1. Living Well with Spinal
Cord Injury
Do’s & Don’ts

2. Mark Wren, MD, MPH
Physical Medicine & Rehabilitation
Medical Director, HealthSouth
Rehabilitation Hospital of Texarkana
3510 Richmond Rd Suite 400
903-831-6275

3. Winningest coach of all
time said…
 Leadership, like coaching, is
fighting for hearts & souls of
men & getting them to believe
in you.
–Eddie Robinson

4. easier…it would be called
football

5. Why is it Important
?
90% of SCI individuals survive
67% greater survival 1990s vs
1970s

7. History Of SCI
 2500 BC - ―An ailment not to
be treated‖
 1940’s - Sir Ludwig Guttmann
pioneers SCI rehab & patients begin
to survive with surgery & antibiotics

8. History Of SCI
 1990 - High dose
Methylprednisolone within
8 hours of injury
 1996 - Peripheral nerve bridges

9. Anatomy 101
The Nervous System

10. Function Equals Form
 Cervical
 Thoracic
 Lumbar and
Sacral

15. SCI Myth #1
People with SCI cannot
lead an active life

18. Mechanism Injury
 Flexion
 Hyperextensio
n
 Compression
 Rotation

26. 12,000 new SCI cases in the United States
each year, 25% to 33% of these individuals
regain some degree of ambulation by the
time of discharge
Melissa Riggins,
Michael Boniger

27. The Cytotoxic Cascade

29. Axonal Regeneration
 PERIPHERAL - Schwann cells
promote growth of nerve fibers
 CNS - Oligodendrocytes inhibit
growth of axons

33. The Future
 Reduce secondary injury -
neuroprotection
 Immunotherapy - antiinflammatory
 Nerve growth factor
 Axonal bridges
 Motor neuron implants
 Control collateral sprouting

34. SCI research
 Chondroitinase ABC + rehab—
improves forelimb function by
sprouting cortiocospinal tract in
chronic SCI, allowing rehab &
improved function
 PTEN deletion enables injured SCI
neurons to mount a robust
regenerative response never seen
before in mammals

35. SCI research
 Epidural stimulation + task-specific
training may reactivate previously silent
spared neural circuits or promote
plasticity
 Miami project begins transplant of
schwann cells in humans (FDA phase 1,
―we believe is as important as man’s 1st
step on the moon!‖

36. Hope for Recovery!
My Mayo Clinic professor said,
―Don’t take away hope.‖
―Let us hold unswervingly to the
hope we profess, for he who
promised is faithful. ―
Hebrews 10:23

37. It Might NOT be today…

38. Hope is the only thing
stronger than fear
 Hunger Games

39. Clinicaltrials.gov

40. Classification of
Spinal Cord Injury

42. Touring ASIA
A: Complete Injury
B: Incomplete Injury
(preserved sensation only)
C: Incomplete Injury (some sensory
and motor function preserved)

43. Touring ASIA
D: Incomplete Injury
(preserved motor function)
E: Normal

44. Golden Rules
1. Rehabilitation is a long process
2. Treatment should not focus
completely on physical deficits
3. Recreational & vocational
therapies are essential

46. Golden Rules
4. Rehabilitation must include
and involve the family
5. You must realistically believe
that improvement is possible

47. The Six Arenas
 Mobility
 Bladder and bowel
 Sexuality
 Skin care
 Complications
 Emotional issues

48. Mobility Therapy
 Transfer techniques
 ROM exercises
 Positioning
 Pressure relief
 Stretching
 Strengthening

58. Biofeedback and
Facilitation

60. Spinning Your Wheels
 Manual
 Power
chair

61. Wheelchair Tips
 Control
 Tires
 Brakes
 Leg rests and foot
rests
 Arm rests
 Seats and cushions

68. Bladder and Bowel

69. Failure to Store
vs.
Failure to Empty

71. Alternatives
 Intermittent catheterization
program
 Foley catheter
 Suprapubic catheter
 Bladder augmentation - diversion
 Condom catheter

73. Bowel Management
 Regular
program
 Stool softeners
 Bulk
 Medications
 Exercise

76. Sexuality
Sex Drives Rules
1. Feeling good about yourself (take care:
PAP, mammogram, colonoscopy ect)
2. Having the ability to communicate
3. Using all your senses
4. Using common sense doesn’t hurt

77. SCI Myth #2
People with SCI cannot
have children

79. Sexual Changes In Women
 Loss of sensation
 Loss of lubrication
 Enhancement other senses
above the level of injury
 Initial loss of menstrual cycle
 Alternative to oral
contraceptive (>DVT risk)

80. Sexual Changes In Men
 Psychogenic erections
 Reflex erections
 Vasoactive substances
 Vacuum tumescence constriction
therapy
 Penile prostheses
 Viagra
®

81. Skin Care
 Loss of sensation
 Pressure relief
 Pressure sores
 Protection
Inspection
Protection

86. Avoid
 Spilling hot foods (burns)
 Smoking (15 year shorter life
span)
 Extreme weather (less adaptation)
 Too much skin moisture (yeast)
 Tight clothing (ulcer)

87. Positions Please!

92. SCI Complications

93. Autonomic Dysreflexia
 Usually injuries above T6
 Pounding headache
 Chills
 Profuse sweating
 Flushing
 Blurred vision
 Stuffed nose

95. What To Do !
 Sit up
 Stop - look - listen
 Catheter check - full
bladder
 Constipation - impaction
 Infection
 Irritants
 Nitroglycerin paste

96. Spasticity
 Excessive muscle tone
 Extension or flexion
 Can be a friend or foe
 Worsened by: pressure
sores, full bladder,
constipation, stress

97. Spasticity Treatment
 Therapy
 Medication
 Standing
program/proning
 Splints
 BOTOX
 Intrathecal Baclofen (ITB)
 Surgery

102. Other Complications
 UTI, stones, renal
failure (annual US,
BUN/Cr)
 Heterotopic ossification
(ROM)
 Osteoporosis (DEXA)
 Bowel obstruction,

104. Other Complications
 Deep vein
thrombosis lovenox
8-12wk, ASA
 Gallstones
 Pneumonia
 Syringomyelia

110. Emotional Responses
 Depression
 Alcohol and substance
abuse
 Violence
 Dependency
 Anxiety

111. Kübler-Ross Six Stages
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
6. Hope

112. SCI Myth #3
People with SCI end up
divorced or in bad marriages

114. Organizations