Treatment

Published: April 24, 2005
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Fifty years ago, a spinal cord injury was usually fatal. Today, there’s still no way to reverse damage to the spinal cord. But advances in recent years have improved the recovery of patients with a spinal cord injury and halved the amount of time survivors must spend in the hospital. Researchers are optimistically working on new treatments, including innovative prostheses and medications that may promote nerve cell Regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, treatment focuses on preventing further injury and enabling people with a spinal cord injury to return to an active and productive life within the limits of their Disability. This requires urgent emergency attention and ongoing care.

If you suffer a head or neck injury, you’ll likely be treated by paramedics and emergency workers who will attend to three immediate concerns — maintaining your ability to breathe, keeping you from going into shock and immobilizing your neck to prevent further spinal cord damage. Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they’ll use to transport you to the hospital.

In the emergency room, doctors focus on maintaining your blood pressure, breathing and neck stabilization and avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities. You may be sedated so that you don’t move and cause more damage while undergoing diagnostic tests for spinal cord injury.

If you do have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

In the early stages of Paraplegia or Quadriplegia, your doctor will treat the injury or disease that caused the loss of function. Immediate treatment may include:

* Medications.

Methylprednisolone (Medrol) is a standard treatment for acute spinal cord injury. This corticosteroid has been proved to bring about significant and sustained recovery in people with a spinal cord injury, if given within eight hours of injury. Methylprednisolone works by reducing damage to nerve cells and decreasing inflammation near the site of injury.

* Traction. You may need traction to stabilize your spine and bring the spine into proper alignment during healing. Sometimes, traction is accomplished by placing metal braces, attached to weights or a body harness, into your skull to hold it in place.

* Surgery. Occasionally, emergency surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured Vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity. However, some surgeons believe it’s safer to wait for several days before attempting any surgery.

Ongoing care After the initial injury or disease stabilizes, doctors turn their attention to problems that may arise from immobilization, such as deconditioning, muscle contractures, bedsores, urinary infection and blood clots. Early care will likely include range-of-motion exercises for paralyzed limbs, help with your bladder and bowel functions, applications of skin lotion, and use of soft bed coverings or flotation mattresses, as well as frequently changing your position. Hospitalization can last from several days to several weeks, depending on the cause and extent of the paralysis and the progress of your therapy. But treatment doesn’t stop when you check out of the hospital. Here are some of the ongoing treatments you can expect.

Rehabilitation.

During your hospital stay, a rehabilitation team will work with you to improve your remaining muscle strength and to give you the greatest possible mobility and independence. Your team may include a physical therapist, Occupational Therapist, rehabilitation nurse, rehabilitation psychologist, social worker, nutritionist, recreation therapist and a doctor who specializes in physical medicine (Physiatrist).

During the initial stages of rehabilitation, therapists usually emphasize regaining leg and arm strength, redeveloping fine Motor skills and learning adaptive techniques to accomplish day-to-day tasks. A program typically includes exercise, as well as training on the medical devices you’ll need to assist you, such as a wheelchair or equipment that can make it easier to fasten buttons or dial a telephone.

Therapy often begins in the hospital and continues for several weeks in a rehabilitation facility. As therapy continues, you and your family members will receive counseling and assistance on a wide range of topics, from dealing with urinary tract infections and skin care to modifying your home and car to accommodate your Disability. Therapists will encourage you to resume your favorite hobbies, participate in athletic activities and return to the workplace, if possible. They’ll even help determine what type of assistive equipment you’ll need for these vocational and recreational activities and teach you how to use it.

Medications. You may benefit from medications that manage the signs, symptoms and complications of spinal cord injury. These include medications to control pain and muscle Spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning. You may also need short-term medications from time to time, such as antibiotics for urinary tract infections.

New technologies. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some apparatuses also may restore function. These include:

* New wheelchairs.

Improved, lighter-weight wheelchairs are making people with spinal cord injury more mobile and more comfortable. The Food and Drug Administration has even approved a wheelchair that can climb stairs and elevate a seated passenger to eye level to reach high places without help.

* Computer devices. Computer-driven tools and gadgets can help with daily routines. You can use voice-activated computer technologies to answer and dial a phone, or to use a computer and pay bills. Computer-controlled technologies can also help with bathing, dressing, grooming, cleaning and reading. * Neural prostheses. These sophisticated devices connect with the nervous system to supplement or replace lost motor and sensory functions. There are Functional electrical stimulation (FES) systems, which use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand, walk, reach and grip. These systems are composed of computer-controlled electrodes that are taped to the skin or surgically implanted and controlled by the user. One of the systems allows someone with a spinal cord injury to trigger hand and arm movements in one arm by shrugging the opposite shoulder. These devices require more research, but they’ve gained a great deal of attention, in part because the late actor Christopher Reeve was able to rely primarily on an FES bicycle that used computer-controlled electrodes to stimulate his legs to cycle. He also had a system implanted to stimulate his breathing.