Spinal Cord Injury-Part 2

By Petrofsky, Jerrold Scott | Palaestra, Fall 2000 | Go to article overview

Spinal Cord Injury-Part 2


Petrofsky, Jerrold Scott, Palaestra


Where are We Now?

Present Treatment

In the first article of this series, published in the Summer 2000 issue of PALAESTRA, 16 (3), 34-42, causes of, and some possible cures for spinal cord injury were presented. However, a cure may not be found for years. While no one can predict how long research will continue until a cure is found, what is certain is there can be orthopedic and muscular damage in the paralyzed parts of the body that may prevent a cure from ever being effective. While the primary injury in a person with spinal cord injury is to the spinal cord itself, lack of movement in part of the body leads to deterioration in the tendons, joints, bones, muscle, and cardiovascular system. These secondary medical problems, as they are called, in themselves can become life threatening. Today, any comprehensive treatment must deal both with paralysis and secondary medical problems.

Secondary Medical Problems Associated with Spinal Cord Injury

Spinal cord injury causes long term damage to the cardiovascular system. Premature aging of the cardiovascular (Petrofsky, 2000a; 2000b;) and other body systems occurs in individuals with spinal cord injuries, reducing lifespan and bringing about long term medical complications (Charlifue, Weitzenkamp, & Whiteneck, 1999). Recent studies show orthopedic injuries are common in individuals with both paraplegia and quadriplegia (Barber, Janus, & Wade, 1996); endocrine changes accelerate with aging in people with paralysis (Bauman, Kahn, Grimm, & Spungen, 1999); sympathetic impairment, a side effect of paraplegia, increases thermoregulatory stress during exercise (Normell, 1974); gastrointestinal function is impaired (Stone, Nino-Murcia, Wolfe, & Perkash, 1990); and incidence of diabetes is much higher in people with spinal cord injuries than the general population (Karlsson, 1999).

Bone fractures are common, rate of incidence being about 7% per year (Kennedy, 1999). Incidence of bladder infections is over 60% per year, while incidence of pressure sores is over 30% per year in a population of individuals with spinal cord injury (Kennedy, 1999).

While these statistics are devastating, modern therapy, especially with computer technology, can have a strong impact on many of these medical complications. But there is a problem. When spinal cord injury first occurs, there is usually aggressive medical treatment and physical therapy. After that initial therapy, however, most individuals with spinal cord injury receive sporadic therapy, due either to a lack of insurance or other reasons (Kennedy, 1999). Since neurological recovery after spinal cord injury can take a few years, many people may have some recovery and never know it due to a lack of aggressive therapy in the years following injury. Therefore, many technologies that may help individuals with spinal cord injury maintain their body condition are never used. This article deals with types of therapies that may be used months or years after a spinal cord injury to maximize function or at least maintain the body in health until that day when a cure may be found. Many of these techniques are not research, they are used at spinal cord injury centers on a daily basis.

A thorough re-evaluation is needed before someone enters therapy, even if it has been only one year since the injury (Petrofsky, 1992; Petrofsky & Phillips, 1984). There is neurological recovery that continues for some years after a traumatic spinal cord injury and, thus, may cause some recovery of function (Umphred, 1990). Therefore, it is important to re-evaluate the person before therapy to assess any changes that may have increased muscle function.

A thorough evaluation includes range of motion and manual muscle testing, a complete history and physical examination, orthotics evaluation, a pulmonary function test, and an ECG. These later tests, as well as a complete blood workup, are important even in people who are in their 30s, since cardiovascular and endocrine diseases progress early in individuals with spinal cord injury. …

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