Injuries to the spinal cord can affect many functions of the body, such as:
Spinal cord reflexes
Normally, messages are sent from the brain through the spinal cord to parts of the body, which leads to movement. When the spinal cord is damaged, the message from the brain cannot get through. The spinal nerves below the level of injury get signals, but they are not able to go up the spinal tracts to the brain. Reflex movements can happen, but these are not movements that can be controlled. They may happen when the foot is touched or with coughing.
Spinal shock
This is the temporary loss of all spinal cord reflexes below the level of injury. This could last days to weeks. When spinal shock ends, spasticity or stiffness starts below the level that the spinal cord was injured. Spinal shock cannot be prevented and must resolve on its own.
Breathing
The muscles (diaphragm, intercostal, and abdominal) needed for breathing and coughing may become weak after an SCI. Coughing is needed to clear the lungs of secretions and bacteria. If a person has a weak cough or cannot clear secretions from their lungs, they will be at higher risk for an infection, such as pneumonia.
An injury at C4 or higher will affect the diaphragm, the muscle that moves the lungs for breathing. A T1 to T11 injury will affect the intercostal muscles, the muscles between the ribs. A T7 to T12 injury will affect the abdominal muscles. The body needs the diaphragm, the intercostal muscles, and the abdominal muscles to breathe and cough well.
If the SCI is cervical (in the neck), a person may need support breathing with a ventilator, either for a short time or forever. If a ventilator is needed, a breathing tube will be placed in the mouth or nose, and then attached to the ventilator. If the ventilator is needed for a long time or you have a lot of lung secretions, a person may need a tracheostomy (trach).
A trach is a tube placed in the trachea (windpipe). It will make it easier to cough up phlegm and for the nurse to suction the lungs. At first, a person will not be able to talk while the trach is in place. As they get better, a talking trach may be used. A trach may not be permanent.
If you are not on a ventilator, you will be encouraged to cough and deep breathe hourly while awake to help keep the lungs healthy and prevent infection. You may also be asked to use an incentive spirometer, a plastic breathing device. You can see on the device how much air is being taken into the lungs. The nurse or therapist will help you to set goals for using this breathing device. Families are welcomed to be involved in helping you use the incentive spirometer.
Neurogenic shock (low heart rate and low blood pressure)
The brain normally controls blood pressure and heart rate. Signals from the brain send messages through the spinal cord to constrict blood vessels and raise the heart rate to keep the blood pressure and heart rate normal. When these signals cannot get through, a person can have low blood pressure and slow heart rate.
Blood pressure may drop when the head of the bed is raised suddenly because blood vessels below the level of injury are dilated. They cannot constrict fast enough to prevent low blood pressure. This is called orthostatic hypotension. To lessen your risk of this, the head of the bed is gradually raised, and an abdominal binder may be used.
Altered temperature regulation
A person may not be able to sweat or make goose bumps below the level of injury. The body cannot adjust its temperature. A person may feel cold and need blankets, then later, feel hot and need a fan or to be uncovered.
Autonomic hyperreflexia
(also known as autonomic dysreflexia or hyperdysreflexia)
People at highest risk for this condition are those with SCIs above T6. This tends to happen after the spinal shock phase. Autonomic hyperreflexia happens because nerve messages that used to go up the spinal cord to the brain are blocked.
Conditions below the level of injury that may lead to autonomic hyperreflexia are:
- Full bladder
- Constipation or a full bowel
- Pain
- Infection
- Skin breakdown
- Ingrown toenail
- Sudden temperature changes in the environment
Symptoms may be:
- High blood pressure
- Low heart rate
- Anxiety
- Severe pounding headache
- Sweating above the level of the injury
- Nasal stuffiness
Each person may have slightly different symptoms.
Autonomic hyperreflexia is a serious condition and needs to be treated right away. Prevention and looking for signs are very important. Stroke, heart attack, or seizures can happen if this is not treated. This is a condition that may happen throughout the rest of your life.
Deep vein thrombosis (DVT)
A DVT is a blood clot that can develop in the legs and arms. It is often caused by a lack of movement. Elastic stockings, sequential compression devices, and/or foot pumps will be placed on your legs or feet to help prevent a DVT. A blood thinning medicine may be used, or a filter may be placed in a blood vessel. Regular exercise of the arms and legs, and turning will be done to help prevent DVTs from forming.
Stomach ileus
Sometimes after an SCI, the stomach and intestine will stop working for a short time. This is called an ileus. Even though the stomach may not be working, it still makes acid. The acid may damage the stomach lining and cause stomach ulcers if it is not removed. A nasogastric (NG) tube may be placed through the nose into the stomach. This tube will be used to help remove stomach acids. Medicines may also be given to help prevent stomach ulcers.
Swallowing
Higher cervical injuries may make it harder to swallow. If this happens, an NG tube may be needed for nutrition and medicines. The tube is placed through the nose into the stomach. Liquid formula will be given either continuously or several times a day. The hospital dietitian helps the health care team choose a formula based on your calorie and fluid needs. If long term tube feeding is needed, a gastric tube (G-tube or PEG tube) may be placed surgically through the wall of the abdomen into the stomach.
Bowel control
Changes in bowel control may happen after an injury. A person may have constipation or diarrhea. A bowel training program including diet, medicines, and digital stimulation may be used. Digital stimulation means to touch inside the rectum to help the bowels move. Developing a bowel training program takes time, but it can be successful.
Bladder control
SCI may also cause the messages between your bladder and brain to be changed. Normally, when the bladder gets full, nerves in the bladder send a message up the spinal cord to the brain signaling the need to urinate (pee). The message to the brain may be lost after an injury.
There is also no bladder tone when spinal shock is present.
At first after a SCI, a urinary catheter will be placed to drain the bladder. As the body starts to adjust to the injury, the catheter will be taken out. Nurses will check the bladder volume. If it is full, a catheter will be put in to drain the urine and then the catheter will be taken out. Over time, a bladder training plan will be started.
Bladder tone may or may not come back depending on the level of your SCI. The bladder may be flaccid (weakened) or spastic (hyperactive). A urologist may be asked to evaluate the bladder and medicines or surgery may be recommended.
Skin
Skin is a protective covering for your body. Too much pressure, heat, or wetness can lead to skin breakdown (bedsores or pressure ulcers) due to a lack of blood flow and oxygen. The skin ulcer can then become infected. After a SCI, the body may not be able to warn of dangers to the skin. So, regular repositioning, turning, and thorough cleaning after going to the bathroom will be needed.
Muscles and tendons
Spasticity can happen after a SCI when signals from the brain to the muscles are blocked. This is often not seen until spinal shock resolves. When spasticity happens, there is resistance to stretching the muscles. It can be painful and lead to contractures, a shortening of the muscles and tendons.
If spasticity is a problem, it can be treated. Repositioning and medicine, such as Baclofen, may help. Botox injections may also be used.
Bones and joints
Pain
With SCI, pain may be acute or chronic. Acute pain may be caused by bruising, broken bones, surgery, or positioning. Chronic pain may be caused by overuse of joints and muscles, or changes in muscles, joints, and ligaments. Pain is treated based on the type and cause of the pain. The most important thing to remember is that pain is real and there is a physical cause. Talk with the health care provider about pain.
Brain injuries
Many people who have had severe trauma to their neck and back may also have injuries to their brain. These can range from a mild concussion to more severe injuries. They can cause difficulty with memory, concentration, or communication, and can cause personality changes.
Sexuality
Love and intimacy are basic needs all people share. A person with SCI still has sexual needs. There may be loss of sensation to the genitals for both men and women. Each person’s injury affects his or her sexuality in a different way. Often, both men and women will still be able to have sexual intercourse.
Men will have erections, some uncontrolled, that may be brought on by sexual thoughts or as a reflex with catheterization or erotic stimulation. Maintaining an erection may be difficult. This is called erectile dysfunction (ED). There are many medical treatments to help with this. The ability to ejaculate may also change. So, men may have difficulty with fertility (the ability to have children). These functions all depend on the level and extent of injury.
For women, nothing prevents sexual intercourse, but vaginal secretions may be less. Women may still be able to have orgasms. For women of childbearing age, menstrual periods often are disrupted and may not start again for 3 to 6 months. Women can still get pregnant and have children, and they may deliver vaginally.
Though sexual intercourse is important, love and intimacy can be shared in many ways. Touching a loved one’s face and hair, kissing, being hugged, sharing ideas and problems, memories, and laughing together are also important.
During the acute phase of injury, your health care provider may not know the degree of sexual function you will have. As you get further along in your rehabilitation, it will be more likely to predict. Talk with your health care team about any changes you might notice. Many rehabilitation centers have sexual counseling programs for patients and families, which help them understand and cope with these changes.