Types of Treatments for Spinal Cord Injuries
Current treatments for spinal cord injuries focuses on preventing further complications and allowing patients to return to as active a life as possible. Immediately after the injury, urgent medical attention is critical to minimize the effects of any head or neck trauma; for this reason, treatment for a spinal cord injury should begin at the scene of the accident. Emergency responders should immobilize the spine as gently and quickly as possible, using a rigid neck collar and a rigid carrying board, which will be used to transport the patient to the hospital.
During the early stages of treatment, care should be focused on maintaining your ability to breathe, preventing shock, preventing further damage, and avoiding complications. Sedation may be necessary to keep a patient immobile and prevent further damage while diagnostic tests are performed. If a spinal cord injury victim is given methylprednisolone within eight hours of an injury, he or she may experience a mild improvement in outcome because the drug helps reduce damage to nerve cells and decrease inflammation near the site of the injury.
Immobilization, Surgery & Rehabilitation
After a spinal cord injury, traction to stabilize the spine or bring it into alignment may be necessary. Traction may involve securing metal braces, attached to weights or a body harness, to the skull to keep the head stable. A rigid neck collar may work in less severe cases. Surgery may be necessary to remove items that are compressing the spine, or to stabilize it to prevent future pain or deformity. Rehabilitation should begin in the early stages of recovery. A rehab team will likely include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, dietitian, recreation therapist, and a doctor with expertise in physical medicine or spinal cord injuries.
At the beginning, therapists will usually focus on maintaining and strengthening existing muscle function, relearning fine motor skills, and working on techniques that will allow the patient to accomplish daily tasks. Other portions of rehabilitation will include: Oral medications, orthopedic procedures, bracing and splinting, and injectable medications may be used to manage spasticity. These types of treatments are usually combined with therapies, such as stretching, positioning, and movement exercises.
Some new treatment options have also emerged:
- Injections of medications like phenol and Botox directly into the muscle.
- Surgical implantation of an intrathecal baclofen pump can deliver medication directly to the brain and spinal cord, targeting spasticity in both the lower and upper limbs. Patients must submit to a trial period to see if they are good candidates.
Restoring Function & Mobility
Therapy can improve some patients' physical function in the upper extremities. Exercises designed to stimulate nerve re-education, muscle strengthening, task training, and others can help reduce long-term complications and regain the ability to perform self-care and other daily activities. Functional electrical stimulation (FES) is a therapy that improves functional abilities by using computer technology to send low-level electrical impulses to contract muscles in the legs, arms, hands, or other areas. This may promote improvements in muscle tone or control.
FES may also improve range of motion, strength, and the functional use of hands, arms, or legs. FES may allow spinal cord injury patients to grasp or hold an item, or move arms or legs in a cycle or stepping motion. FES can also help patients perform exercise to improve blood circulation, aerobic conditioning, heart health, and overall wellbeing. FES can also help improve muscle movement patterns, prevent bone density loss, and reduce spasticity. Diaphragm pacing involves a minimally invasive procedure to implant four electrodes into the diaphragm muscle and a fifth just below the skin near the other electrodes. These electrodes are then connected to an external stimulator, causing the diaphragm to contract and helping with breathing.
Diaphragm pacing can have the following benefits:
- Reduce or eliminate the need for a ventilator
- Help patients breathe and speak more naturally
- Make daily activities easier to accomplish
- Decrease the risk of contracting respiratory infections
- Improve senses of smell and taste
- Increase mobility
- Reduce need for external power sources to maintain breath
Bladder management options include:
- Medication: Certain medications improve bladder function by reducing bladder contractions, lowering urinary frequency, improving bladder control, increase bladder storage, and assisting to empty the bladder.
- Intermittent Catheterization: A patient or care provider inserts a thin tube through the urethra and into the bladder several times a day to empty it.
- Continuous catheter drainage: A health care professional inserts a catheter through the urethra or abdominal wall and into the bladder to continuously empty it
- Surgery: Bladder reconstructive surgery may resolve or improve bladder symptoms and management.
Bowel management options include:
- Medication: Medications can help manage the timing and consistency of bowel movements.
- Anal irrigation: Anal irrigation is a new deigned to fight constipation and facilitate effective bowel movement management.
- Surgery: Reconstructive surgery may resolve difficulties in bowel management.
Treatment from Rehabilitation Centers
Wheelchair programs at rehabilitation centers will assess patients to determine what form of mobility assistance they will require to navigate their home, work, and community environments. A good program should allow the patient to try a wide variety of manual and power wheelchairs in different environmental challenges.
Selecting the appropriate wheelchair will allow a patient to:
- Maximize independence and safety in the home
- Improve posture and function in the wheelchair
- Prevent secondary problems from improper seating
Music therapy is a staple at many rehabilitation centers. A music therapist addresses the cognitive, speech/language, physical, and psychosocial needs of a patient, using Neurologic Music Therapy techniques. Music therapy can help facilitate functional movements and/or cognitive and speech behaviors. Music therapists also use song writing to help individuals cope with their new reality.