While more than 11,000 people sustain spinal cord injuries (SCI) each year, many Americans first learned about them when actor Christopher Reeve was paralyzed. That was in 1995.
In that short time span, tremendous advances have been made in improving the quality of life for individuals with SCI through better treatment and new rehabilitation therapies.
"Most of the care for acute and long-term spinal cord injuries is provided by specialists in PM&R," explains David Chen, MD, a PM&R physician and director of the spinal cord injury program at the Rehabilitation Institute of Chicago. "Often we become an injured patient's primary care physician, because we are more familiar with the unique nuances and secondary issues of the condition."
This "familiarity" has led to significant advances in both technology and techniques that will maximize the capabilities of people with spinal cord injuries in all aspects of their lives—physical, emotional, social and vocational.
Among the many technological advances are improved, lighter weight wheelchairs that are easier to maneuver. "These significantly improve the quality of life from a practical, everyday standpoint of being comfortable and getting around," states Steven Kirshblum, MD, director of the spinal cord injury and ventilator program at the Kessler Institute for Rehabilitation in New Jersey, who treated Christopher Reeve.
Kirshblum adds that new wheelchairs are being developed that can actually climb stairs. "This will help overcome some of the environmental and architectural barriers that can exist to both work and social opportunities."
Voice-activated computer technology is further enhancing the lives of those living with SCI. The assistance of a computer can make certain activities less exhausting. In some cases, voice-activated technology has made many of the daily tasks of living and working possible for the very first time—such as answering and dialing the phone or using a computer to e-mail messages and pay bills.
Although still being studied, treadmill-assisted walking may also greatly improve ambulation. This therapy is based on the theory that a central pattern generator (CPG) resides in the spinal cord that controls rhythmic locomotion patterns such as walking or running. Repetitions of walking are believed to reactivate the CPG so the injured patient can re-learn the stepping mechanism and walk.
"A lot of PM&R physicians are involved in this therapy because we know about this neurologic condition and how the body responds to activity," reports Chen. "I evaluate how each patient responds to this therapy to see if there is improvement or if their spasticity worsens and we need to change medication or alter bracing for their limbs."
New electrical stimulation devices that are implanted in the body have recently been developed that can restore some hand movement. These allow people with SCI to write and feed themselves. Other electrode implants can help better control bladder and bowel function. Electrical stimulation devices can also assist with breathing so that some people do not have to be on a ventilator.
And developments in new and safer techniques and medications for erectile dysfunction have enhanced the quality of life for many individuals and couples. "These have been studied and are now approved for clinical use," says Kirshblum. "There are also greatly improved techniques in fertility that allow those with SCI to have children."
PM&R physicians are also involved in improving pharmacological interventions that enhance functioning, decrease complications and increase strength.
Just ten years ago, the leading cause of death among the SCI population was infection from bladder and bowel complications. Today, thanks to medical advancements, those complications can be treated. Chen reports that the leading cause of death for people with SCI now is the same as those without it—heart disease. He adds that exciting studies are under way to see if high doses of steroids lessen the severity of SCI if they are administered soon after the injury occurs.
Search for a Cure
Breakthroughs in stem cell research hold the greatest promise of a cure, but re-growing damaged nerves is a long way off. Should a stem cell cure arrive, PM&R medicine will play a critical role in retraining muscles and re-learning activities of daily living.
"PM&R helps our patients with spinal cord injury live better and prepares them for the cure when it does arrive," says Kirshblum.
But both specialists stress that there will probably not be a "magic bullet" in the short-term. It is a combination of therapies that provide a better quality of life.
"The quest for a spinal cord injury cure has been dramatic. There has been a great push for research money dedicated to a cure," concludes Kirshblum. "While we all want a cure, right now we have hope and rehabilitation to enhance a person's life."
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