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Paraplegia After Spinal Cord Injury
WHAT YOU SHOULD KNOW:
- Paraplegia (payr-ah-PLEE-jah) is a type of spinal cord injury (SCI). You may become paralyzed if you were in a car or sports accident and break your back. Having a tumor or other diseases in your spinal canal also can cause paraplegia. Paraplegia means that the part of the spinal cord inside your back has been injured. The symptoms of paraplegia are different depending on where and how badly your spinal cord is injured. You may have one or more of the following signs or symptoms:
- Your muscles may be limp, especially in your arms and legs.
- You may not be able to move and feel anything below the damaged area.
- You may not be able to control your bowel (BMs) or bladder (urine).
- It is possible for the nerves to start working again if you spinal cord is just bruised or swollen. The longer that there is no change in your signs and symptoms, the less likely that you will see improvement.
CARE AGREEMENT:You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.
- Many problems may happen after a spinal cord injury. Some of these problems include having your blood pressure go too low or your heart beat too slowly. You may have trouble breathing, or be unable to breathe on your own. Being paralyzed can cause skin sores and muscle contractures.
- A spinal cord injury increases your risk of getting a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
- Sometimes your body cannot respond correctly to problems like bladder or bowel problems. This is called autonomic dysreflexia , and it causes your blood pressure to get very high. If not treated quickly, this can cause a stroke or even death. If you have paraplegia and do not get treatment, you may not be able to safely care for yourself. Talk to caregivers if you have questions or concerns about your medicines or care.
WHILE YOU ARE HERE:
What happens right after my spinal cord injury?
- Decreasing movement: Caregivers work very hard to make sure your spine does not move. A rigid (hard) collar with blocks and a back board with straps are used to stop any movement. This is especially important while you are being transported (moved) to the hospital. This may be uncomfortable but is very important in preventing more injury to your spinal cord. You may then be put in a special bed to continue to keep your spine stable and to help prevent skin problems.
- Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
- Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
- An IV is a small tube placed in your vein that is used to give you medicine or liquids.
What happens once I am in the hospital?
You may be taken to the intensive care unit (ICU) after leaving the emergency department. You will be monitored very closely while in the ICU. Following are some of the things that caregivers do to watch you closely:
- Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
- Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
- Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
- Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
- Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
- Vital signs:
- This includes checking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To check your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine, which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope.
- It is very important for your blood pressure not to get too low right after a spinal cord injury. When your blood pressure gets too low, less blood flows to your spinal cord. This can cause even more damage to your spinal cord. Caregivers check your vital signs often, especially right after the injury.
What tests can my caregivers do to learn how badly my spinal cord is injured?
From test results, caregivers will learn about your SCI, and plan your treatment. You may need one or more of the following tests:
- Neurologic tests: Caregivers may ask you questions, and do sensation (feeling) tests. You are asked to try moving different parts of your body and to describe what you feel. Caregivers may use pinpricks, touching, or repositioning of your arms and legs. These tests help caregivers find out whether you have a complete or incomplete spinal cord injury.
- X-rays: These tests show where along the spine the damage happened. If you cannot move into positions needed for x-rays, caregivers may order a CT scan or MRI.
- CT scan: This test is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your neck and spine. Your caregivers look at the pictures to see areas that the x-rays showed might be injured. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps the spinal cord show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish.
- MRI: This test is also called magnetic resonance imaging. MRI allows your caregivers to see inside your body. During the MRI, pictures are taken of your neck and spine. Caregivers use these pictures to show where and how much damage of your spinal cord has occurred. An MRI may be needed if you are in pain or having muscle spasms.
Can my spinal cord injury be fixed?
No, the injury to your spinal cord cannot be repaired, even with surgery.
- You may need surgery to stabilize (support) the bones in your spine. Pieces of vertebra or disc may be pressing on the spinal cord or nerve roots coming out of the spinal cord. You may need surgery to remove these pieces of bone or disc. Surgery also can be done to line up the bony spinal column. Caregivers may use bone from your hip, or metal rods and screws to support your spine.
- You may need a halo brace or a Philadelphia collar if the bones or ligaments that support your spine are injured. Another type of brace may be used if the injury is in your chest or lower back area. These braces include a clamshell (plastic body jacket) or a plaster or plastic body cast.
- You may be able to have surgery or use pieces of equipment to help you move. Surgery may not be done for a year after your SCI to allow you to recover as much as possible.
- Muscle tendon transfer: This is a type of surgery that would help you straighten your elbow and strengthen your hand grip.
- Functional electrical stimulation (FES): FES is used to stimulate a muscle with electricity to make it move. Electrodes may be placed on your skin or put into your muscle during surgery. This may help with some activities, such as sitting upright or finger movement.
What will be done if I have breathing problems?
- Your breathing muscles and nerves may not work correctly after a SCI. You may not be able to inhale as much air, and it may take more effort to breathe. This makes it much easier to have breathing problems, such as pneumonia. You may also have respiratory failure (be unable to breathe for yourself).
- If you cannot breathe for yourself you may need an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may be put into an incision (cut) in the front of your neck. The tube may be connected to a ventilator, which is a machine to breathe for you. You may need one or more of the following to treat your breathing problems:
- Phrenic nerve electromyography: The test is also called EMG. It measures the electrical activity of the breathing muscles at rest and when they are in use. An EMG also tests the phrenic nerves that control muscles.
- Pulmonary function tests: These tests help caregivers learn how well your lungs work and are also called "PFTs." PFTs may also help your caregivers decide on the best treatment for you. During the tests you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers learn how well your lungs are moving and working. You may feel short of breath after these tests.
- Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
- Respiratory care: Caregivers will work very closely with you to help your lungs work as well as possible and to prevent problems. How much trouble you have breathing depends on where your spinal cord is injured. You may need a mechanical ventilator to breathe for you. An endotracheal or "ET" tube in your throat, or a trach in your neck is hooked to a ventilator. Oxygen can then be given to you by the ventilator. Ask your caregiver for more information about pulmonary hygiene for people who have a SCI.
What are contractures?
Contractures happen when muscles, tendons, or ligaments in your body shorten. This results in less movement of a joint, such as your knee or ankle. Contractures can begin to happen as early as one week after your spinal cord injury. Contractures can be caused by nerve changes from the spinal cord to the muscles. Spasticity is when your arms or legs move uncontrollably, and may also cause contractures. Ask caregivers for more information about preventing and treating contractures.
What are common problems after a spinal cord injury?
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common problems after a SCI. These problems can be life-threatening. A DVT is a condition that happens when a thrombus (blood clot) forms in a vein. A PE is a condition that happens when a thrombus blocks a pulmonary (lung) artery.
How can I know if I am developing a DVT or PE?
Caregivers will teach you the signs and symptoms of a DVT and PE. The symptoms of a DVT include tenderness, pain, swelling, warmth, or skin color changes at a spot on your leg. The symptoms of a PE include very bad and sudden chest pain and difficulty breathing. Blood in your sputum (spit) is another symptom. Tell your caregivers if you feel or see any of these problems.
- Arterial doppler: This test is done to see how much or how little blood is flowing through an artery (blood vessel). A small machine is placed on the skin over the artery. You can hear a "whooshing" sound when the blood is flowing through the artery. An "X" may be marked on your skin where caregivers feel or hear the blood flowing best. The doppler may be used to see if you are developing a deep vein thrombus.
What can be done to prevent and treat a DVT?
Caregivers may give you medicine to slow your blood from clotting. You may have a bed that rotates to keep your blood moving well through your body. The bed also helps stop pressure from being placed on any part of your body for too long.
- Pressure stockings: These tight elastic stockings help keep blood from staying in the legs and causing clots.
- Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the boot or legging. This helps push the blood back up to your heart to help keep clots from forming.
- Vena cava filter: Caregivers may suggest that you need a special filter called a vena cava filter put into a blood vessel to collect clots. You may need this surgery if medicines and other treatments are not enough to stop DVTs and PEs.
How will I eat and drink?
- Diet: At first after the SCI, caregivers may not have you eat. You may have a nasogastric (NG) tube in your nose to keep your stomach empty. You may also be fed through this tube for a short time. When you are able to eat food again, you may need to have help feeding yourself. Family and friends may want to spend time with you helping you eat. You may need to use special utensils and dishes. Eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy.
- Drinking liquids: Men 19 years old and older should drink about three Liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about two Liters of liquid each day (about 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
What medicines may I need to take?
You may need to take one or more of the following medicines:
- Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
- Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
- Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
- Antiulcer medicine: This medicine helps decrease the amount of acid that is normally made by the stomach.
- Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
- Blood thinners: This medicine helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
- Diuretics : You may get medicine to help keep your spinal cord from swelling. This medicine may also be given to decrease swelling that may be pressing on your spinal cord.
- Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
- Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
- Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
- Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
- Steroids: This medicine may be given to decrease inflammation.
What is occupational therapy?
- Occupational therapist (OT) caregivers will help you learn how to care for yourself as much as possible. This therapy teaches you special skills for bathing, dressing, preparing a meal, house cleaning, eating, and possibly driving. An occupational therapist will help you choose special equipment to help you at home. You may be able to return to the kind of work you did before the SCI. Occupational therapists can help you learn new ways to do things and learn how to use tools to accomplish things.
- An OT also looks at your home and workplace, and suggests changes that you will need. The OT also teaches your family members and caregivers safe ways to help care for you. He may suggest ways to keep your home or workplace safe. These ideas may prevent falls and keep you from being injured. Occupational therapy will also help you become active in your community outside of the hospital.
What is physical therapy?
- Physical therapist (PT) caregivers help you increase strength and endurance and improve coordination. The therapists work with you to reduce spasticity, keep muscles strong, and protect your skin from pressure sores. Spasticity is when your arms or legs move without you wanting them to, or they resist being moved.
- Physical therapists can help you have better control over bladder and bowel function. PTs also teach you ways to use assistive devices, such as wheelchairs or braces. They will teach you how to prevent falls and injuries. PTs may work with your joints to help you keep full range of motion. Physical therapists also use methods such as ultrasound, hot packs, and ice.
What will caregivers do for me if I am in pain?
- Some people continue to have nerve pain after a SCI. Different kinds of medicines can be used to control your pain. Treatments, such as nerve blocks and transcutaneous electrical nerve stimulation may work well. Ask your caregivers for more information about these treatments.
- Your caregiver may suggest that you go to a pain clinic to help you learn new ways to live with your pain. There are many ways to help control pain, such as relaxation therapy or special breathing exercises. People at a pain clinic can teach you these different methods so that pain medicines are not the only way to control your pain.
Why is skin care so important?
- Being paralyzed can cause serious problems for your skin. You may develop decubitus ulcers. These are also called pressure ulcers or sores, bed sores, or ischemic ulcers. A pressure sore happens when an area of skin or the tissue under the skin is dead or dying. This is caused when the blood flowing to the area is slowed down or stopped.
- Pressure sores happen most often when you sit or lie on a bony area for too long. Bladder or bowel accidents can wet your skin, making your skin even weaker. You may not feel a cut or scratch until it has become a larger problem. Sliding from the bed to a chair or having muscle spasms can rub or tear your skin. Caregivers will help you prevent pressure sores. Therapists will teach you how to move to keep from putting pressure on one area for too long. Ask for more information about how to care for your skin when you have a SCI.
What is autonomic dysreflexia?
Autonomic dysreflexia is a condition that happens when your body reacts to a problem. Common problems causing autonomic dysreflexia include having a full bladder, or being unable to have a bowel movement. It is also called "AD" or autonomic hyperreflexia . This very serious emergency can be life threatening. AD causes your blood pressure to go dangerously high. High blood pressure can cause a stroke, seizure, and even death. It is most common in people who have a SCI at or above the sixth thoracic (chest) level (T6). Ask caregivers for more information about autonomic dysreflexia.
What is neurogenic bladder?
Having a SCI can change the nerve pathways from your brain to your bladder (the organ where urine is stored). Neurogenic bladder is a condition where you cannot tell when your bladder is full, or cannot stop it from emptying.
- Bladder training: You may lose some or all of your bladder control after a spinal cord injury. Caregivers can work with you to teach your body to urinate at specific times each day. This helps prevent urine from building up and overflowing from your bladder. A bladder training program includes this and other methods to empty your bladder. Ask caregivers for more information about neurogenic bladder and a bladder training program.
What is neurogenic bowel?
Neurogenic bowel is a condition where the brain and nervous system cannot control bowel functions after a SCI. Having a SCI changes an interrupt the nerve pathways from your brain to your gastrointestinal or "GI" system.
- Bowel program: Most people with a SCI can learn how to control their bowel function. A bowel program is started while you are in the hospital after having a SCI. Bowel programs help you get rid of BM at regular planned times. This will help prevent or decrease the chance of having a BM when you do not want to. A bowel program will also help prevent constipation, impaction, and obstruction. Ask caregivers for more information about neurogenic bowel and a bowel training program.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.