What to expect after a catastrophic spinal cord injury

What to expect after a catastrophic spinal cord injury

The period directly following a spinal cord injury can be incredibly difficult for the person affected and their family. However, learning more about what a serious spinal cord injury means, and what may occur in the near future is very important.

Spinal cord injuries can affect people in all sorts of ways. Aside from the known physical effects that such an injury can have on the body, those who suffer such an injury also have to learn to live with the mental and emotional effects. Of course, they are not alone. It is estimated that there are currently about 50,000 people living with a spinal cord injury (SCI) in the UK today – and that there are about 2,500 people who are newly injured in such a way every year.

People of all ages, ranging across every demographic, live with an SCI. According to a 2010 report about spinal injuries in Britain, roughly 80% of spinal cord injuries are a result of trauma or an accident – such as a fall or a road traffic accident. This is what is referred to as a ‘traumatic’ SCI, whereas ‘non-traumatic’ SCIs refers to when the injury has been caused by illness. Of course, all SCIs can be traumatic. This is true of both the person living with such an injury and their family.

For those who have been newly injured and their families, it can help to read about and understand the processes surrounding the diagnosis, rehabilitation and recovery of those with spinal cord injuries. At Better Healthcare, we’ve curated a comprehensive guide to help people better understand spinal cord injuries, how they are diagnosed and the processes involved on the road to recovery.

What is a spinal cord injury?

To understand spinal cord injuries, it’s helpful to define what the ‘spinal cord’ is. The spinal cord is a grouping of nerves and tissue that extends from the base of your brain to the bottom of your back protected by 33 rings of bone (vertebrae) and spinal fluid.

For a person to have full control over their bodily functions and mobility, the health of the brain and the spinal cord are of the utmost importance. It’s the conduit for communication between your brain and your organs, muscles and nerves. It’s how the brain sends message to arms and legs to get them (or try to get them) to move and why we can feel pain.

Injury to the spinal cord may interrupt these messages pathways, leading to a partial or total loss of control, movement or feeling in parts of the body. This not only includes limbs but internal organs too. How much your body can be affected by such an injury is determined by the type of damage to the spinal cord. For example, injuries closer to the neck can paralyse most of the body, while damage lower down the spine will affect the areas below the damage.

As stated earlier, the spine is made up of 33 vertebrae with spinal nerve roots in between. Those vertebrae are grouped into four regions.

  • Cervical vertebrae (C1 to C7) and spinal nerve roots C1 to C8 – the neck region
  • Thoracic vertebrae (T1 to T12) and spinal nerve roots T1 to T12 – the chest/dorsal region
  • Lumbar vertebrae (L1 to L5) and spinal nerve roots L1 to L5– the lower back region
  • Sacral vertebrae (S1 to S5) and spinal nerve roots S1 to S5 – the pelvic region

When one of these areas is damaged, it can disrupt and destroy communication between segments of the spinal cord and lead to paraplegia (leg paralysis), quadriplegia (leg and arm paralysis) and hyperreflexia (overresponsive or overreactive reflexes which may lead to dangerously high blood pressure levels).

What happens following a spinal cord injury?

If someone has a spinal cord injury – often as a result of a road traffic accident, fall or sporting accident – the immediate signs of such an injury are almost always physical. The person may partially or totally experience one or more of the following symptoms:

  • A loss of movement in the legs
  • A loss of movement in the chest, trunk, arms or hands
  • A loss of bladder and bowel control
  • A loss of feeling in some regions of the body
  • Stinging sensations, pain and spasms
  • Difficulties breathing (if the injury was to the upper neck)
  • Changes to sexual sensitivity, fertility and function

While most of these symptoms are going to be noticeable if someone has been in an accident, it can be harder to spot in those who develop a ‘non-traumatic’ spinal cord injury – with it reliant on the person affected to notice changes in their bodily movements and functions.

Some of the aforementioned symptoms may be partial – so there may be changes to a person’s ability to walk that isn’t necessarily paraplegia.

Diagnosis of a spinal cord injury

Correct diagnosis of an SCI is typically achieved through observation by medical professionals at a hospital, through consultation of the person’s medical history and the context through which the affected person had come to experience the symptoms. Time is crucial – especially when the injury is the result of an accident. The best chance of recovery is linked with the sooner treatment is sought out.

The medical history can be contextually relevant as it may reveal previous complaints to a GP or other healthcare professionals that could indicate some level of pre-existing spinal cord injury symptoms or other inter-related medical conditions.

Doctors will test the patient’s muscles and reflexes – particularly in the arms and legs. It is not uncommon for the person to be immobilised on a backboard while such checks are taking place as movement can lead to further damage. From here, X-rays will be performed of the neck and back to identify any vertebrae dislocations or fractures that can occur in some spinal cord injuries. Additionally, if the spinal cord injury is of non-traumatic origin, an X-ray can help identify any infections, tumours or arthritis that may be causing the problem.

The next step is a computed tomography (CT) scan to identify any further injuries to the vertebrae not observable via X-ray. A magnetic resonance imaging (MRI) scan may also be employed to examine the ligaments, nerves, intervertebral discs and, of course, the spinal cord. An MRI is better suited to helping doctors evaluate any damage or problems with the soft tissues than a CT scan.

A few days after an injury has been identified, further neurological examinations can help doctors assess the totality of the injury, and tests may be performed to determine the person’s sense of touch and the strength of their muscles.

Following the realisation or diagnosis of an SCI, there’s a lot of focus on the physical complications and difficulties. However, it’s worth noting the emotional and mental distress that the affected person and their loved ones can go through.

Both depression and anxiety are incredibly common in the early days as people are left wondering if their life will ever be the same again. This is a normal response. Loved ones who are providing emotional support to the affected person can be of great help in these uncertain times. However, some organisations, such as Back Up, can also help the affected person and their loved ones come to terms with the traumatic experience.

Treatment of spinal cord injury

Once the injury is understood, specialists will weigh up the various treatment options. Some level of recovery is possible for every person, but the levels of recovery can vary. This is due to there being no way to reverse the damage caused to the spinal cord wholly. Nevertheless, new treatments surrounding cell regeneration continue to be researched and great strides have been made over the years. As such, a lot of treatment focuses on minimising the damage caused by the injury.

As SCIs are often the result of a severe accident or trauma, treatment typically begins at the scene of the accident. The key is to immobilise the spine as quickly as possible, but also as gentle as possible. Often this is done via a rigid carrying board as well as a rigid neck collar.

At the hospital, the first priority for doctors is to ensure the person is breathing and isn’t in shock so that any other potential complications are avoided (such as respiratory and cardiovascular difficulties, or deep vein blood clots). Usually, people are transferred to a specialist spine injury ward or centre where neurosurgeons, spinal cord specialists, orthopaedic surgeons and other expert healthcare professionals can assess and treat the injury.

Treatment options include: medication, which is sometimes used to treat acute SCI; immobilisation on special beds to help align the spine; and some experimental treatments may be employed to promote nerve regeneration, prevent cell death and moderate inflammation.

Surgery is often an essential treatment option. This may be done to stabilise the spine, to control or prevent further complications or, more commonly, to remove bone fragments, herniated disks, fractured vertebrae and any foreign objects that are causing compression on the spine.

Outside of surgery, other complications can also arise that may also need separate treatment, including:

  • Pressure sores
  • Blood clots
  • Urinary tract infections (UTIs)
  • Bowel incontinence
  • Muscle spasms
  • Pneumonia
  • Chronic pain
  • Depression and anxiety

From here, the focus is primarily on rehabilitation.

Rehabilitation and the road to recovery

It’s difficult to know what to expect after a spinal cord injury. Furthermore, there is a lot of uncertainty on the road to recovery as every person’s recovery is different. However, it’s usually within the first six months after the injury that significant mobility and function improvements are made. Generally, it’s thought that the level of function and mobility achievable by a person following an SCI is apparent by 12 months. Any issues remaining by this point are, unfortunately, likely to be permanent.

During the early days of recovery, rehabilitation teams will work with the patient to maintain and strengthen muscular function, teach adaptive techniques including how to cope with day-to-day tasks and the re-development of the fine motor skills. As such, the person will be taught many new skills and will be encouraged to continue with activities they enjoyed doing before the injury, stay social and return to either work or studies.

During this period, support is essential – both physically and emotionally. There are devices designed to assist people in getting around and continuing with everyday life, but emotional support is just as crucial. Depression and anxiety are common in those with a spinal cord injury as their life has gone through an unpredicted and drastic change.

Substance abuse and other complex life changes resulting from a difficulty to cope emotionally may derail recovery efforts, so it’s vital that the affected person receives support as they work to get back to a good place mentally and physically.

Better Healthcare carers can help with recovery

Having support around the home is also very important. Lots of people who are living with a spinal cord injury (SCI) go back to their homes but find dealing with what were previously simple tasks is now challenging. It may also be a stressful time for family members or friends who live with the person injured as they find that their responsibilities change.

One of the ways to help ease this pressure and to encourage further recovery and rehabilitation is to hire a professional care worker. Experienced care workers can be of great assistance with not only physical tasks but also in providing moral and emotional support.

Help can be in the form of assisting with any physiotherapy exercises or even just providing some companionship around the house. It also includes moderate housework, preparing meals or even buying and collecting shopping and prescriptions, respectively. This is precisely what Better Healthcare’s carers do for those living with spinal cord injuries.

Our qualified, professional carers can provide home care and live-in care services. At Better Healthcare, our people-centred services are tailored to the specific needs of our clients – meaning that we can be there as often as you want.

For more information on how our home care and live-in care workers support people recovering from spinal cord injuries, give our team a call on 0800 668 1234 or get in touch with your local Better Healthcare office today.