Spinal Cord Rehabilitation

Spinal cord injuries vary in degree, but generally there are recognized phases of recovery that every person dealing with such an injury will progress through during their rehabilitation. For each patient, the length of a phase of the recovery process varies.

Spinal cord injuries are generally classified in two categories: complete or incomplete. An incomplete spinal cord injury means that some signals from the brain are still able to reach the extremities, so some level of motion is possible. A complete injury means that the patient has no sensation or ability to move below the level of injury.  Similarly, the treatment of spinal cord injuries may be divided into two categories: acute care and rehabilitation.

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Step One:

Emergency Medical Care

The initial medical care in any spinal cord injury is focused upon preventing further injury and minimizing the effects of head or neck trauma, usually occurring at the scene by emergency medical services. The spine is carefully immobilized through the use of a neck collar and rigid carrying board upon which the injured person is transported to the hospital for a full assessment. The process follows these steps:

  • Accident Occurs (Vehicle Accident, Fall, Construction Accident or Other)
  • Emergency Services is Contacted and Arrives
  • Patient is Carefully Immobilized to Avoid Further Damage
  • Emergency Lifesaving Techniques are Applied by EMTs
  • Patient is Transferred to Hospital or Spinal Cord Treatment Center

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Step Two:

Acute Stage Treatment

The most urgent issues for a spinal cord injury patient involve maintaining the ability to breathe, preventing shock, and making sure that the patient does not have complications. Complications may include the retention of stool or urine, respiratory problems, or formation of blood clots in the immobilized extremities.

An SCI patient often remains heavily sedated during the acute care phase so that no movement occurs that could increase the level of damage and diminish the ability to recover. Intravenous medications are administered to reduce inflammation. The injured person may have other injuries, and the period of time in which the acute stage is treated depends to some degree on the scope of injuries.

Once the patient is stabilized, he or she is moved to intensive care or to a regional spinal cord injury treatment center to be treated by neurosurgeons and other health care professionals trained in the treatment of spinal cord injuries. Extensive testing is done to determine the level of damage to the spinal cord.

The spinal cord may be crushed, bruised or torn. The spinal cord generally will not be severed, but is more likely to be compressed, destroying critical nerve cells needed to send signals to the parts of the body below the level of the injury.

The medical assessment assists in determining the location of the injury, whether the spinal cord has been merely bruised or has been torn, and the correct treatment plan for the specific patient. The doctors develop a treatment plan for the patient based upon that assessment.

Patients who have suffered an injury to the spinal cord at the neck often suffer respiratory difficulty, and cannot breathe without assistance. These are the most serious cases, and will require a more extensive treatment plan. The patient will require ongoing assistance for all basic needs.

  • Patient Assessment in Emergency Room
  • Emergency Care is administered to Address Breathing and Other Critical Issues
  • Patient Transferred to Acute Care Department or Spinal Cord Treatment Area of Hospital

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Step Three:

Surgery

Some spinal cord injuries require surgical intervention to remove bone fragments, foreign objects, or fractured vertebrae that may be compressing the spinal cord. The surgery will take place once the patient has been stabilized to a level at which he or she can survive the surgery.

The surgery will generally occur as early as is possible. There is some evidence that early surgical intervention (within 24 hours of the injury) may lead to better outcomes for patients who have foreign objects such as bone fragments or other tissue pressing upon the spinal cord.

  • Patient Undergoes Surgery to Remove Foreign Objects (Bone Fragments, Tissue) in Spine
  • Surgery to Repair Broken Areas of Spine
  • Medications Administered to Reduce Inflammation and Promote Healing
  • Patient Carefully Monitored Before, During and After Surgery to Avoid Complications

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Step Four:

Addressing Secondary Medical Problems (Ongoing)

There are many secondary medical issues that may arise, including deconditioning, muscle contraction, pressure ulcers, bowel and bladder issues and infections to the respiratory system, as well as blood clots. Most spinal cord injuries affect the bowel and bladder and can lead to serious complications including kidney damage. Many spinal cord injury survivors experience phantom pain below the injury site including freezing and burning sensations.

Depression is common among spinal cord injury survivors. Pain, fatigue, changes in body image and loss of independence can contribute to depression. It can be treated through counseling and medication.

All of these issues must be carefully monitored so the patient doesn’t develop a condition that could be dangerous or life threatening.

  • Careful Monitoring of Patient Condition
  • Assessment of Issues Such as Bowel and Bladder Function to Avoid Complications
  • Treatment to Address Muscle Contraction and the Development of Blood Clots or Infections
  • Monitoring of Patient Position to Avoid Pressure Sores

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Step Five:

Rehabilitation

The process of rehabilitation provides the tools to help the spinal cord injury survivor deal with the most serious effects of spinal cord injury such as reduced bladder function, muscle spasticity and loss of sensation, and advance toward independence. Rehabilitation marks the transition from a focus on medical treatment to a focus on restoring function to handle daily activities. It starts once the patient has recovered to a degree that the process can be initiated.

As a general rule, a rehabilitation facility that has received accreditation from the Rehabilitation Accreditation Commission for spinal cord injury shows that the facility meets a certain standard of care.

The initial phase of rehabilitation involves regaining as much movement in the arms and legs as possible, depending on the location and severity of the injury. The paralyzed parts of the body often are spastic and the bowel and bladder become spastic as well. The pace of rehabilitation depends on the patient. The earlier it begins, the better for the patient, as movement of the limbs is essential to maintain cardiovascular health during recovery.

There are various systems employed to help spinal cord injury survivors regain a level of independent action. Some of the most common processes used in spinal cord rehabilitation centers include the Dardzinski Method used by WalkAmerica, the processes developed by the National Institute of Neurological Disorders and Stroke Coordination Dynamics Therapy and others, all of which follow a general pattern of treatment and rehabilitation. Newer technologies employed in treating spinal cord injuries allow patients to recover additional functions that were not possible in earlier years.

The team of professionals involved in the rehabilitation process may include a physical therapist, occupational therapist, rehab nurse and psychologist, social worker, a dietician, recreation therapist and a physician who is a specialist in spinal cord injuries. The patient is educated on what to expect, and the importance of maintaining existing muscle function and mobility.

Work will be undertaken for the patient to restore fine motor skills and to learn adaptive techniques to assist in the performance of day-to-day tasks. This process generally takes several months to complete, and the patient will be busy learning new skills and training on how to operate in daily life with impairments.

 

  • Patient Transferred to Rehabilitation Facility or Spinal Cord Rehab Center in Hospital
  • A Full Rehabilitation Program Developed for Patient
  • Physical Therapy Begins
  • Occupational Therapy
  • Intensive Work with Rehabilitation Nurse
  • Training in the use of Medical Equipment
  • Education of Patient on Condition and How to Maintain Health and Mobility
  • Family Trained to Assist Patient
  • Ongoing Monitoring of Progress by Spinal Cord Injury Specialist

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Step Six:

Recovery

The recovery may vary in length, but generally, the level of recovery of function is reached within about six months.

Many patients recover more than their doctors anticipate. The spinal cord had redundant pathways to send signals and people can regain motor skill function even after injuries that damage 90 percent of the neural pathways.

Some people may experience minor improvements in condition for up to a year after the injury.

  • Patient is Assessed for Final Level of Recovery
  • Final Training Prior to Transfer Home

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Step Seven:

Home Care

After the rehabilitation process is completed, the injured person has been trained on how to operate in life with his or her impairments, and is ready to return home. The home must be refitted in many cases so that the individual can move about in a wheelchair, and various areas of the home may need adjustment, including the bathroom.

  • Home Refitted to Accommodate Medical Equipment
  • Patient Transferred Home
  • Ongoing Training for Driving and Other Advanced Tasks
  • Careful Monitoring of Patient Condition (Ongoing)
  • Join a Spinal Cord Injury Support Group

The costs of rehabilitation and ongoing care for spinal cord injury survivors make it imperative to understand your legal options if your injury was caused through the negligence of another party. The attorneys at Hecht, Kleeger and Damashek can review your accident at no charge and explain your legal options.

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