Spinal Cord Injuries: Access to SCI Services for a Better Life

Spinal Cord Injury (SCI) Day is an annual event observed on September 5th to raise awareness about spinal cord injuries and the challenges faced by individuals living with this condition. In 2023, the global campaign focuses on the theme "Access to SCI services; a life less complicated."

This theme highlights the importance of providing accessible and comprehensive services to enhance the quality of life for individuals with spinal cord injuries. Join us as we delve into what Spinal Cord Injury (SCI) is and how access to SCI services can empower lives, making them less complicated and more fulfilling.

The spine, or backbone, is the flexible column of bones that runs from the base of the skull to the pelvis, serving as the central support system for the body. It protects and encloses the spinal cord, which is a vital pathway for transmitting nerve impulses throughout the body. However, damage or trauma to the spinal cord can lead to spinal cord injury (SCI), a devastating condition that affects millions of people worldwide.

What is spinal cord injury (SCI)?

According to the World Health Organization (WHO), the annual incidence for spinal cord injury ranges from 250,000 to 500,000, cases worldwide, underscoring the significant impact of this condition on individuals' lives. Spinal cord injury can bring about the loss of motor, sensory, and autonomic functions, causing a cascade of physical, emotional, and psychological changes. In this blog post, we will explore what spinal cord injury is, its causes, impacts, and treatments.

Understanding spinal cord injury is crucial for promoting awareness and better treatments for those affected by this life-changing condition.

SCI refers to damage or trauma that occurs to the spinal cord, resulting in the loss of motor, sensory, and autonomic functions. The spinal cord is a crucial part of the central nervous system, which carries nerve signals between the brain and the rest of the body. When the spinal cord is injured, it can lead to a range of disabilities, depending on the severity and location of the injury.

Common causes of spinal cord injuries include accidents, falls and sports-related injuries.

Spinal Cord, The Christopher Reeve Foundation

What are some of the consequences of SCI?

1. Muscle weakness - SCI often results in paralysis or loss of muscle function below the level of injury. The extent of paralysis depends on which part of the spinal cord is affected.

2. Sensory changes - SCI can cause changes in sensation, including loss of feeling or altered sensations in affected areas, which may affect a person’s ability to perceive touch, temperature and pain.

3. Bowel and bladder dysfunction - SCI may lead to difficulties with bowel movements and urinary control. To manage these challenges, the use of catheters or other techniques may be required.

4. Respiratory complications - Depending on the level and severity of the injury, respiratory challenges may arise. Impaired breathing, reduced lung capacity, and increased susceptibility to infections can be potential consequences.

These may also lead to secondary health complications, for example:

• Pressure sores with reduced mobility (also known as bedsores)

  1. These sores occur when prolonged pressure is applied to a specific area of the body, especially over bony prominences like the buttocks, hips and heels.

  2. In people with SCI, pressure sores develop due to loss of sensation and impaired mobility.

  3. When they are unable to feel or move certain body parts, they may unknowingly remain in one position for an extended period, leading to constant pressure on specific areas.

  4. This can cause the skin and underlying tissues to break down, resulting in pressure sores.

• Blood clots

  1. This can occur as a result of reduced mobility and impaired bloodflow.

  2. When movement is limited, blood can pool in the legs and lead to formation of clots in the deep veins.

  3. These clots can be dangerous if they dislodge and travel to other parts of the body like the brain and cardiac, which can results in stroke and heart attack respectively.

• Muscle spasms

  1. They are involuntary and often sudden contractions or tightening of muscles in the body.

  2. SCI disrupts the normal communication between the brain and muscles, leading to imbalances in nerve signals.

  3. This can result in muscle spasms, which can be uncomfortable or even painful.

  4. Spasms may be triggered by various factors, such as changes in position, irritation or injury to the affected area, or even emotional stress.

• Osteoporosis

  1. Osteoporosis is a common complication in SCI due to reduced weightbearing on the bones, muscle disuse and hormonal changes.

  2. This lack of mechanical stress leads to accelerated bone loss.

• Chronic pain

  1. This can arise from damaged nerves in the spinal cord or other related structures.

  2. The pain may be localized to the site of injury or radiate to other parts of the body.

  3. The intensity and characteristic of pain can vary significantly; ranging from a constant, dull ache to a sharp, shooting sensation.

• Infection

  1. This can occur in various areas, including the respiratory system, urinary tract and skin.

  2. These infections can range from mild to severe, and may require antibiotics or other medical interventions for treatment

• Autonomic dysreflexia

  1. Autonomic dysreflexia is a potentially life-threatening condition that can occur in persons with SCI, especially those with injuries above T6 level.

  2. It is characterised by a sudden and exaggerated response of the autonomic nervous system to certain stimuli below the level of injury.

  3. This abnormal response can lead to a rapid increase in blood pressure, severe headaches, flushing, sweating, and other symptoms.

• Joint stiffness and contractures with reduced mobility

  1. Contractures refers to abnormal tightening of muscles, tendons and other soft tissues, leading to reduced joint mobility.

  2. In SCI, contractures can occur due to prolonged immobility, muscle imbalance, and loss of normal range of movement.

  3. When individuals are unable to move or exercise certain muscles regularly, the affected muscles can become stiff, inflexible, and resistant to stretching

  4. Contractures can result in joint deformities, limited mobility, and functional impairment

What can be done to manage these challenges?

• Skin integrity and pressure sores

  1. Prevention is possible and critical, through regular repositioning, maintaining proper hygiene, using specialised cushions or mattresses to distribute pressure, and keep the skin clean and dry.

  2. Regular monitoring, education and collaboration with healthcare providers are key factors in preventing and managing pressure sore complications.

• Blood clots

  1. Reduced risk of blood clot formation in SCI includes early mobilization, use of compression stockings or devices, and sometimes the use of blood thinning medications under the advice of the doctor.

  2. It is important to look out for swelling, pain or warmth in the legs; which may be signs and symptoms of a blood clot and require prompt medical attention.

• Muscle spasms

  1. Managing muscle spasms in SCI includes a combination of medications, physiotherapy, stretching exercises, and other relaxation techniques to help alleviate the discomfort and improve overall mobility.

• Osteoporosis

  1. Osteoporosis management in SCI involves proper nutrition, weight-bearing exercises as tolerated and medications if indicated, to reduce the risk of fractures and optimize bone health.

• Chronic pain

  1. Chronic pain management includes a multipronged approach involving medications, physiotherapy, nerve blocks and psychological interventions if indicated; with the aim of improving quality of life and functional outcomes.

• Infections

  1. Timely identification, preventive measures, and regular medical are crucial in minimizing the risk of infections and managing such occurrences in persons with SCI.

• Autonomic dysreflexia

  1. Autonomic dysreflexia requires immediate attention and identification of the triggering stimulus, as it can be a medical emergency if left untreated.

  2. To minimise the risk of autonomic dysreflexia, it is critical to understand the potential triggers and familiarise with its signs and symptoms for early detection (e.g. blocked urinary catheter resulting in bladder distension and AD)

• Contractures

  1. Management of contractures include physiotherapy interventions, involving stretching exercises, positioning and use of assistive devices.

If you or someone you know has a Spinal Cord Injury, get in touch with us to help you manage your condition and promote your physical abilities and independence. Drop us an email at hello@thrivehealthcare.com.sg today!

Written by:

Lenis Phoa

Physiotherapist, Thrive Healthcare