Acceptation and adaptation
1. Accepting the SCI and its complications and side effects such as the fact will help patients to encounter with problems.
2. Patient and his or her problems accepting by family and society will help him or her to adoption with new condition and prevent of patient’s seclusion.
3. It is necessary for patient to achieve complete classic treatments such as removing pressure from spinal cord and vertebral fixation under neurosurgical supervision.
4. Patient and his or her family must know that specific conditions such as Uncontrolled Pain, seclusion and social isolation prone patients to drug abuse or Opioids addiction, therefore they must prevent or solve these problems as soon as possible.
5. Finding suitable job and economic independence are important factors for patient’s self-confidence. SCI patients can do some job better than other.
Spinal cord function in normal conditions
1. Transmission movement signals from brain to limbs.
2. Transmission properioception signals from limbs to brain
3. Urine sensation and voluntary control of urination.
4. Defecation sensation and voluntary control of defecation.
5. Sexual sensation and function.
Spinal cord injury in cervical area lead to paralysis in four limbs and spinal cord injury in lumbar area cause inferior limb paralysis.
Motor complications management and muscles atrophy prevention in SCI patients
1. Physiotherapy and appropriate exercise must be done daily for prevention of arthrodesis.
2. Accomplishment electrical stimulation and active physiotherapy in incomplete SCI (for moveable limbs).
3. Patient education for wheelchair using in move, stand up and sitting position in cervical and lumbar spinal cord injury.
4. Patient education for standing on special bed under physiotherapist and occupational Therapist.
5. Patient education for stand up with brace under occupational therapist.
6. Patient education for walking by brace and medical stick.
7. Patient education for walking by brace and walker.
It is necessary that patient achieve better level in movement, appropriately with his or her ability.
Sensory complications management and bed sore prevention in SCI
1. For prevention of bed sore, avoidance from permanent pressure on one area of body is necessary. For this purpose, changing position frequently and using of bed fluctuated and air beds on wheelchair are recommended.
2. Patient must avoid from body contact with sharp and hot or cold things in sensory less area. Prevention from rubbing in limbs and joints is necessary.
3. Prevention of dry skin by moisturizers and emollient agents and observe hygiene in fingers and nails.
4. In using of brace or walker remember that there is not properioception function in SCI and patient is susceptible for falling, injuries and bone fractures, therefore observation by family members or occupational therapist in these times is necessary.
5. Sedation pains after SCI are possible by suitable drugs and in some conditions by surgery. Patient must avoid from using alcohol and opioids for sedation.
Urinary Incontinence in SCI
1. Urinary Incontinence is the inability to sense bladder filling and control the passage of urine.
2. Long time using of constant catheter (Foley catheter, condom- sheet and pad) propose patient to urinary tract infections, decrease bladder capacity and dirty sense in patient.
3. If upper limbs are functional, patient can use of CIC (Clean Intermittent Catheterization by Nelaton catheter) in 3-4 hours interval gap and therefore prevention of complications in urinary tract will be easier.
4. If there is urine incontinence between CIC, bladder dilator and bladder neck constrictor drugs can be useful.
5. If there is high bladder pressure and renal failure possibility, counseling with urologist can offer other new method.
6. For prevention of renal stone, regular fluid intake is necessary.
Usually SCI patients complain are constipation, Incontinence of defecation and necessity of pad using. Intestinal conditioning and using of suppository laxative drugs for defecation induced is helpful. High Fiber diets include fruits and vegetables in per meal and low fat and carbohydrate diet are recommended for constipation prevention. Limit rice, bread and fat intake. Patient must try to have normal weight.
Appropriate physical activity, physiotherapy and occupational therapy fallow up is important for intestinal movement improving and constipation prevention.