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Treatment begins with the emergency
medical personnel who make an initial evaluation and immobilise
the patient for transport. Immediate medical care within the
first 8 hours following injury is critical to the patient's
recovery. Nowadays there is much greater knowledge about the
moving and handling of spinal injury patients. Incorrect
techniques used at this stage could worsen the injuries
considerably.
When injury occurs and for a period of time thereafter, the
spinal cord responds by swelling. Treatment starts with steroid
drugs, these can be administered at the scene by an air
ambulance Doctor or trained paramedic. These drugs reduce
inflammation in the injured area and help to prevent further
damage to cellular membranes that can cause nerve death. Sparing
nerves from further damage and death is crucial.
Each patient's injury is unique. Some patients require surgery
to stabilise the spine, correct a gross misalignment, or to
remove tissue causing cord or nerve compression. Spinal
stabilisation often helps to prevent further damage. Some
patients may be placed in traction and the spine allowed to heal
naturally. Every injury is unique as is the course of post
injury treatment that follows.
Spinal
Cord Shock
When a spinal cord injury is caused due to trauma, the body goes
into a state known as spinal shock. While spinal shock begins
within a few minutes of the injury, it make take several hours
before the full effects occur. During spinal shock the nervous
system is unable to transmit signals, some of which may return
once spinal shock has subsided, the time spinal shock lasts for
is approximately 4-6 weeks following the injury. In some rare
cases spinal cord shock can last for several more months.
The loss of these signals will effect the persons movement,
sensation and how well the body’s systems function. Often the
persons loss of movement and sensation below the level of the
spinal cord injury may appear complete soon after the injury.
This may mask the real extent of the damage. Usually, over the
first few weeks the some of body systems adjust to the effects
of the injury and their function improves. Therefore, during
this time and the early stage of ANY new injury it is unlikely
that an accurate prediction of any recovery or permanent
paralysis can be made.
Surgery
Depending on the circumstances, when surgery is required, it may
be performed within 8 hours following injury. Surgery may be
considered if the spinal cord is compressed and when the spine
requires stabilization. The surgeon decides the procedure that
will provide the greatest benefit for the patient.
Different tissue and bony structures including vertebrae
misaligned from the force of injury, a herniated
disc, or a haematoma can cause spinal cord compression. An
unstable spine may require spinal instrumentation and fusion to
build in support.
Spinal instrumentation and fusion can be used to provide
permanent stability to the spinal column. These procedures
correct, join, and solidify the level where a spinal element has
been damaged or removed (e.g. herniated disc)
Instrumentation uses medically designed hardware such as rods,
bars, wires and screws. Instrumentation is combined with fusion
(bone grafts) to permanently join two or more vertebrae.
Healing Broken Bones Without
Surgery
Surgery isn't the only way to repair broken bones in the neck
and back a more conservative and less invasive approach is to
allow the bones to heal naturally with the help of
halo traction where
needed. This approach may mean up to two months complete
bed rest.
Recovery
Once the patient is stabilised, care and treatment focuses on
supportive care and rehabilitation. Family members, nurses, or
specially trained carers give supportive care. This care might
include helping the patient bathe, dress, change positions to
prevent bedsores, and other assistance.
Rehabilitation often includes physical therapy, occupational
therapy, and counselling for emotional support. Each program is
designed to meet the patient's unique needs.
The services may be initially provided while the patient is
hospitalised or on a specialist spinal injuries unit. Following
hospitalisation, some patient's are admitted to a rehabilitation
facility. Other patients can continue rehabilitation on an
outpatient basis and/or at home.
A physiotherapy (PT) program can facilitate the restoration of
muscle strength, flexibility, improve mobility, coordination,
and maintain body functions through exercise. Massage,
hydrotherapy, and other treatments can help to relieve pain.
Gait training may be taught to patients with difficulty walking,
which could include teaching the patient how to use assistive
devices (e.g., walker, crutches or a cane). physiotherapy
benefits the patient be preventing complications from surgery or
illness.
Occupational therapy (OT) teaches the patient how to cope with
everyday life. OT encourages independence by helping the patient
with daily tasks such as dressing, bathing, food preparation,
going to the toilet, and other activities of daily living.
Speech and language therapy may be included. These skills cross
over to the workplace, helping the patient develop their full
potential. This might include teaching the patient how to use
different muscles to complete tasks such as writing.
Sometimes more than the support from family and friends is
needed to cope with spinal cord injury. Many types of
counselling are available including psychiatrists,
psychologists, and group therapy.
see also:-
Complications
-
Rehabilitation
- Rehabilitation Functional
Goals -
Spinal Injury
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