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:
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.
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:
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.