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.