Spinal
cord injury and spinal cord disease are very complex medical
conditions; are major life events, patients often facing tremendous
challenges in adapting to changes in physical functioning but
also their living situation, lifestyle, relationships and ageing.
The consequences also extend to family, friends and the community.
As every person is a unique individual then no two injuries are
alike having unique consequences. The vertebral level(s) of the
injury determines the neurological consequences. All sensory,
motor and autonomic functions depend on the uninterrupted two-way
communication to the brain from the spinal nerves via the spinal
cord; an interruption leads to a dysfunction. An injury to the
cord itself (upper motor neurone) with preservation of normal
spinal cord segments below the level of injury will result in
a hypertonic (spastic) paralysis; an injury of the conus medullaris
without preservation of normal spinal cord segments or a cauda
equina injury will have a lower motor neurone injury resulting
in a flaccid paralysis.
Higher residual voluntary control of movement and sensation occur
when the injury affects a lower vertebral level, a T10 level
injury will retain more sensation and movement, may be able to
walk whilst a C4 level injury will be a wheelchair user.
An incomplete injury offers the potential of a better recovery
than a complete injury though it is rare that sensation and function
returns to the same level as pre-injury.
Many report anxiety and depression as a consequence of SCI; some
studies report this to be between 15-45%.
Other neurological consequences of SCI may include pain, numbness,
strange and unpleasant sensations (dysethesia), hypertonia (spasticity),
weakness and bowel/bladder alterations.
Studies report that between 25 to 93% report pain at various
times occurring in different areas of the body at differing times
during recovery. Lower levels of injury tend to produce higher
levels of pain than higher injury levels. Often the pain becomes
persistent impacting negatively on stress and depression. The
pain can be classified into - neuropathic pain, musculoskeletal
and visceral pain. Neuropathic pain is common since it arises
from actual damage or dysfunction of the nervous system such
as that which occurs in SCI. Neuropathic pain is described as either sharp, shooting, “electric-like” or burning
pain.
Spasticity (hypertonia) does not appear immediately after injury
since the “spinal shock” removes the spinal cord's
reflexes below the level of injury, the reflexes returning after
a period varying from a few weeks to several months. Spasticity
and spasms are more likely to occur in tetraplegia or incomplete
injuries than paraplegia or complete injuries. Spasticity and
spasms, if severe, can greatly reduce overall quality of life
by interfering with mobility, self-care, sleep, stamina, rehabilitation
and can increase the risk of decubiti ulcers, fractures and
dislocations. Additionally, spasticity can increase the workload
of patient caregivers and family members. |
