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Spinal Cord Injury: Bladder Care and Management Part 1

Bladder care and urination can be big issues for people living with Spinal Cord Injury or SCI. Some basic knowledge and preventative care can go a long way managing these bladder care issues.

The body's urinary system has three major functions. It makes urine in the kidneys; stores urine in the bladder; and removes urine from the body through the urethra. The kidneys filter waste products and water from the blood to form urine. The urine moves from the kidneys to the bladder through tubes, called ureters. The bladder temporarily stores the urine. The bladder is made of muscle and can stretch to hold about 2 cups of urine. The muscles (sphincters) at the neck of the urethra control the flow of urine from the bladder. When the sphincter muscles relax, the urine flows out through the urethra. The urethra is a slender tube that runs from the bladder to the outside of the body. Once the bladder starts to empty, it normally empties all of the urine.

How the Urinary System Works After a Spinal Cord Injury: Nerves near the end of the spinal cord (the sacral level of the spine) control how the urinary system works. The spinal cord injury usually does not affect how the kidneys work or how the urine collects in the bladder. The changes that usually take place after an SCI are how the bladder and sphincter muscles work. After a spinal cord injury, messages can no longer travel normally between the bladder or sphincter muscles and the brain. Individuals usually cannot feel when the bladder is full or they do not have the "urge" to urinate. The bladder muscles and sphincter muscles must work together so you have control of when you urinate (empty your bladder). These muscles also cause the bladder to empty completely.

What is a Bladder Management Program? A bladder management program allows you to plan for bladder emptying in an acceptable manner when it is convenient for you. This helps you avoid accidents and prevent infections. Your level and type of injury affect the choice you and your doctor make for your bladder program. Because each person's injury is different, your doctor will probably conduct some tests to see how your bladder functions. You also need to consider your hand function. How easy is it for you to do your own bladder program? Can you manage alone or will you need help? During your rehabilitation you learn different ways to empty your bladder. The methods most frequently used are intermittent catheterization (ICP); indwelling catheter (Foley); and the condom external catheter for males. You may use just one program or a combination of methods. You will need to decide the method that works best for you.

How does level of injury affect your Bladder Management Program? Generally there are 2 ways the bladder works after a spinal cord injury. Spastic or Reflex Bladder means that when your bladder fills with urine, a reflex automatically triggers he bladder to empty. The problem with a spastic bladder is you do not know when the bladder will empty. You are also at greater risk for sphincter dyssynergia. Spastic or Reflex bladder usually occurs when the injury is above the T12 level. The choices in bladder management methods for an individual with a spastic/reflex bladder include ICP, indwelling catheter (Foley), and condom catheter (males). Flaccid or non-reflex bladder means one's reflexes may be sluggish or absent. You may not feel when the bladder is full. It then becomes over-distended or stretched. This can cause the urine to back up through the ureters to the kidneys. Stretching also affects the muscle tone of the bladder. Individuals with injuries below T12/L1 usually have a flaccid bladder. The bladder management program most commonly used with flaccid bladder is ICP. To avoid problems, do not allow too much urine (over 400 cc) to collect in your bladder if it is flaccid.

 

By: RRTC in Secondary Complications in SCI at the University of Alabama at Birmingham, Dept. of P M & R

 

Spinal Cord Injury: Bladder Care and Management Part 2

Urinary tract infections and Bladder Cancer

Bladder care and urination can be big issues for people living with Spinal Cord Injury or SCI. Some basic knowledge and preventative care can go a long way managing these bladder care issues.

Urinary Tract Problems: Kidney (renal) failure used to be the leading cause of death for individuals with a spinal cord injury. Today with the improved methods of bladder management, there are fewer and less severe complications with the kidneys. The more common cause of death related to the urinary tract is now sepsis (a blood stream infection resulting from a symptomatic infection in the urinary tract) rather than kidney failure. The loss of normal bladder function after spinal cord injury places one at increased risk for urinary tract infection (UTI), regardless of the type of bladder management used. A urinary tract infection can occur in the bladder, the kidney, or other parts of the urinary tract. Urinary tract infection remains the most common secondary medical complication following a spinal cord injury and it is certainly one of the most costly.

Urinary Tract Infection: Most persons with a spinal cord injury (80%) have bacteria in the urine that are identified by a urine culture. This is not considered serious unless it leads to signs or symptoms. Your doctor may be able to identify a serious UTI by its symptoms and a physical exam. Bladder infection (cystitis) is the most common. Symptoms of a bladder infection may include going to the bathroom frequently, passing blood in the urine, cloudy and odorous urine, increased spasticity in the lower extremities, fever and chills. Depending on your level of injury, you may feel a burning with urination, or discomfort in the lower pelvic area, abdomen, or lower back. Infection of the testicles (epidymitis) can have any of the symptoms of a bladder infection plus the scrotum is swollen, hot and red. An individual with an incomplete injury may feel pain in the testicles.

Treatment of UTI: Because symptoms are similar for any UTI, you must see your doctor for lab tests to determine the need for treatment. Research shows that UTIs that do not have symptoms usually do not need treatment with antibiotics. Use an antibiotic only when symptoms (fever, chills and pain) are present. Excessive treatment with antibiotics may lead to resistant strains of bacteria, which become more difficult to treat

Medical Problems in the Urinary Tract: Other medical problems can develop in the bladder, kidneys, and ureters. Dyssynergia occurs when the bladder contracts but the sphincter does not open. The urine can "back up" in the kidneys. This is called "reflux" action. Treatment includes medications or surgery to open the sphincter. Kidney and bladder stones can form. They interfere with the function of the kidney/bladder and cause infection. Incontinence or urine leakage may be a problem for some individuals. Treatment can include both drugs and surgery. Medications are often used to control bladder spasms and tighten the sphincter muscles. Several surgical options are available for treating incontinence, including various forms of urinary diversion. A new urinary reservoir ("pouch") is made from bowel tissue. The ureters are implanted into the new bladder "pouch". The urine is drained through an opening (stoma) in either the navel or stomach wall. A new surgical method is bladder augmentation cystoplasty. Here the bladder is enlarged using bowel tissue. Since surgery involves both the urinary and gastrointestinal systems, recovery time is longer.

Bladder Cancer: Research in aging with SCI shows a small increase in the risk of bladder cancer among individuals with spinal cord injury who have been using indwelling catheters for a long period of time. In a study at Craig Hospital the rate of bladder cancer was only .2% in those seen over the first 10 years post-injury. But by 30 years post injury the risk was at 9%. If you've used an indwelling catheter for more than 10 years, have regular cystoscopic evaluations. Smoking also increases the risk for developing bladder cancer

By: RRTC in Secondary Complications in SCI at the University of Alabama at Birmingham, Dept. of P M & R

Spinal Cord Injury: Bladder Care and Management Part 3

Treatment and Maintaining Bladder Health

Bladder care and urination can be big issues for people living with Spinal Cord Injury or SCI. Some basic knowledge and preventative care can go a long way managing these bladder care issues.

Treating Medical Problems in the Urinary Tract: Problems in the urinary tract often do not have any symptoms. This means they can go undetected until they become serious. Your routine physical exam and laboratory studies are the best ways to find problems early and treat them before they become serious. Your doctor can then treat problems before there are serious complications.

Keeping your Urinary System Healthy: Individuals with SCI are more likely to have UTIs or problems with the urinary system. To avoid problems and keep your urinary system healthy, empty your bladder completely. After your SCI, you may not have the "urge" to urinate. Your bladder often does not empty completely. When the bladder does not empty completely, germs or bacteria are likely to grow in the urine left in the bladder. These bacteria can cause an infection in the bladder. Use a "clean technique" catheterization. Always wash your hands before and after doing the catheterization. Be sure your catheter and equipment are clean. Keep Skin Clean and Dry Research studies show that harmful bacteria usually remain on the skin in the genital area of individuals with SCI. This may be related to skin moisture, urine leakage, pH, local skin temperature, personal hygiene, and/or neurogenic bowel management. If you have urine leakage or a bowel accident, change your wet, soiled clothes immediately. Clean the area around the genitals with soap and water every day. Drink plenty of liquids. A steady intake of fluids helps "wash out" bacteria and waste materials. Drinking the recommended amount of liquids helps avoid problems and lessens the chance of stones forming. How much fluid you need to drink each day depends on your bladder management program. With an indwelling catheter, you need to keep your fluid intake high. This means drinking 15 - 8 oz. glasses or 3 quarts of liquids each day. If you do intermittent catheterization, you need to drink 8 to 10 - 8 oz. glasses or 2 quarts between breakfast and dinner. The recommendation is to make water your "beverage of choice". Make it your #1 beverage and drink all other beverages in moderation. Limit carbonated beverages to 1 per day.

Keep Bladder Pressures Low: While you need to drink the recommended amount of fluids, you also need to empty your bladder on a regular schedule. With ICP, your goal is to limit the amount of fluid that collects in the bladder to 8 ounces or less (400 cc). This means you can intake about 4 oz each hour while awake. Drinking more fluids than this causes the bladder to over stretch, making you more susceptible to infection or reflux. You need to catheterize more frequently if you drink more.

Take Medications As Prescribed: There are different times that your doctor may prescribe medication to treat problems related to your bladder management program. It is very important to take only the medication that is prescribed and to finish taking all the medicine as directed.

 

Have a Regular Urological Checkup: If you have infections and get ill more than once or twice a year, this alerts you that something may not be right with your bladder management program. Check with a urologist to see how your bladder is working. A regular urological exam that includes renal scan and KUB is recommended. The renal scan checks to see how your kidneys are functioning. The KUB is simply an X-ray of the abdomen that can detect kidney or bladder stones. These tests may be done once every 6 months, annually, or every 2 years, depending on your medical history.

By: RRTC in Secondary Complications in SCI at the University of Alabama at Birmingham, Dept. of P M & R

Spinal Cord Injury: Choosing a Rehabilitation Center Part 1

Choosing a rehabilitation center is very important. Not all rehabilitation centers have a spinal cord injury program. Do as much research as possible and don't be afraid to ask questions. Since each individual’s needs will vary, with the help of the NSCIA, we have put together some questions and information to help get you started, but keep in mind it’s just a reference to help get you started.

 A good rehabilitation center does not necessarily need to adhere to all of these guidelines. Feel free to print this page out and take it with you on your visit, or keep it handy when you make your phone inquiries.

Some questions to consider when inquiring about a rehabilitation center

  • Are the beds for people with SCI in the same area of the facility? Are there people in the SCI program of the same age and sex as the person considering admission?
  • Do the people in the SCI program have similar levels and kinds of spinal cord injury e.g., quadriplegia, paraplegia, incomplete and complete?
  • What is the average number of people admitted annually to the SCI program? (program staff should treat people with SCI on a regular basis to acquire and maintain expertise.)
  • Is the SCI program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? Has it been designated as a Model Spinal Cord Injury Center by the National Institute of Disability Research and Rehabilitation (NIDRR)?  Click here for a current list of Model spinal cord injury centers)
  • Is the SCI program part of a SCI rehabilitation system operated by the state?
  • Are there treatment specialists in the SCI program who speak the primary language of the individual seeking treatment?
  • Will the treatment team develop a rehabilitation plan with both short and long term goals?
  • Will an experienced case manager be assigned to help family members obtain medical payments and other benefits from public and private insurance? Will a team member be assigned to coordinate treatment and act as a contact for staff and family members?

Staffing/Rehabilitation Program Elements

  • Is the physician in charge a Physiatrist? If not, what credentials does he/she have? How long has the physician in charge been directing programs specializing in SCI? Is there physician coverage seven days a week? Twenty-four hours a day?
  • Do the regular nursing staff and other specialists responsible for providing treatment in the SCI program have specific training in treating SCI? Is the nursing staff employed by the hospital or employed through an outside agency?
  • Does the program ensure the availability of rehabilitation nursing and respiratory care on a twenty-four hour basis?
  • Are there consultants available at the facility or nearby medical centers? These should include neurosurgery, neurology, urology, orthopedics, plastic surgery, neuropsychology, internal medicine, gynecology, speech pathology, pulmonary medicine, general surgery and psychiatry.
  • How often and for how long each day will participants get treatment by specialists such as occupational and physical therapists? Treatment should be no less than three hours per day.
  • Are other specialties such as driver education, rehabilitation engineering, chaplaincy, and therapeutic recreation available if needed?
  • Are activities planned for SCI program participants on weekends and evenings?
  • How much time is spent teaching SCI program participants and their families about sexuality, bowel and bladder care, skin care and other essential self-care activities?
  • Does the SCI program offer training in the management and hiring of personal care assistants? If so, how much time is spent by staff on this topic?

Discharge Planning

  • Are SCI program participants given educational self-care manuals when they are discharged?
  • Will staff members develop a formal discharge plan with program participants and their families?
  • Does the facility and discharge planner work with local Independent Living Centers? Do they incorporate referrals to these centers into their discharge planning? Is there an independent living unit available for program participants and families to practice self-care skills? Can family members stay there also?
  • If the facility does not have an independent living unit do they encourage overnight therapeutic leave prior to discharge?
  • Will someone be assigned as a liaison to provide follow-up services? Will a staff member visit or make arrangements for someone locally to evaluate the home for modifications?
  • Will the follow-up plan include:
  • Referral to an appropriate physician and other medical specialists in the community?
  • Regular follow-up visits with this physician or a spinal cord injury unit physician?
  • Regular urological evaluations?
  • Scheduled equipment evaluations?
  • If appropriate, a thorough vocational evaluation and referrals to a vocational rehabilitation program?

 *The National Spinal Cord Injury Association Resource Center (NSCIRC) provides information and referral on any subject related to spinal cord injury. Contact the resource center at 1-800-962-9629.

 

Spinal Cord Injury: Choosing a Rehabilitation Center Part 2

Special Programs

Choosing a rehabilitation center is very important. Not all rehabilitation centers have a spinal cord injury program. Do as much research as possible and don't be afraid to ask questions. Since each individual’s needs will vary, with the help of the NSCIA, we have put together some questions and information to help get you started, but keep in mind it’s just a reference to help get you started.

 A good rehabilitation center does not necessarily need to adhere to all of these guidelines. Feel free to print this page out and take it with you on your visit, or keep it handy when you make your phone inquiries.

SPECIAL PROGRAMS

         Pediatric Programs

  • Because incidence rates of SCI among children are relatively low, rehabilitation hospitals and programs usually do not maintain a separate program or unit exclusively for children with SCI. As an alternative, caregivers may consider facilities/programs which place children with SCI in rehabilitation units with other children with chronic disabilities. Hopefully, this will provide families and children with opportunities to share common experiences and information with each other, and may lead to the development of support networks in the community.
  • It is possible that children may be placed in units with other children who are too ill for rehabilitation. Children generally derive greater benefit if they undergo rehabilitation with other children who are actively involved in the rehabilitation process.
  • Are the beds for children with spinal cord injuries in one area or in the same location as children with similar disabilities?
  • Are children of the same sex and similar age currently in the program/facility?
  • Is the physician in charge an individual with experience in rehabilitation? Does this physician have experience with children? If not, what are his/her qualifications? Do the other staff members specialize in pediatrics?
  • How many children with SCI does the program/facility admit on an annual basis?
  • Does the program/facility offer educational programs for children and young adults undergoing treatment? If not, does the facility coordinate tutoring programs with local schools? If so, who is responsible for payment?
  • Are there child-life or therapeutic recreation specialists on staff? (Child life specialists develop programs for children and families which strive to maintain normal living patterns and minimize the clinical environment. Therapeutic recreation specialists focus on teaching persons with disabilities new leisure and sports skills to maximize their independence).
  • Are young siblings and friends allowed to visit the unit?
  • Does the program/facility offer adaptive technology to help children communicate and learn?
  • Is counseling available for siblings and families members?
  • Is the equipment used by therapists, appropriate for children?
  • Does the facility/program provide patient education materials for children and family members?

Ventilator Programs

  • Is the physician who directs the program a board certified Pulmonologist or a Physiatrist? Does he/she have experience with SCI? Are ventilator users treated on the same unit?
  • How long has the facility been providing treatment for ventilator users?
  • If the treatment team determines that an individual cannot breathe independently, what kinds of services are offered to assist them in living as independently as possible?
  • Are people in the unit similar in age to the person considering admission?
  • Will they have the opportunity to meet ventilator users who have returned to the community and maximized their independence?

Special Considerations

         Psycho social/Counseling Services

  • What types and how many hours of psycho social services are available? These should include peer support, individual and group psychotherapy, couples, vocational and substance abuse counseling? Does the facility offer sexuality and fertility counseling?

         Facility Policies/Family Members

  • Do facility policies encourage family members including siblings regardless of age, to participate in rehabilitation programs? Are there living arrangements for family members participating in training? What other services, parking, meals and etc. are provided? Are counseling and other social services available to family members?

Discharge Planning

  • Are SCI program participants given educational self-care manuals when they are discharged?
  • Will staff members develop a formal discharge plan with program participants and their families?
  • Does the facility and discharge planner work with local Independent Living Centers? Do they incorporate referrals to these centers into their discharge planning? Is there an independent living unit available for program participants and families to practice self-care skills? Can family members stay there also?
  • If the facility does not have an independent living unit do they encourage overnight therapeutic leave prior to discharge?
  • Will someone be assigned as a liaison to provide follow-up services? Will a staff member visit or make arrangements for someone locally to evaluate the home for modifications?
  • Will the follow-up plan include:
  • Referral to an appropriate physician and other medical specialists in the community?
  • Regular follow-up visits with this physician or a spinal cord injury unit physician?
  • Regular urological evaluations?
  • Scheduled equipment evaluations?
  • If appropriate, a thorough vocational evaluation and referrals to a vocational rehabilitation program?

 *The National Spinal Cord Injury Association Resource Center (NSCIRC) provides information and referral on any subject related to spinal cord injury. Contact the resource center at 1-800-962-9629.

 

Some basic questions and answers about Spinal Cord Injuries, Part 1

What is Spinal Cord Injury?   Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. Frequent causes of damage are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida, Friedreich's Ataxia, etc.). The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.
   A person can "break their back or neck" yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized.
   
What is the spinal cord and the vertebra?   The spinal cord is about 18 inches long and extends from the base of the brain, down the middle of the back, to about the waist. The nerves that lie within the spinal cord are upper motor neurons (UMNs) and their function is to carry the messages back and forth from the brain to the spinal nerves along the spinal tract. The spinal nerves that branch out from the spinal cord to the other parts of the body are called lower motor neurons (LMNs). These spinal nerves exit and enter at each vertebral level and communicate with specific areas of the body. The sensory portions of the LMN carry messages about sensation from the skin and other body parts and organs to the brain. The motor portions of the LMN send messages from the brain to the various body parts to initiate actions such as muscle movement.

   The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and 
Parasympathetic Nervous Systems. 

The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience. The vertebra are named according to their location. The eight vertebra in the neck are called the Cervical Vertebra. The top vertebra is called C-1, the next is C-2, etc. Cervical SCI's usually cause loss of function in the arms and legs.

What are the effects of SCI?   The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.
The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses. 
Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers. Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.      Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder. Sexual functioning is frequently with SCI may have their fertility affected, while women's fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature,   inability to sweat below the level of injury, and chronic pain. 

How many people have SCI?  Who are they? Approximately 450,000 people live with SCI in the US. There are about 10,000 new SCI's every year; the majority of them (82%) involve males between the ages of 16-30. These injuries result from motor vehicle accidents (36%), violence (28.9%), or falls (21.2%).Quadriplegia is slightly more common than paraplegia.       

Is there a cure?
   Currently there is no cure for SCI. There are researchers attacking this problem, and there have been many advances in the lab (see research updates). Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury.

 Do people with SCI ever get better?
   When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to go down and people may regain some functioning. With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning.

 Does everyone who sustains SCI use a wheelchair?
   No. Wheelchairs are a tool for mobility. High C-level injuries usually require that the individual use a power wheelchair. Low C-level injuries and below usually allow the person to use a manual chair. Advantages of manual chairs are that they cost less, weigh less, disassemble into smaller pieces and are more agile. However, for the person who needs a power chair, the independence afforded by them is worth the limitations. Some people are able to use braces and crutches for ambulation. These methods of mobility do not mean that the person will never use a wheelchair. Many people who use braces still find wheelchairs more useful for longer distances. However, the therapeutic and activity levels allowed by standing or walking briefly may make braces a reasonable alternative for some people.
   Of course, people who use wheelchairs aren't always in them. They drive, swim, fly planes, ski, and do many activities out of their chair. If you hang around people who use wheelchairs long enough, you may see them sitting in the grass pulling weeds, sitting on your couch, or playing on the floor with children or pets. And of course, people who use wheelchairs don't sleep in them, they sleep in a bed. No one is "wheelchair bound."

 Do people with SCI die sooner?
   Yes. Before World War II, most people who sustained SCI died within weeks of their injury due to urinary dysfunction, respiratory infection or bedsores. With the advent of modern antibiotics, modern materials such as plastics and latex, and better procedures for dealing with the everyday issues of living with SCI, many people approach the lifespan of non-disabled individuals. Interestingly, other than level of injury, the type of rehab facility used is the greatest indicator of long-term survival. This illustrates the importance of and the difference made by going to a facility that specializes in SCI. People who use vents are at some increased danger of dying from pneumonia or respiratory infection, but modern technology is improving in that area as well. Pressure sores are another common cause of hospitalization, and if not treated may lead to death.
   Overall, 85% of SCI patients who survive the first 24 hours are still alive 10 years later. The most common cause of death is due to diseases of the respiratory system, with most of these being due to pneumonia. In fact, pneumonia is the single leading cause of death throughout the entire 15 year period immediately following SCI for all age groups, both males and females, whites and non-whites, and persons with quadriplegia.
   The second leading cause of death is non-ischemic heart disease. These are almost always unexplained heart attacks often occurring among young persons who have no previous history of underlying heart disease.
   Deaths due to external causes is the third leading cause of death for SCI patients. These include subsequent unintentional injuries, suicides and homicides, but do not include persons dying from multiple injuries sustained during the original accident. The majority of these deaths are the result of suicide.

Do people with SCI have jobs?
   People with SCI have the same desires as other people. That includes a desire to work and be productive. The Americans with Disabilities Act (ADA) promotes the inclusion of people with SCI to main streaming day-to-day society. Of course, people with disabilities may need some changes to make their workplace more accessible, but surveys indicate that the cost of making accommodations to the workplace in 70% of cases is $500 or less.

    

Some basic questions and answers about Spinal Cord Injuries, Part 2

Is there a cure for Spinal Cord Injury?
   Currently there is no cure for SCI. There are researchers attacking this problem, and there have been many advances in the lab (see research updates). Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury.


 Do people with SCI ever get better?
   When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to go down and people may regain some functioning. With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning.

 Does everyone who sustains SCI use a wheelchair?
   No. Wheelchairs are a tool for mobility. High C-level injuries usually require that the individual use a power wheelchair. Low C-level injuries and below usually allow the person to use a manual chair. Advantages of manual chairs are that they cost less, weigh less, disassemble into smaller pieces and are more agile. However, for the person who needs a power chair, the independence afforded by them is worth the limitations. Some people are able to use braces and crutches for ambulation. These methods of mobility do not mean that the person will never use a wheelchair. Many people who use braces still find wheelchairs more useful for longer distances. However, the therapeutic and activity levels allowed by standing or walking briefly may make braces a reasonable alternative for some people.
   Of course, people who use wheelchairs aren't always in them. They drive, swim, fly planes, ski, and do many activities out of their chair. If you hang around people who use wheelchairs long enough, you may see them sitting in the grass pulling weeds, sitting on your couch, or playing on the floor with children or pets. And of course, people who use wheelchairs don't sleep in them, they sleep in a bed. No one is "wheelchair bound."

 Do people with SCI die sooner?
   Yes. Before World War II, most people who sustained SCI died within weeks of their injury due to urinary dysfunction, respiratory infection or bedsores. With the advent of modern antibiotics, modern materials such as plastics and latex, and better procedures for dealing with the everyday issues of living with SCI, many people approach the lifespan of non-disabled individuals. Interestingly, other than level of injury, the type of rehab facility used is the greatest indicator of long-term survival. This illustrates the importance of and the difference made by going to a facility that specializes in SCI. People who use vents are at some increased danger of dying from pneumonia or respiratory infection, but modern technology is improving in that area as well. Pressure sores are another common cause of hospitalization, and if not treated may lead to death.
   Overall, 85% of SCI patients who survive the first 24 hours are still alive 10 years later. The most common cause of death is due to diseases of the respiratory system, with most of these being due to pneumonia. In fact, pneumonia is the single leading cause of death throughout the entire 15 year period immediately following SCI for all age groups, both males and females, whites and non-whites, and persons with quadriplegia.
   The second leading cause of death is non-ischemic heart disease. These are almost always unexplained heart attacks often occurring among young persons who have no previous history of underlying heart disease.
   Deaths due to external causes is the third leading cause of death for SCI patients. These include subsequent unintentional injuries, suicides and homicides, but do not include persons dying from multiple injuries sustained during the original accident. The majority of these deaths are the result of suicide.

Do people with SCI have jobs?
   People with SCI have the same desires as other people. That includes a desire to work and be productive. The Americans with Disabilities Act (ADA) promotes the inclusion of people with SCI to main streaming day-to-day society. Of course, people with disabilities may need some changes to make their workplace more accessible, but surveys indicate that the cost of making accommodations to the workplace in 70% of cases is $500 or less.