howdoesthespinalcordaffecttherestofthebody

How Does a Spinal Cord Injury Affect the Rest of the Body?

People who survive a spinal cord injury will most likely have medical complications such as chronic pain
and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart
problems. Successful recovery depends upon how well these chronic conditions are handled day to day.

Breathing

Any injury to the spinal cord at or above the C3, C4, and C5 segments, which supply the phrenic nerves
leading to the diaphragm, can stop breathing. People with these injuries need immediate ventilatory
support. When injuries are at the C5 level and below, diaphragm function is preserved, but breathing
tends to be rapid and shallow and people have trouble coughing and clearing secretions from their
lungs because of weak thoracic muscles. Once pulmonary function improves, a large percentage of
those with C4 injuries can be weaned from mechanical ventilation in the weeks following the injury.

Pneumonia

Respiratory complications, primarily as a result of pneumonia, are a leading cause of death in people
with spinal cord injury. In fact, intubation increases the risk of developing ventilator-associated
pneumonia (VAP) by 1 to 3 percent per day of intubation. More than a quarter of the deaths caused by
spinal cord injury are the result of VAP. Spinal cord injury patients who are intubated have to be
carefully monitored for VAP and treated with antibiotics if symptoms appear.

Irregular heart beat and low blood pressure

Spinal cord injuries in the cervical region are often accompanied by blood pressure instability and heart
arrhythmias. Because of interruptions to the cardiac accelerator nerves, the heart can beat at a
dangerously slow pace, or it can pound rapidly and irregularly. Arrhythmias usually appear in the first 2
weeks after injury and are more common and severe in the most serious injuries.

Low blood pressure also often occurs due to loss of tone in blood vessels, which widen and cause blood
to pool in the small arteries far away from the heart. This is usually treated with an intravenous infusion
to build up blood volume.

Blood clots

People with spinal cord injuries are at triple the usual risk for blood clots. The risk for clots is low in the
first 72 hours, but afterwards anticoagulation drug therapy can be used as a preventive measure.

Spasm

Many of our reflex movements are controlled by the spinal cord but regulated by the brain. When the
spinal cord is damaged, information from the brain can no longer regulate reflex activity. Reflexes may
become exaggerated over time, causing spasticity. If spasms become severe enough, they may require
medical treatment. For some, spasms can be as much of a help as they are a hindrance, since spasms
can tone muscles that would otherwise waste away. Some people can even learn to use the increased
tone in their legs to help them turn over in bed, propel them into and out of a wheelchair, or stand.

Autonomic dysreflexia

Autonomic dysreflexia is a life-threatening reflex action that primarily affects those with injuries to the
neck or upper back. It happens when there is an irritation, pain, or stimulus to the nervous system below
the level of injury. The irritated area tries to send a signal to the brain, but since the signal isn't able to
get through, a reflex action occurs without the brain's regulation. Unlike spasms that affect muscles,
autonomic dysreflexia affects vascular and organ systems controlled by the sympathetic nervous system.

Anything that causes pain or irritation can set off autonomic dysreflexia: the urge to urinate or defecate,
pressure sores, cuts, burns, bruises, sunburn, pressure of any kind on the body, ingrown toenails, or
tight clothing. For example, the impulse to urinate can set off high blood pressure or rapid heart beat
that, if uncontrolled, can cause stroke, seizures, or death. Symptoms such as flushing or sweating, a
pounding headache, anxiety, sudden high blood pressure, vision changes, or goosebumps on the arms
and legs can signal the onset of autonomic dysreflexia. Treatment should be swift. Changing position,
emptying the bladder or bowels, and removing or loosening tight clothing are just a few of the
possibilities that should be tried to relieve whatever is causing the irritation.

Pressure sores (or pressure ulcers)

Pressure sores are areas of skin tissue that have broken down because of continuous pressure on the
skin. People with paraplegia and quadriplegia are susceptible to pressure sores because they can't
move easily on their own.

Places that support weight when someone is seated or recumbent are vulnerable areas. When these
areas press against a surface for a long period of time, the skin compresses and reduces the flow of
blood to the area. When the blood supply is blocked for too long, the skin will begin to break down.

Since spinal cord injury reduces or eliminates sensation below the level of injury, people may not be
aware of the normal signals to change position, and must be shifted periodically by a caregiver. Good
nutrition and hygiene can also help prevent pressure sores by encouraging healthy skin.

Pain

People who are paralyzed often have what is called neurogenic pain resulting from damage to nerves in
the spinal cord. For some survivors of spinal cord injury, pain or an intense burning or stinging
sensation is unremitting due to hypersensitivity in some parts of the body. Others are prone to normal
musculoskeletal pain as well, such as shoulder pain due to overuse of the shoulder joint from pushing a
wheelchair and using the arms for transfers. Treatments for chronic pain include medications,
acupuncture, spinal or brain electrical stimulation, and surgery.

Bladder and bowel problems

Most spinal cord injuries affect bladder and bowel functions because the nerves that control the involved
organs originate in the segments near the lower termination of the spinal cord and are cut off from brain
input. Without coordination from the brain, the muscles of the bladder and urethra can't work together
effectively, and urination becomes abnormal. The bladder can empty suddenly without warning, or
become over-full without releasing. In some cases the bladder releases, but urine backs up into the
kidneys because it isn't able to get past the urethral sphincter. Most people with spinal cord injuries use
either intermittent catheterization or an indwelling catheter to empty their bladders.

Bowel function is similarly affected. The anal sphincter muscle can remain tight, so that bowel
movements happen on a reflex basis whenever the bowel is full. Or the muscle can be permanently
relaxed, which is called a "flaccid bowel," and result in an inability to have a bowel movement. This
requires more frequent attempts to empty the bowel and manual removal of stool to prevent fecal
impaction. People with spinal cord injuries are usually put on a regularly scheduled bowel program to
prevent accidents.

Reproductive and sexual function

Spinal cord injury has a greater impact on sexual and reproductive function in men than it does in
women. Most spinal cord injured women remain fertile and can conceive and bear children. Even those
with severe injury may well retain orgasmic function, although many lose some if not all of their ability to
reach satisfaction.

Depending on the level of injury, men may have problems with erections and ejaculation, and most will
have compromised fertility due to decreased motility of their sperm. Treatments for men include
vibratory or electrical stimulation and drugs such as sildenafil (Viagra). Many couples may also need
assisted fertility treatments to allow a spinal cord injured man to father children.

Once someone has survived the injury and begun to psychologically and emotionally cope with the
nature of his or her situation, the next concern will be how to live with disabilities. Doctors are now able
to predict with reasonable accuracy the likely long-term outcome of spinal cord injuries. This helps
patients set achievable goals for themselves, and gives families and loved ones a realistic set of
expectations for the future.
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How Does Rehabilitation Help People Recover From Spinal Cord Injuries?

No two people will experience the same emotions after surviving a spinal cord injury, but almost
everyone will feel frightened, anxious, or confused about what has happened. It's common for people to
have very mixed feelings: relief that they are still alive, but disbelief at the nature of their disabilities.

Rehabilitation programs combine physical therapies with skill-building activities and counseling to
provide social and emotional support. The education and active involvement of the newly injured person
and his or her family and friends is crucial.

A rehabilitation team is usually led by a doctor specializing in physical medicine and rehabilitation (called
a physiatrist), and often includes social workers, physical and occupational therapists, recreational
therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists, and
other specialists. A case-worker or program manager coordinates care.

In the initial phase of rehabilitation, therapists emphasize regaining leg and arm strength since mobility
and communication are the two most important areas of function. For some, mobility will only be possible
with the assistance of devices such as a walker, leg braces, or a wheelchair. Communication skills, such
as writing, typing, and using the telephone, may also require adaptive devices.

Physical therapy includes exercise programs geared toward muscle strengthening. Occupational
therapy helps redevelop fine motor skills. Bladder and bowel management programs teach basic
toileting routines, and patients also learn techniques for self-grooming. People acquire coping strategies
for recurring episodes of spasticity, autonomic dysreflexia, and neurogenic pain.

Vocational rehabilitation begins with an assessment of basic work skills, current dexterity, and physical
and cognitive capabilities to determine the likelihood for employment. A vocational rehabilitation
specialist then identifies potential work places, determines the type of assistive equipment that will be
needed, and helps arrange for a user-friendly workplace. For those whose disabilities prevent them from
returning to the workplace, therapists focus on encouraging productivity through participation in
activities that provide a sense of satisfaction and self-esteem. This could include educational classes,
hobbies, memberships in special interest groups, and participation in family and community events.

Recreation therapy encourages patients to build on their abilities so that they can participate in
recreational or athletic activities at their level of mobility. Engaging in recreational outlets and athletics
helps those with spinal cord injuries achieve a more balanced and normal lifestyle and also provides
opportunities for socialization and self-expression.