Spinal Cord Injuries
Characteristics and Causes of Spinal Cord Lesions
Spinal Cord Lesions represent damage to a segment of the spinal cord, which interrupts normal brain communication. Among non traumatic causes are circulatory diseases, infections and cancers. Traumatic causes are most frequently ascribable to car or work accidents and sports related injuries.
Consequences for the Patient
The spinal cord lesion involves the loss of function located below the affected spinal segment. The lesion is “complete", if the patient has completely loss movement and feeling in parts of the body below the injury. Conversely the lesion is “incomplete”, if the patient retains partial movement skills and sensitivity.
The height of the lesion on the spinal cord determines the severity of loss. The extreme damage is when the injury is high, meaning to one the cervical vertebrae (C1 to C7). Moderately extreme are lesions of the dorsal (T1 to T12), lumbar (L1 to L5) and sacral (S1 to S5). Less serious are lesions where the injury is to the vertebrae of the coccyx area (from Co1 to Co4,5).http://www.hsantalucia.it/en/rewalk-training-center
Urologic Rating and Nursing
Proper nursing care can correct the positioning of the patient and minimize adverse skin reactions of the patient to prevent the risk of pressure ulcers, commonly called “Bedsores”. Also a priority is at least partial recovery of the patient’s function of the bladder and bowel. Upon the recommendation of the urologist, who evaluates bladder function, it may be appropriate for the rapid introduction of intermittent catheterization, considered the international standard of reference to return as much elasticity to the bladder as is possible.
Physiotherapy and Robotics
In the case of incomplete lesions, physiotherapy aims to allow a recovery of standing and walking. Exercises take place in the gym and in the pool, with technological aids, and are important components to the recovery of autonomy. At the Santa Lucia Foundation there is an active ReWalk Training Center for training the patient using an exoskeleton model to assist with walking and allowing the patient to regain the upright position in daily life.
Respiratory Failure
Spinal cord damage often results in the appearance of thoracic deformity or stiffness, thereby reducing lung volume. Patients with spinal cord injuries can be treated with pulmonary rehabilitation to prevent lung infections and to protect the airway from secretions and food. Respiratory failure is treated with bronchial unblocking techniques, oxygen therapy and mechanical ventilation. The invasive mechanical ventilation is appropriate for tracheostomised patients needing an artificial airway.
Dysphagia
Together with respiratory failure often occur problems of dysphagia, or swallowing disorders. Changes in breathing may also interfere with the functionality of swallowing. In this case the physician can request a clinical and instrumental evaluation of a speech pathologist, which analyzes the movement of swallowing and provides, in collaboration with specialized speech therapists, an appropriate rehabilitation treatment. The treatment may also involve parenteral nutrition (intravenous) or a progressive food intake program (from liquid to smooth to finally solid foods).
Psychological Support and Social Services
The treatment plan is shared by the multidisciplinary team with the patient and family through a series of meetings throughout the different phases of the rehabilitation process. Psychologists support the family, to address and overcome any emotional or relational deficits. At discharge, social workers discuss with the family the opportunities offered by the local community, along with the possible need to transfer to an environment that ensures continuity of care (RSA) rather than returning home. If home return is possible, the need for physical adaptation of the architectural environment to the needs of the disabled person may be discussed.