes, and sensation.   The initial examinations may help to predict long term recovery from SCI.  Precautions may be taken to prevent movement of the spine during the evaluation.

Diagnostic Process: Imaging of the spine may include X-rays, CT scans and/or MRIs.  Blood tests are usually obtained to assess if bleeding, infection or chemical abnormalities are present.  If a brain injury also occurred, tests of thinking and other additional tests may take place.

Rehab Management: The primary goals of rehab are to provide the patient and families with education about SCI, improve function and prepare the patient for return to the community.  Prevention of further injury or complications is crucial.  This may include surgery to maintain spine stability, breathing devices or specialized programs and equipment to prevent injury to the skin while in bed.   Many SCI patients experience difficulty controlling urinating or bowel movements.  Patient and families will receive education and training on performing bowel and bladder programs.  Physical therapy and occupational therapy work with strengthening, stretch and mobility and helping the patient learn techniques to care for himself.   Assistive devices, ramps, and other changes in the environment may also be helpful. Medications may be used to address disorders that may be associated with SCI such as spasticity, depression and pain.  These may include. Recovery depends on how severe the injury is. Most improvement is seen in the first 6 months after the injury. 

Other Resources for Patients and Families: There are numerous associations that provide support and information for patients and families. The Paralyzed Veterans of America (PVA) provides support and other resources on their website (www.pva.org) for people with SCI and their caregivers. Your physician or care team may provide you with additional resources based on your needs.

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