What's the treatment and rehabilitation for spinal cord injury?

A person who may have a spinal cord injury should not be moved. Treatment of SCI begins with immobilization. This strategy prevents partial injuries of the cord from severing it completely. Use of splints to completely immobilize suspected SCI at the scene of the injury has helped reduce the severity of spinal cord injuries in the last two decades. Intravenous methylprednisone, a steroidal anti-inflammatory drug, is given during the first 24 hours to reduce inflammation and tissue destruction.

Rehabilitation after spinal cord injury seeks to prevent complications, promote recovery, and make the most of remaining function. Rehabilitation is a complex and long-term process. It requires a team of professionals, including a neurologist, physiatrist or rehabilitation specialist, physical therapist, and occupational therapist. Other specialists who may be needed include a respiratory therapist, vocational rehabilitation counselor, social worker, speech-language pathologist, nutritionist, special education teacher, recreation therapist, and clinical psychologist. Support groups provide a critical source of information, advice, and support for SCI patients.

People with spinal cord injuries are strapped to a firm board before being moved to a hospital. Movement without this precaution can completely sever the cord. A drug called methylprednisone, which is a steroid-type anti-inflammatory drug, is given intravenously during the first 24 hours to help reduce inflammation and swelling, and the destruction of tissue around the spinal cord. If blood has accumulated around the spinal cord, it will be removed to reduce pressure on the area. Surgeons may also insert steel rods around the spinal column to stabilize it. A compressed spinal cord is treated by removing the cause of the compression through surgery or radiation therapy. If the compression is caused by an infection, it is treated with antibiotics and draining the abscess, which is the source of infection. When spinal cord injury causes paralysis and loss of sensation, treatment is aimed at rehabilitating the patient to help him or her regain as much function as possible.

Rehabilitation after spinal cord injury requires a great deal of support and patience, and involves a team that might include neurologists, rehabilitation specialists, physical therapists, occupational therapists, respiratory therapists, social workers, speech therapists, nutritionists, special education teachers, recreation therapists, and clinical psychologists. Complications of paralysis, such as pressure ulcers, can be prevented by making sure the patient is turned frequently in bed. A regular program of physical therapy that includes range of motion exercises can help prevent muscle contracture. In severe cases, surgery may be necessary to cut the shortened tendon and release the contracture. In cases where heterotopic ossification is a problem, the patient is given a drug containing etidronate disodium to help to regulate the body’s calcium use. It is extremely important to pay close attention to bowel and bladder care for patients with spinal cord injuries. Keeping the area clean can help prevent autonomic dysreflexia. Patients who have lost bowel control may require stimulation through pressure on the abdomen to help move the bowels. Patients with loss of bladder control may need to be catheterized by inserting a thin tube through the urethra to the bladder to drain urine into a collecting bag. It is important to provide the patient with sufficient fluids and a fiber-rich diet. Research has found that paraplegic patients may respond to electrical stimulation of the muscles. This approach is still experimental, but may offer some the ability to walk without assistance. 85% of patients with spinal cord injuries who survive the first 24 hours are alive 10 years later. The amount of function that can be recovered depends upon the location and severity of the injury.

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