Patients with spinal cord injuries present a unique set of challenges for medical management and rehabilitation. Loss of strength in the extremities requires a special focus on rehabilitation techniques to become as functionally independent as possible. Based on the deficits of the individual, there may be an emphasis on family training.
Patients with spinal cord injury experience many changes in their physiology, including gastrointestinal, genitourinary, cardiovascular, pulmonary, musculoskeletal, neurologic, and psychological changes that require regular monitoring. By understanding these physiologic changes, a practitioner can successfully evaluate and treat patients with spinal cord injury.
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• Patients with new spinal cord injuries have unique challenges that are best addressed in an inpatient rehabilitation setting.
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• A spinal cord injury patient’s functional goals should be based on their level of injury.
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• Patients with spinal cord injuries at C7 or below should be able to become functionally independent.
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• There are multiple medical issues the physician should evaluate, and with which patients should familiarize themselves. These include pain, spasticity, neurogenic bowel or bladder, pressure injuries, autonomic dysreflexia, and pulmonary compromise.
Historical note and terminology
Records of traumatic spinal cord injury date back to approximately 3000 BC in Egypt. Many early accounts from Egypt, the Roman Empire, and the Renaissance focused on acute management to minimize the damage done to the spine. It was not until the 19th century that people started to study the medical sequelae of spinal cord injury, determining that appropriate monitoring and treatment of the secondary complications were important in extending life for these patients (57). Education on these secondary aspects of spinal cord injury remains today a mainstay in spinal cord injury rehabilitation, along with physical and functional modalities to make these patients more independent.