The Covid-19 pandemic has been an unprecedented time for all, with or without disability. Persons with spinal cord injury are more vulnerable than others, and were left to fear severe complications and poor disease outcome. When confronted with protective measures and a lockdown, the physical, psychological and social needs of those persons in a wheelchair cannot be overstated. That’s why this year focus Spinal Cord Injury Day 2020 will be on the prevention of Covid-19 for persons with spinal cord injury, with the slogan “Covid-19 and SCI: Staying well”.
According to World Health Organization (WHO) between 2,50,000 and 5,00,000 people suffer a spinal cord injury (SCI) around the world, every year. Most of the spinal cord injuries are due to the avoidable reasons such as road accidents, falls or violence. As per the statistics from USA, depending on the severity, SCI can cost an injured individual USD 334,000 to 1 million in the first year after injury. Costs in each subsequent year range from USD 41,000 to 178,000. And it isn’t always bad luck that causes spinal cord injuries. Approximately 2500 people sustain a spinal cord injury every year in the UK.
Spinal Cord Injury Day
Keeping in view of its importance, International Spinal Cord Society (ISCoS) has decided to observe ‘Spinal Cord Injury Day’ on 5th September every year with the intention of increasing awareness amongst the general public. It is presumed that the awareness would facilitate an inclusive life for persons with disability and ensure greater chances of success of prevention programs.
The goal of management is to get the spinal injured to lead an inclusive life. Because of the permanence of disability in complete injuries, prevention assumes special significance. The common saying is, ‘Prevention is better than cure’. But in fact, where a spinal cord injury is concerned, ‘Prevention is Cure’. Most spinal cord injuries can be prevented.
ISCoS promotes the highest standards of care for spinal cord injured throughout the world. Through its medical and multi disciplinary team of professionals ISCoS endeavours to foster education, research and clinical excellence. Hence it is only appropriate for ISCoS to take up such an initiative with the potential of having a significant impact globally. The affiliated societies of ISCoS will be helping ISCoS implement its action plan globally. ISCoS is approaching world bodies including WHO, UN, UNICEF, etc to declare 5th September as an official SCI Day.
Prevention is Cure
- Always wear a seatbelt when driving or riding in a motor vehicle and use child safety restraints in the vehicle.
- Always wear a helmet when riding a motorcycle or bicycle.
- Never drive a motor vehicle under the influence of alcohol or drugs, or ride with anyone who has.
- Avoid distractions (like phone calls, texting) while driving and pay close attention to the road.
- Follow the speed limits and traffic rules.
- Keep a clean home and eliminating fall hazards inside the house. Slips and falls occur frequently in the home.
- When participating in sports, always use appropriate protective equipment.
- Never dive into shallow and dirty water.
- Use window guards to prevent falls
- Use clinical interventions for risk factors, such as visual impairment, alcohol or substance use.
- Safe road infrastructure, safe vehicles, proper enforcement of traffic rules, and timely and effective emergency care are essential components in reducing incidence of spinal cord injuries.
About Spinal Injuries
Spinal injuries can turn your whole life upside down in an instant so they can be devastating. 21 to 30-year-olds are the age group that are most likely to be spinally injured, but it can happen to people of any age.
There are several different types of spinal injury depending on how far up the spinal cord the damage occurs. Some types of spinal injury will result in paralysis below the site of the injury, and others may not cause paralysis. It all depends on how damaged the spinal cord is.
Spinal cord injury (SCI) and the resultant paralysis has devastating physical, mental, social, sexual and vocational consequences for the injured. In addition, the injury increases the economic burden on the person who sustains an SCI and potentially his or her entire support network.
The spinal cord is a long, fragile tube-like structure that begins at the end of the brain stem and continues down almost to the bottom of the spine. It consists of nerves that carry incoming and outgoing messages between the brain and the rest of the body. The human spinal cord acts as our entire centre for reflexes. It is composed of 26 individual back bones called vertebrae. The vertebrae are separated by disks made of cartilage, which act as cushions, reducing the forces generated by movements such as walking and jumping.
Common causes of SCI:
- Road accidents
- Sports injuries
- Assault and violence
- Due to diseases such as arthritis, osteoporosis, infections(TB)
Spinal Cord can indirectly also result in spinal injury disease due to:
- Infections such as meningitis and polio
- Inflammatory diseases
- Autoimmune diseases
- Degenerative disease
Symptoms may include partial or complete loss of sensation and movements of arms, legs and/or body. The most severe spinal cord injury affects the systems that regulate bowel or bladder control, breathing, heart rate and blood pressure.
Spinal fractures or dislocation of a vertebra:
Such fractures can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Generally spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from mild ligament and muscle strains, to fractures and dislocations of the bony vertebrae, to debilitating spinal cord damage. Pain, difficulty walking, paralysis can occur. Many fractures heal with conservative treatment; however severe fractures may require surgery to realign the bones.
Spinal Cord Compression:
Spinal cord compression occurs when a mass places pressure on the cord. A mass can include a tumour or bone fragment. Compression can develop anywhere along the spinal cord from the neck to the lower spine. Some causes include certain degenerative diseases, such as arthritis, ruptured disk, Injury to the spinal cord or the area around the cord can lead to swelling can lead to compression.
Type of spinal cord injury
SCI can be incomplete and complete.
Incomplete spinal cord injuries:
With incomplete injuries, the cord is only partially disconnected, allowing the injured person to retain some function.
Complete spinal cord injuries:
By contrast, complete injuries occur when the spinal cord is fully severed, eliminating function.
Complications of spinal cord injury:
Damage can be either temporary or permanent. These changes translate into loss of muscle function, sensation, or autonomic function in parts of the body served by the spinal cord below the level of the lesion.
Treatment of Spinal Cord Injury includes:
- Immediate treatment is required for SCI since, time between injury and treatment has an impact on the treatment outcome.
- Medicines like corticosteroids often reduce swelling that can damage the spinal cord
- If spinal cord pressure is caused by a growth that can be removed or reduced before the spinal nerves are completely destroyed, paralysis may improve.
- Spinal Cord Injury Surgery is needed in following cases:
- Realign the spinal bones (vertebrae)
- Remove fluid or tissue that presses on the spinal cord (decompression laminectomy)
- Remove bone fragments, disk fragments, or foreign objects
- Fuse broken spinal bones or place spinal braces
Physiotherapy Management and Rehabilitation of spinal cord injury includes the following:
- Stretching exercises to help maintain tendon and muscle length and/or to reduce muscle spasms.
- Flexibility exercises for entire body.
- Breathing exercises to help prevent chest infection and maximize lung function.
- Posture and balance exercises are to help reduce the pain that is associated with impaired balance and posture.
- Improve your functional activities and walking exercises
- Electronic muscle stimulators and exercise equipment are also used.
Goals of Rehabilitation include:
This generally involves an interdisciplinary team to contribute to the rehab process of patient
- Physiotherapy focusing on lower limbs function and on helping with difficulties with mobility
- Occupational therapists address upper limb dysfunction and difficulties in activities of daily living
- bowel and bladder dysfunction and the management of pressure ulcers
- Dealing with emotional and behavioural concerns of the newly injured patient and with any potential cognitive dysfunction with help of physiatrist
- Speech-language for assisting in speaking and swallowing
- Support to family and educating them to take care of patient
Spinal cord injury recovery occurs within the first six months after injury. Any remaining loss of function present after 12 months is much more likely to become permanent. Maintaining a positive outlook is extremely important for patients with spinal cord injury patients.
This article is prepared by Dr.B.S.V.Raju, MS, DNB(Ortho), M.Ch(Neuro Surgery);
Senior Consultant Neuro & Spine Surgeon, Aster Prime Hospital, Ameerpet, Hyderabad.