It is very important to learn about the changes that have taken place in the body and how to prevent complications. You must learn to speak up and ask questions. It is important to actively participate in care.
Communicating is important to all of us. Often people with SCIs feel a lack of control. The more a person is able to communicate their needs, feelings, concerns, or thoughts, the more control they will have.
Communicating after an SCI may be different if a person has a breathing tube or trach. It is very important to find a way to communicate as soon as possible. Other ways to communicate that can be used if a person cannot speak are:
- Communication board: This is a picture/word board. A person can blink, raise an eyebrow, or respond in another agreed upon way to indicate which letter has been chosen. The board also has pictures of basic needs with the word above the picture. Computerized communication: This is a computer with responses that are chosen by moving the mouth, eyes, arms, jaw, or shoulder.
Keep the lungs clear
Take deep breaths and cough often. Use the incentive spirometer each hour while awake. Also, a person may be taught how to do a “quad cough.” This is done by using an upward force by the heel of the hand to push in and up on the diaphragm while a person is trying to cough.
Wear the anti-embolism stockings and sequential compressive devices or foot pumps. Also, family can help with range of motion exercises for the arms and legs, and with turning as directed by the health care team.
Nutrition plays helps with healing and keeping the skin healthy. When under stress or during illness, the body needs more calories. A hospital dietitian will help to figure the calories needed for the best healing and skin protection.
Changes in sensation create a need to make sure there is regular repositioning and turning, and good cleaning after bowel or bladder incontinence. Extra attention to the skin is very important to prevent problems. Use of heating pads and cold packs must be closely checked. Frequent skin checks can also help prevent problems. Specialty mattresses, wheelchair pads (Roho cushions), and other skin care items may be used.
Signs of skin breakdown (bedsores or pressure ulcers) are:
- Red areas that do not go away
- White skin after the pressure source is moved
- Skin spots that turn black or brown
- Tear, cut, or "rug burn" look to the top layer of skin
To help prevent skin problems, a person is fitted for a wheelchair. This most often happens at rehabilitation. Even in a personalized wheelchair, a person should shift their weight often.
Bowel and bladder control
Follow the recommendations of the health care team on diet, fluid intake, and on bowel and bladder programs. Bladder training will start to help with bladder control. This may involve catheterizations every 4 to 6 hours. This depends on the amount of urine in the bladder. The goal is to keep the bladder from being too full. Based on the level of injury, a person may learn to do catheterizations.
A program to keep the joints and muscles moving is called “range of motion.” Physical and occupational therapists work with people to keep their current strength and range of motion. Gentle stretching of the muscles helps to do this. In spite of therapy, a person may have less range of motion. If this happens, changes in therapy, medicines, or surgery may be needed.
This means bone spurs have developed around joints. It is important to get early treatment when signs start to prevent or limit complications. Tell the health care team if you have any of these changes:
- Sudden loss of joint motion or less range of motion
- Pain with movement or touch
This is uncontrolled muscle spasms in the arms and legs. Spasms can be caused by:
- Rapid movements
- Tight clothing
Exercises and medicine can help to control spasms. Hand/finger splints and ankle splints may also be used to keep muscles and tendons in the hands, lower arms, feet, and lower legs from shortening.
If the injury is at T6 or above, a person is at risk for autonomic hyperreflexia. If the injury is incomplete or lower than T6 it can still happen, but with milder symptoms. The main cause of autonomic hyperreflexia is most often a full bladder. The second and third most common causes are constipation (a full bowel) and skin irritation or skin breakdown. It can also be caused by:
- Straps on splints that are too tight
- Wearing shoes that are too small
- Wearing tight clothes or belts, such as wearing jeans when you have been used to wearing sweatpants
- Not taking supplies for bladder or bowel care when away from home
- Small items that may be in your shoes, such as paper that comes in the toes of new shoes, or in your seat cushion, such as small toys
- Sitting on a wallet
- Seat cushion out of position
- Caffeine or alcohol that can cause a higher urine volume
- Drinking too much alcohol or taking sedatives that make you too drowsy to care for yourself
- Being in an accident or emergency and not being able to tell anyone about your risk for autonomic hyperreflexia. A person should wear a medical ID warning of risk for autonomic hyperreflexia.
Ask questions about autonomic hyperreflexia and tell your health care team about any signs right away. This may be a serious medical emergency.
Choose the right rehabilitation facility
It is important to choose a rehabilitation facility that will best meet a person’s needs. A social worker will help with this. Family members play a vital role in gathering information about facilities (see Appendix III).