DIAGNOSIS OF SPINAL CORD INJURY (SCI)
If there is history of trauma, immediately ensure the patient has a working airway, is breathing and has a pulse.
Next assess an individual’s neurologic function by testing the patient’s muscle power and sensation in their arms and legs. If there is visible weakness or the patient is not fully conscious, keep in a rigid cervical collar and on a spine board until a full imaging evaluation can be done
• X-rays - Can be helpful in patients who are suspected of having post-traumatic spinal cord injury. X-rays can show vertebral problems, fractures, degenerative changes in the spine and tumors.
• Computerized tomography (CT) scan - A CT scan may provides better view of the abnormalities compared to an X-ray. It reveals bone, disk and other problems.
• Magnetic resonance imaging (MRI) - MRI employs a powerful magnetic field and radio waves to produce computer-generated images. It is useful to identify herniated disks, blood clots or other masses that may be compressing the spinal cord.
TREATMENT OF SCI
It's not possible to reverse spinal cord damage. However new treatments such as prostheses and medications that can stimulate nerve cell regeneration and improve the function of the remaining intact nerves
Treatment of SCI focuses on preventing further injury and empowering people with a spinal cord injury to lead a near normal and productive life
IMMEDIATE TREATMENT IN ACUTE PHASE
• Maintaining airway
• Prevention of shock
• Neck immobilization to prevent further cord damage
• Prevention of complications such as urine and stool retention, respiratory or cardiovascular difficulty, and deep vein thromboses in the extremities
Patients with SCI need to be admitted to the intensive care unit for treatment or even transferred to a specialized regional spine injury center equipped with neurosurgeons, orthopedic surgeons, neurophysicians, nurses, psychologists, therapists and social workers with experience in treating SCI
• Medications - Earlier Intravenous (IV) methyl prednisolone was used to treat acute spinal cord injury in the past. But given the potential side effects, such as blood clots and pneumonia, it is no longer recommended routinely after a spinal cord injury
• Immobilization - Traction to stabilize your spine, and bring it into proper alignment or both. In some cases, a rigid neck collar may be useful. A special bed can also be used to immobilize the patient
• Surgery - Surgery is required to remove bony fragments pressing the cord, foreign objects, herniated disks or fractured vertebrae compressing the spine. Surgery will also help to stabilize the spine and prevent future pain or deformity.
• Newer treatments - Researchers are looking for newer ways to halt cell death, reduce
• inflammation and promote nerve regeneration. In some cases, doctors may significantly lower the body temperature — a condition known as hypothermia — for 24 to 48 hours to help control inflammation and promote healing.
Once the initial condition stabilizes, the aim of treatment is preventing secondary problems that may arise, such as de-conditioning, bowel and bladder control issues, infections, muscle contractures, pressure ulcers, bowel and bladder issues and blood clots.
The length of hospital stay depends on severity of the condition and incidence of complications. Once the patient is well enough to undergo further treatment, he may be shifted to a rehabilitation facility.
REHABILITATION OF SCI PATIENTS
• Rehabilitation will start during the early stages of recovery. The rehabilitation team may include a nurse, physical therapist, an occupational therapist, a rehabilitation a psychologist, a social worker, a dietitian, a recreation therapist, and a specialist doctor in physical medicine (physiatrist) and treatment of spinal cord injuries.
• The initial stages of rehabilitation focuses on physiotherapy to strengthen and maintain existing muscle function, training of fine motor skills, and learning adaptive techniques to manage daily tasks.
• The patient is taught several new skills, use of equipment and technologies to help independent living as much as possible. that can help you live on your own as much as possible.
• Psychologists work with the patient to deal with the anxiety and depression associated with SCI and the disruption in their lives.
• Occupational therapists help the patients relax with new hobbies and vocational training to make these patients self-sufficient and independent economically
NEWER ASSISTIVE DEVICES FOR SCI PATIENTS
Modern wheelchairs - Improved, lighter weight wheelchairs help patients with SCI more mobile and more comfortable. Electric wheelchair are available. Some wheelchairs can even climb stairs, move over rough ground and elevate a seated passengers to higher level without help
Electronic aids - Devices that work on electricity can be switched on or off with electronic aids such as switch or voice-controlled and computer-based remotes.
Computer adaptations - Computers can be very powerful tools in patients with impaired hand movement, and range from simple to complex, such as key guards or voice recognition. Patients need to be trained in computer adaptations
Electrical stimulation devices - These sophisticated devices use electrical stimulation to produce actions, such as controlling arm and leg muscles to enable people with spinal cord injuries to stand, walk, reach out and hold objects
Robotic gait training - This new technology is used to retrain patients to walk after a spinal cord injury.
PREVENTION OF SCI
• Always wear a seat belt while travelling in a car
• Wear proper protective gear while playing sports or riding
• Avoid diving into water unless you make sure it’s deep enough and there are no rocks or stones
PROGNOSIS OF SCI PATIENTS
Most marked recovery is usually seen in the first six months, but some people may continue to show
small improvements for up to one to two years.
Many people lead full and productive lives after a spinal cord injury. However, most of SCI patients will
require assistive devices such as walkers or wheelchairs for mobility, and some may even be paralyzed from the neck down.
Patients need to undergo training with daily living activities and learn to perform routine tasks differently.
Pressure sores and urinary tract infections are common complications that should be prevented .
SPINAL CORD INJURY - DIAGNOSIS & MANAGEMENT
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- Full Name: Lakshmi Venkataraman
- Name of Your College/Medical School: SRMC&RI Porur Chennai
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