Spinal cord injury

Abstract

A spinal cord injury (SCI) is damage to any part of the spinal cord or nerves extending from the spinal cord that often results in permanent changes in motor and/or sensory abilities and other body functions below the point of the injury. The physical impairments from SCI vary as a function of the level and completeness of the injury. Nearly every aspect of a person's life physical health, work, personal relationships, and recreation may be affected following SCI. Adjustment involves learning new adaptive behaviors and attitudinal change, so psychologists play a crucial role in assisting the rehabilitation process. This self-directed learning module highlights basic management and approaches to intervention both established and experimental. The revised American Spinal Injury As sociation classification of spinal cord injury (SCI) further defines the examination and classification guidelines. The incidence of traumatic SCI remains at approximately 10,000 cases per year, with 32 years the average age at injury. Initial management includes establishment of oxygenation, circulation (mean blood pressure >85mmHg), radiographic evaluations for spine instability, intravenous methylprednisolone, and establishment of spinal alignment. Prevention measures for medical complications include pressure relief for skin, thromboembolism prophylaxis, prevention of gastric ulcers, Foley catheter drainage to prevent urine retention, and bowel care to prevent colonic impaction. Nontraumatic SCI from spinal stenosis, neoplastic compression, abscess, or multiple sclerosis becomes more common with aging. Experimental treatments for SCI include antibodies to block axonal growth inhibitors, gangliosides to augment neurite growth, 4-aminopyridine to enhance axonal conduction through demyelinated nerve fibers, and fetal tissue to fill voids in cystic spinal cord cavities. Early comprehensive rehabilitation at a SCI center prevents complications and enhances functional gains.