What is the spinal cord? What is its significance?

The spinal cord is a nerve package that is part of the central nervous system as a continuation of the brain located inside the spine. All the nerves that go to our arms and feet, as well as the rib cage muscles, bladder, intestine, a number of nerves that go to the genitals come out of the spinal cord.

What are the causes of spinal cord injury?

The spinal cord travels in the spinal canal in the middle of the spine, which extends from the brain to the neck, back, waist and coccyx, and this bone is protected by the structure. As a result of damage to the spines for any reason, the spinal cord in it is damaged and spinal cord injury occurs. The most common cause of spinal cord injury in the world and in our country is traffic accidents. Subsequent falls from heights, gunshot wounds, sports injuries, especially jumping into shallow water are the most common causes of traumatic spinal cord injuries. Apart from traumatic causes, they can cause spinal cord injury in non-traumatic causes such as spinal cord tumors, spinal cord infections, motor neuron diseases, disc hernias.

What is the clinical picture after spinal cord injury?

Paralysis of varying types occurs according to the level of injury. This picture is generally called spinal cord injuries.

What does Paraplegia/Tetraplegia mean?

Dysfunction of the arms, trunk, legs and pelvic organs as a result of motor and/or sensory loss or disorder as a result of injury to the spinal canal in the spinal canal in the neck area is called tetraplegia, and dysfunction of the trunk, legs and pelvic organs as a result of motor and/or sensory loss or disorder as a result of injury to the spinal cord in the spinal canal in the back and waist region is  called paraplegia  .

What is a complete/incomplete injury?

If the spinal cord is fully damaged at the level at which the spine is broken, there is a complete loss of movement and sensation below the level of injury, and this is called a complete injury  and  is referred to as ASIA A. However, if the spinal cord is partially damaged at the level of the fracture, the loss of movement and sensation below the level of injury is also partial, and this is  called incomplete injury and  is expressed as ASIA B-C-D-E according to the movement condition.

What are the problems that can be seen in patients?

The most important is partial or complete loss of movement and sensation in the muscles below the level of injury, depending on the level of injury and whether the injury is complete or incomplete. Since the nerve leading to the bladder and intestines will be affected, large ablutions and problems of feeling or controlling urine and related urinary tract problems, bowel problems are seen. If the bladder is not emptied sufficiently, blood pressure problems that reach dangerous dimensions can be seen. If adequate bladder rehabilitation is not done, kidney failure may be faced in the following years. Since the patient is constantly lying down, bed sores develop if good follow-up and positioning are not done. Bed sores are very difficult to heal and treat. Since the muscles and bones are not used due to lying down, there may be melting in the muscles and bones and limitations of movement in the joints. Very severe and unbearable neuropathic pain and contractions called spastity are problems that prevent the rehabilitation program and affect the quality of life of the patient. In addition, a number of problems may occur in sexual functions in patients with spinal cord injury.

Do they benefit from rehabilitation?

Paralysis caused by spinal cord injuries are unfortunately irreversible if they are complete injuries. In patients with partial spinal cord injury, partial or complete return in movements may occur within a few months/years. Early and qualified rehabilitation is essential for the prevention of the problems listed above in patients with both complete and partial spinal cord injuries and for the patient to continue his / her life independently by using the remaining functions in the best way.

What is done in rehabilitation?

The aim of patients with spinal cord injury is to prevent complications and to ensure that the patient is independent in life. For this purpose, the main goal is to try to regain the strength in the muscles with loss of strength. For this purpose, conventional treatment approaches such as range of motion opening exercises, stretching exercises, muscle strengthening exercises, neurofacilitation techniques as well as newer and advanced rehabilitation approaches such as robotic rehabilitation, pool treatments, virtual reality treatments, biofeedback, functional neuromuscular electrical stimulation, transcranial magnetic stimulation techniques can be included in the treatment plan. In addition, within the rehabilitation program, bladder and bowel emptying should be carried out at regular intervals and adequate follow-up, air mattress and positioning to prevent bed sores, in-bed exercises to prevent muscle and bone resorption and bringing the patient to the vertical position as soon as possible, appropriate patients should be carried out with devices and external supports over time, and the development of wheelchair transfers for patients who could not be carried out in a self-sufficient way.  must be added.