Spinal cord injuries: paralysis and treatment
Spinal cord injuries (SCI) are among the most devastating physical injuries one can suffer. We have had SCI clients whose first reaction was to wish for death rather than life with paralysis.
In our law practice over several decades, we have represented numerous spinal cord injury survivors. Most had benefited from rehabilitation services at Shepherd Center or Emory Rehabilitation Hospital, both of which are near us in Atlanta. All these clients were injured in motor vehicle crashes or falls.
One client who had been a high-powered government executive before an accident made him quadriplegic initially wanted to just turn his face to the wall and die, but after rehab, he used funds from his settlement to equip himself to write books and begin a second career in college teaching.
Another spinal cord injury client was a young woman in college who went on to teach elementary school in a wheelchair, participate in adaptive sports, move west on her own, and become Ms. Wheelchair California.
Spinal cord injury paralysis occurs when there is damage to the spinal cord, which is a long, thin, tubular bundle of nerves that runs from the base of the brain down to the lower back. The spinal cord is responsible for transmitting messages between the brain and the rest of the body, and damage to the spinal cord can result in a loss of neurological function.
The degree of neurological function loss depends on the location and severity of the spinal cord injury. In general, spinal cord injury paralysis can result in a range of symptoms, including loss of sensation, loss of movement, loss of bowel or bladder control, sexual dysfunction, and breathing difficulties.
The location of the spinal cord injury determines which parts of the body are affected. A spinal cord injury that occurs in the cervical (neck) region will typically result in tetraplegia (also known as quadriplegia), which is paralysis of all four limbs and the torso. A spinal cord injury that occurs in the thoracic (chest) region or below will typically result in paraplegia, which is paralysis of the lower limbs and the lower half of the body. Symptoms include loss of sensation, loss of movement, loss of bowel or bladder control, sexual dysfunction, and breathing difficulties.
Diagnosis of spinal cord injury usually begins with paramedics at an accident scene or with emergency physicians and nurses in a hospital emergency department. Neurological screening in the triage process usually picks up on severe spinal cord injury pretty quickly. However, sometimes a developing SCI is initially subtle in the context of other injuries sustained in a crash. The diagnosis of spinal cord injury (SCI) typically involves a combination of medical history, physical examination, and diagnostic tests. Along with triage, and stabilizing the patient, the medical team will perform a thorough physical examination to assess the patient’s neurological function, including muscle strength, sensation, and reflexes. This may include a rectal exam to check for any loss of bowel or bladder control, which can be indicative of SCI.
Diagnostic tests may include:
– X-rays: X-rays can help identify fractures or dislocations in the spine.
– CT scan: A CT scan can provide detailed images of the spine and help identify any damage to the spinal cord.
– MRI: An MRI can provide even more detailed images of the spinal cord and surrounding tissues, and can help identify the location and extent of the injury.
– Electromyography (EMG): EMG can help evaluate the electrical activity of muscles and nerve cells in the limbs, and may be used to assess the extent of nerve damage.
Family members of spinal cord injury victims often must be advocates for the patient, firmly but respectfully pressing medical personnel and insurance companies to approve the transfer to a top SCI rehabilitation center such as Shepherd or Emory in Atlanta. Such transfers may depend upon bed availability and meeting medical criteria of stabilization for admission.
Once SCI victims are admitted to a rehabilitation facility, family members may be included in treatment team meetings. As your attorneys, we are available to accompany you, with permission, to begin coordinating with the treatment team in evaluating the patient’s long-term financial needs and how we may assist in meeting those needs. This is the beginning of the development of a life care plan that we may present in litigation. We listen first, build rapport, and then ask questions about points we need to effectively advocate for the SCI victim.
Medical treatment for spinal cord injuries may include medication, surgery, physical therapy, occupational therapy, and assistive devices such as wheelchairs, braces, etc.
Medications can play an important role in the treatment of spinal cord injuries by managing pain, reducing inflammation, preventing infections, and improving neurological function. The specific medications used will depend on the individual patient’s needs and the specifics of their injury.
Pain management is a critical aspect of treating spinal cord injuries, and medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants may be prescribed to manage pain. However, the use of opioids must be carefully monitored due to the risk of addiction and other side effects.
Corticosteroids such as methylprednisolone may be used to reduce inflammation and swelling around the spinal cord, which can help preserve neurological function. These medications are typically administered within the first 8 hours after injury and may be continued for several days.
Antibiotics may be prescribed to prevent or treat infections, which can be a serious complication of spinal cord injuries. Bladder and bowel dysfunction are common after spinal cord injuries, and antibiotics may be used to prevent urinary tract infections and other infections that can occur due to the inability to empty the bladder properly.
Medications such as baclofen and tizanidine may be used to manage spasticity, which is a common complication of spinal cord injuries. These medications help to relax the muscles and reduce spasms.
In some cases, experimental medications may be used to promote nerve regeneration and improve neurological function. These medications may include growth factors, stem cells, or other drugs that have been shown to promote nerve growth and repair.
Surgery for spinal cord injuries can be divided into two main categories: decompression surgery and stabilization surgery.
Decompression surgery involves removing any material that is putting pressure on the spinal cord, such as bone fragments, herniated disks, or tumors. This type of surgery is aimed at preventing further damage to the spinal cord and potentially improving neurological function.
Stabilization surgery is used to stabilize the spine and prevent further damage. This may involve fusing two or more vertebrae together, using metal plates, screws, or rods to hold the spine in place. This type of surgery can also be used to correct spinal deformities that have resulted from the injury.
In some cases, a combination of decompression and stabilization surgery may be necessary. The goal of surgery is to prevent further damage to the spinal cord and potentially improve neurological function. However, the outcome of surgery is highly dependent on the severity of the injury and the individual patient’s response to treatment. Rehabilitation is often necessary after surgery to help the patient recover and regain as much function as possible.
Due to the disruption of nerves controlling body functions, SCI victims have neurological complications affecting bowel, bladder, and sexual functions. The extent of dysfunction depends on the level and severity of the SCI.
Bowel management is an important aspect of care for individuals with spinal cord injury (SCI) as the injury can result in disruption of nerve pathways that control bowel function, leading to constipation, diarrhea, or incontinence. Effective bowel management can help prevent complications such as fecal impaction, bowel obstruction, and bowel accidents.
There are several approaches to bowel management in SCI, including:
1. Diet and fluid management: A high-fiber diet and adequate fluid intake can help regulate bowel movements and prevent constipation. It is important to avoid foods that can cause constipation, such as dairy products, red meat, and refined carbohydrates.
2. Medications: Laxatives, stool softeners, and suppositories can be used to help regulate bowel movements and prevent constipation. However, it is important to use these medications under the guidance of a healthcare professional, as they can have side effects.
3. Digital stimulation: This involves inserting a finger into the rectum to stimulate the anal sphincter and initiate bowel movements. This can be done manually or with the help of a device.
4. Manual evacuation: This involves manually removing stool from the rectum using a gloved finger or a device. This may be necessary for individuals with severe constipation or impaction.
5. Bowel training: This involves establishing a regular routine for bowel movements, usually through the use of digital stimulation and manual evacuation. This can help prevent constipation and promote regular bowel movements.
6. Colostomy: In some cases, a surgical procedure called a colostomy may be necessary. This involves creating an opening in the abdomen through which stool can be eliminated. This may be necessary for individuals with severe bowel dysfunction that is not responsive to other treatments.
Effective bowel management requires a comprehensive approach that takes into account the individual’s specific needs and preferences. It is important for individuals with SCI to work closely with their healthcare team to develop a personalized bowel management plan that meets their needs and promotes optimal bowel function.
Bladder and Urinary complications:
Spinal cord injury (SCI) can have a significant impact on bladder function due to the disruption of the nerve pathways that control bladder muscles and sphincter. Some of the common bladder problems associated with SCI include:
1. Urinary incontinence: This is the inability to control bladder function, leading to involuntary urine leakage. It can occur due to the disruption of nerve pathways that control bladder muscles and sphincter. Treatment options include the use of absorbent pads or diapers, medication, and intermittent catheterization.
2. Difficulty emptying the bladder: SCI can also lead to difficulty emptying the bladder completely, leading to a buildup of urine in the bladder. This can cause urinary tract infections and other complications. Treatment options include the use of medication, intermittent catheterization, or surgical procedures.
3. Frequent urinary tract infections: Individuals with SCI are at increased risk of urinary tract infections due to the disruption of nerve pathways that control bladder function. Treatment options include the use of antibiotics and the prevention of urinary stasis through intermittent catheterization or other means.
4. Bladder stones: SCI can also lead to the formation of bladder stones due to the buildup of minerals in the bladder. Treatment options include the use of medication to dissolve the stones, or surgical procedures to remove them.
5. Autonomic dysreflexia: This is a potentially life-threatening condition that can occur in individuals with SCI who have a level of injury at or above the sixth thoracic vertebra. It results from an exaggerated response of the autonomic nervous system to a noxious stimulus, such as a bladder or bowel distension. Treatment options include the removal of the noxious stimulus and the use of medication to lower blood pressure.
SCI can also affect sexual function. Men with SCI may experience erectile dysfunction, difficulty achieving or maintaining an erection, or retrograde ejaculation. Women with SCI may experience decreased lubrication, difficulty achieving orgasm, or reduced sensation. Treatment options include medication, vacuum erection devices, penile injections, and surgical procedures.
Physical therapy is an essential component of the rehabilitation process for individuals with spinal cord injuries (SCI). The goal of physical therapy is to maximize functional independence and improve overall quality of life for the person with SCI.
The specific physical therapy interventions used for SCI depend on the severity and location of the injury, as well as the individual’s overall health and goals. Below are some common physical therapy interventions used for SCI, varying according to level of the injury and residual capability.
1. Range of motion exercises: These exercises help maintain flexibility and prevent joint contractures, which can occur due to immobility.
2. Strengthening exercises: Strengthening exercises help improve muscle strength and endurance, which can help with functional tasks such as transferring, standing, and walking.
3. Balance and coordination training: These exercises help improve balance and coordination, which can reduce the risk of falls and improve overall mobility.
4. Gait training: If paralysis is not complete, gait training involves working on standing and walking, either with or without assistive devices such as braces or walkers.
5. Functional electrical stimulation (FES): FES is a technique that uses electrical impulses to stimulate paralyzed muscles and improve muscle function. This technique can be used to help with walking, standing, and other functional tasks.
6. Assistive devices: Physical therapists can help individuals with SCI choose and learn how to use assistive devices such as wheelchairs, walkers, and braces.
It is important to note that physical therapy is just one component of the overall rehabilitation process for SCI. In addition to physical therapy, individuals with SCI may also receive occupational therapy, speech therapy, and other interventions to address their specific needs and goals.
Occupational therapy is an important component of the rehabilitation process for individuals with spinal cord injury (SCI). The goal of occupational therapy is to help individuals with SCI regain the ability to perform activities of daily living (ADLs) and improve their overall quality of life. Here are some common interventions used in occupational therapy for SCI:
1. Self-care training: Occupational therapists can teach individuals with SCI how to perform self-care tasks such as bathing, dressing, and grooming using adaptive techniques and equipment.
2. Upper extremity therapy: Individuals with SCI often experience weakness or paralysis in their upper extremities. Occupational therapists can provide exercises and therapeutic activities to help improve strength, coordination, and function in the arms and hands.
3. Environmental modifications: Occupational therapists can evaluate the home and work environments of individuals with SCI and make recommendations for modifications to improve accessibility and safety.
4. Adaptive equipment: Occupational therapists can help individuals with SCI select and learn to use adaptive equipment such as wheelchairs, lifts, and other assistive devices.
5. Work retraining: Occupational therapists can help individuals with SCI return to work by providing vocational training and job accommodations.
6. Leisure activities: Occupational therapists can work with individuals with SCI to identify and participate in leisure activities that are meaningful to them. This can include activities such as sports, hobbies, and social outings.
It is important to note that occupational therapy is just one component of the overall rehabilitation process for SCI. In addition to occupational therapy, individuals with SCI may also receive physical therapy, speech therapy, and other interventions to address their specific needs and goals.
Adaptive techniques and equipment can help people with spinal cord injuries (SCI) to live more independently and improve their quality of life. Here are some examples:
1. Wheelchairs: Wheelchairs are one of the most common pieces of equipment used by people with SCI. There are many different types of wheelchairs available, including manual and power wheelchairs, which can be customized to meet an individual’s specific needs. Some wheelchairs are designed for use indoors, while others are designed for outdoor use. In Georgia, Cumberland Island National Seashore even has beach wheelchairs available for visitors.
2. Assistive Devices: There are various assistive devices that can help people with SCI to perform daily activities, such as dressing, grooming, and eating. These can include devices such as dressing sticks, reachers, and adaptive utensils.
3. Transfer Equipment: Transfer equipment such as transfer boards and transfer benches can help individuals with SCI to move from their wheelchair to other surfaces, such as a bed or a car.
4. Standing Frames: Standing frames can help people with SCI to stand upright and experience the benefits of weight-bearing. Standing frames can also help to improve circulation, reduce muscle spasms, and prevent pressure sores.
5. Adapted Vehicles: Adapted vehicles can help people with SCI to travel independently. These vehicles can be modified to include hand controls, lifts, and other adaptive equipment.
6. Home Modifications: Home modifications such as grab bars, wheelchair ramps, and widened doorways can help to make a home more accessible for someone with SCI.
7. Sports Equipment: There are many adaptive sports and recreational activities available for people with SCI, such as wheelchair basketball, hand cycling, and adaptive skiing. Adaptive sports equipment can include specialized wheelchairs, hand cycles, and other equipment designed for people with disabilities.
Overall, adaptive techniques and equipment can help people with SCI to live more independently, participate in activities they enjoy, and improve their overall quality of life. It is important to work with healthcare professionals and assistive technology specialists to determine the best equipment and techniques for each individual’s unique needs.
Mouth operated control devices
Even a person who is a complete quadriplegic may regain a degree of agency with mouth-operated control devices. Sip and puff and tongue controls are two types of assistive technology that can be used by individuals with quadriplegia to control wheelchairs and computers.
Sip and puff controls use a straw-like device that is placed in the user’s mouth. By sipping or puffing on the device, the user can control the movement of the wheelchair. For example, sipping may cause the wheelchair to move forward, while puffing may cause it to move backward. Sip and puff controls can also be used to control other devices, such as l
Red environmental controls, communication devices, and computer software.
Tongue controls use a small magnet that is attached to the user’s tongue with a piercing. The magnet is connected to a sensor on the user’s wheelchair or computer, which allows them to control the movement of the device by moving their tongue in different directions. Tongue controls can be an effective alternative to traditional joystick controls for individuals with limited hand or arm function.
Both sip and puff and tongue controls require training and practice to use effectively. However, once mastered, these technologies can provide individuals with quadriplegia with greater independence and control over their environment.
In addition to controlling wheelchairs, sip and puff and tongue controls can also be used to operate computers. For example, individuals with quadriplegia can use these devices to control the mouse cursor, type using an on-screen keyboard, and access software applications. There are a variety of software programs and applications available that are specifically designed for use with assistive technology, making it easier for individuals with quadriplegia to use computers and access information.
Overall, sip and puff and tongue controls are important assistive technologies for individuals with quadriplegia, providing them with greater independence and control over their environment. It is important for individuals with quadriplegia to work with healthcare professionals and assistive technology specialists to determine the best technology for their unique needs.
Psychological effects of spinal cord injuries.
Spinal cord injury (SCI) almost always have a significant impact on a person’s psychological well-being. Dir to a profound effect on a person’s sense of self, identity, and relationships with others. Additionally, the sudden and traumatic nature of SCI can result in feelings of shock, disbelief, and grief.
Depression is a common psychological effect of SCI. Depression can be caused by a range of factors, including the loss of physical ability, social isolation, and chronic pain. Depression can also make it more difficult for people with SCI to engage in rehabilitation and can lead to a slower recovery.
Anxiety is another common psychological effect of SCI. Anxiety can be caused by a range of factors, including the uncertainty of the future, the loss of control over one’s body, and the fear of experiencing medical complications. People with SCI may also experience post-traumatic stress disorder (PTSD) as a result of the traumatic event that caused their injury.
Furthermore, individuals with SCI usually experience significant changes in their relationships and social lives. SCI tremendously impedes ability to participate in social activities, leading to social isolation and feelings of loneliness. This often has a huge impact on their mental health.
Finally, the physical limitations of SCI can lead to feelings of frustration, anger, and a sense of helplessness. These feelings can be exacerbated by the challenges of adapting to a new way of life, including learning new skills and coping with the physical, emotional, and financial strain of the injury.
The treatment team at a major spinal cord injury rehabilitation center can help to optimize the best attainable degree if recovery. As attorneys experienced in spinal cord injury cases, we stand ready to work with the patient’s family and treatment team to obtain funds for an optimal life care plan.
If you or a loved one have experienced a catastrophic spinal cord injury in a motor vehicle crash or an accident on business property, either submit our inquiry form or call 404-253-7862.
If you or a loved one have suffered a spinal cord injury, submit our inquiry form or call us now at 404-253-7862.
Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949. The founders of the firm were also among the founders of the Georgia Trial Lawyers Association. Current partners include former presidents of the State Bar of Georgia and the Atlanta Bar Association.
Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was the lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School, and completed certificate courses in trial practice, negotiation and mediation at Harvard Law School.