By Matt Lalande in Spinal Cord Injuries on October 16, 2020
Suffering a spinal cord injury is a catastrophic event that changes your life and presents you with challenges you never thought you would have to face. Suddenly, you can’t move your legs and/or your arms. Tasks that were simple and taken for granted before your injury, such as reaching for a glass of water, brushing your teeth, or getting out of bed, are now hard, if not impossible. You have to relearn ways of doing such tasks, which before had been done without even thinking.
During rehabilitation you will learn new ways to adapt your activities of daily living so that you can become as independent and functional as possible. Recovery after spinal cord injury varies, but there are some consistencies in regards to health care that are well known to help ameliorate one’s quality of life after a spinal cord injury. Here are eight things to consider:
Diet & Nutrition & Hydration – diet and nutrition are the foundation and building blocks of maintaining good health after a spinal cord injury. It can be easy to fall back on boxed food and food that’s convenient, the problem is that it’s usually not that healthy for you and frankly doesn’t taste that great. It does take more effort and planning to develop a healthy, affordable and consistent diet plan but it’s an investment in your body. Proper nutrition and hydration are also important in preventing skin breakdown(presure sores) and healing when a wound has occurred. Eating a properly balanced diet provides the vitamins, proteins, and other materials essential for healthy, elastic skin. Drinking plenty of fluids also can improve skin health. Poor fluid intake can result in brittle skin that tears or rapidly breaks down with prolonged pressure.
Exercise– Early on in your recovery exercise and activity are part of the rehabilitation process but as you return home, old routines and complacency can set in and it can be difficult to develop, maintain and be active in a consistent routine. If you’re going to have any hope of developing your strength and maintaining your stamina after a spinal cord injury you need to exercise or focus on strength training. Low impact or low resistance type exercises are recommended by most spinal cord injury doctors, as well as strestching exercises like Tai Chi, and Qi gong are often helpful at improving flexibility, my balance, breathing capacity and lung function.
Research suggests that for people with spinal cord injury, exercise can also prevent secondary conditions, such as diabetes, cardiovascular disease, pressure sores, urinary tract infections, and respiratory disease. In addition, exercise helps prevent deconditioning (getting out of shape) and obesity, and it provides mental health benefits.
Lungs– Immediately after a spinal cord injury, especially an upper level cervical spine injury the strength of your diaphragm and the efficiency of your lungs may be impaired. It is important to focus immediately on the repair and recovery of the diaphragm, lungs, and throat. If you have had a tracheotomy or throat operation it’s important that you listen to your the medical professionals, but if you have the ability to breath on your own it’s immensely important to strengthen your respiratory system early. It’s also important to strenghten your lungs in case you need to clear your airways in the event that you choke while eating or drinking. Remember your former strength and lung capacity is not what it was after a spinal cord injury.
Heart- Your heart is strong and resilient, but needs care and strengthening after a spinal cord injury. Your blood pressure is a major factor in the recovery, care and longevity of your body. Without the assistance of your muscles, your heart will take on the extra burden of pushing blood through your circulatory system.
Spinal cord injury can affect your circulation in two important ways. First, it can change your blood pressure (the force with which your blood goes to the blood vessels). After an SCI, some nerves stop sending the messages to keep your arteries tight. As a result, your blood pressure may stabilize at a level that is lower than before the injury. As a result of this change in circulation, decreased blood pressure may cause you to become lightheaded when you sit or stand up. This change can also cause your heart rate to slow, which may cause dizziness or lightheadedness.
Second, SCI can change how well blood flows from your body to your heart. The muscles affected by the injury no longer flex and relax as they did before your injury, and the blood does not move throughout your body as well as before. These circulation changes may cause edema (swelling) in your legs and hands, depending on the level of your injury, and blood clots in your legs or lungs. When a blood clot stays in the veins in your leg it’s called a thrombus. Swelling, redness, and/or pain most often in a leg can be a sign of a blood clot.
Urinary tract– spinal cord injuries can affect the function of the urinary system and may result in loss of bladder control and urinary tract complications. According to spinal cord injury journals, keeping the urinary tract healthy and free from trauma is often an on-going battle and full time job after a spinal cord injury. The urinary system can’t get messages properly anymore after a spinal cord injury. Nerve centers in the brain and the spinal cord are important to urination (voiding). Communication between these nerve centers occurs through long nerve fibers that run the length of the spinal cord. SCI can affect this communication and therefore, problems with urine storage and bladder emptying may result. Injury to the spinal cord can result in changes in the ability to sense when your bladder is full or your ability to empty your bladder on your own.
Remember – you may be embarrassed to discuss your urinary issues with medical professionals, family members, friends, paid caregivers, or support group members. It is very important to consult medical professionals when you have kidney and bladder problems, such as urinary incontinence, bladder and/or kidney infection, bladder and/or kidney stones and a high pressure bladder. A bladder infection occurs when bacteria enter the bladder and multiply. The most common causes of repeated infections are poor hygiene, incomplete bladder emptying, the presence of a foreign object in the bladder (for example, a bladder stone or catheter) and not completing antibiotic treatment for a previous infection.
Skin integrity– your skin is your largest organ and must be protected especially if you lack sensation. Your skin can break down through direct cutting, tearing, shearing, pressure from sitting and tight fitting clothing. Skin can break down from direct contact to moisture and perspiration. Wrinkles in clothes can irritate your skin along with heavy seams, bunched up pockets, and snug waistbands. Sitting or lying in one position for long periods can cause skin break down. Good nutrition can play a major factor in both protecting and maintaining skin integrity along with healing and repairing already damaged skin.
It’s recommended by doctors that you should inspect or direct the inspection of your skin every morning as you bathe and dress for the day and every evening /night as you undress for bed. Any changes in the condition of your skin should be identified by description, measurement, and cause of damage. Inspecting your skin less than twice a day will make identifying the cause more difficult (by having to assess a 24-hour period of time versus a 12-hour period of time). Such delay allows more time for damage before resolving the problem. Remember to direct others or to personally look for any areas of skin that are darker than your natural skin tone, red areas, bruises, cuts, scrapes, or swollen areas. These indicate potentially serious skin damage that should be immediately addressed and monitored. Breaks in the skin surface should be discussed with your physician and/or SCI treatment team.
Pressure Sores – are preventable injuries but the hardest to heal. Again, your skin is your largest organ and first defense against foreign bodies and infection. Pressure wounds occurs from poor circulation and lack of oxygenated blood to an area of the body that has had too much weight on it. Remember, your circulation to your skin after your injury is no longer normal. It is not getting as much blood flow as it was before your injury. Areas of your body that are padded with lots of skin, like your thighs, are going to have more blood flowing to them than areas that are mainly bony, like your elbows, heels, hips, ankles, shoulders, back, low back, and the back of the head. When the skin in an area of your body has had the blood flow cut off to it, it dies. The skin turns red or dark purple. The darker your skin, the darker the area of the pressure sore. The area may feel warmer to the touch than the surrounding skin. Pressure sores can be mild or can be severe. More severe pressure sores can go into the muscle. Very severe pressure sores can go into the bone. The stages of a pressure sore start with reddened skin. If the pressure sore gets worse, the reddened skin forms a blister. The blister then forms an open wound. The open wound can become a crater. Also, You should be aware of the signs of infection so you can seek proper medical care. The signs of infection are:
– Thick yellow or green pus
– A bad smell from the sore
– Redness or warmth around the sore
– Swelling around the sore
– Tenderness around the sore
The signs that the infection has spread to the rest of the body are fever or chills, mental confusion or difficulty concentrating (more than normal if you have mental confusion or difficulty concentrating already), rapid heartbeat and weakness.
Remember, if you’re in bed or in a wheelchair, change your position no less than every two hours. If you are in a manual wheelchair, it’s importnat that you learn how to perform manual pressure releases. If you are in an electric wheelchair that tilts back, you can perform a pressure release electronically.
Mental Health – the physical changes caused by SCI can be emotionally devastating, even for the most psychologically well-functioning individuals. The big challenge of adjusting to the change in your psychological sense of self and your relationships with the rest of society comes with the change in your view of your physical self. At first, you probably had a great deal of free time in the hospital and thought a lot about what happened to you. Maybe more importantly, you probably also thought about what would happen to you in the future. As the days passed, you received more and more information from professionals, family, friends, and other patients, or you found information on your own. All of this information and thinking may have made you ask questions like, “Will I ever be able to walk and/or hold things like I did before my injury or illness?” Some experts have compared spinal cord injury survivors’ reactions to the grief process of a person who has lost a loved one. After all, SCI, like death, involves a loss—that of the ability to move and/or feel certain parts of the body. It’s important that spinal cord injury victims obtain proper psychological help if available, to help deal with the stages of grief, shock, depression, anger, anxiety and denial – experienced by many.
If you’ve suffered a spinal cord injury due to the neligence or fault of another person, driver or company, it’s important that you speak to a lawyer with experience that can help assist in the discharge home, deal with insurance aspects and ensure that you are taken care of financially. Living well with a spinal cord injury can require a lot of rehabilitation, medical care, and special equipment – which can cost in the millions over a person’s lifetime, depending on the age of the victim and the extent of the spinal cord injury.
As you move from the rehabilitation setting back into your community, you will no doubt need more supports and services that may not be covered OHIP, such as assistance with personal care, such as bathing, eating, and dressing; meal preparation and household chores; disability-accessible transportation; assistance with shopping for groceries and personal care supplies and changes to your home to improve access to your living space. It’s important that these cost of your requirements are considered from the start of your case – especially if someone caused your injury.