The Unwavering Pillar: The Vital Role of Family after Spinal Cord Injury

A spinal cord injury is a life-altering event that can significantly impact not just the individual affected but also their entire support network. Among the key players in this network, family members often stand at the forefront, serving as the unwavering pillars of strength, support, and care. Their role is not just to provide assistance but also to provide emotional, physical and psychological support for the well-being and recovery of the individual.

Family is the strongest pillar after Spinal cord injury.

The Immediate Impact after SCI

The moment an individual experiences an SCI, the entire family is impacted. Shock, disbelief, and emotional upheaval often accompany the initial news. In such tough time, family members become the first helping hands, offering comfort, reassurance, and a sense of stability to the survivor. Not only the comfort and reassurance but they also provide a sense of normalcy amidst chaos. In most of the cases family members are not aware of what is SCI and how to deal with it. So, along with being the helping hand for the survivor they also needs to gather knowledge about SCI and it’s complications.

Emotional Support and Encouragement

Emotional well-being plays a very important role in the recovery journey of SCI. Family members often act as emotional anchors, lending a listening ear, providing empathy, and fostering an environment of positivity. Definitely, the positivity is the reason that SCIs regain their health speedily. Additionally, the family members play a crucial role in preventing feelings of isolation and depression that can often accompany after such a life-altering event.

The consistent encouragement and motivation by these constant pillars contribute significantly to the injured individual’s mental resilience. Their unwavering belief in the person’s ability to adapt and overcome challenges becomes a driving force during the recovery process.

Physical Care and Assistance

Other than emotional support, family members also helps SCIs with proper physical assistance. They becomes caregiver for the survivors immediately after their injury. After SCI the survivors lose their mobility depending on their level of injury and therefore require significant physical support. The practical aspects of caregiving post-SCI are multifaceted and demanding. From aiding with daily activities to ensuring accessibility within the home, family members often take on the role of primary caregivers. Tasks like mobility assistance, personal care, helping in daily activities and managing medical needs become integral parts of their daily routine.

Adaptation and Environmental Adjustments

The family’s role extends beyond physical care; they are instrumental in creating an inclusive and supportive environment. Adapting the living space, altering routines, and making adjustments from installing ramps and handrails to rearranging furniture for easier mobility, these adaptations are essential for the injured person’s comfort and independence. This inclusivity not only aids the individual’s physical well-being but also fosters a sense of belonging and normalcy, crucial for mental health.

Learning and support

Families often need to undergo a learning process post-SCI, understanding the intricacies of the injury and how to support the individual in the best possible way. As, the impact and severity of the injury is different for different individuals. Also post-SCI the individuals faces a lot of challenges like immobility, bladder & bowel dysfunction and many more.

Moreover, family members may need to advocate for the injured person, navigating healthcare systems, rehabilitation programs. Their dedication and advocacy often ensure that the individual receives the best possible care and resources for their recovery.

Conclusion

In the journey of recovery after a spinal cord injury, the role of family stands unparalleled. Their unwavering support, dedication, and sacrifices contribute immensely to the individual’s rehabilitation and quality of life. Moreover, the demanding nature of caregiving can be emotionally and physically draining. Thus, respite care and self-care are vital for caregivers as well.

– By Dr. Virendra Vikram Sigh(Physiotherapist)

The Vital Role of Nutrition In SCI

Different forms of nutrition in food

SCI can have a profound impact on an individual’s life; it does not only affect the mobility but also overall health and well-being. There are so many issues and secondary complications that come with SCI such as loss of control over bladder & bowel, neurogenic bladder and bowel, urinary tract infection, chronic constipation, weight management, pressure sores and a lot more. To tackle with these complications along with rehabilitation, maintaining a good nutrition is also crucial. Nutrition plays a very important role in supporting the recovery and long-term health in SCI patients.

In this blog, we will explore why nutrition is essential for individuals with SCI and provide tips to optimize dietary habits.

Importance of Nutrition In SCI Patients:

After an SCI, the body’s nutritional needs may change, and proper nutrition becomes even more vital. Here are some key considerations and the crucial role of nutrition after a spinal cord injury:

12 main vitamins


1. Adequate Calories and Protein Intake

SCI often leads to changes in metabolism, muscle breakdown, tissue damage and a decrease in body mass. Consuming enough calories through extra protein rather then carbohydrates is essential to support the body’s healing process, maintain muscle mass, and prevent complications such as pressure sores and infections.

Protein-rich foods like pulses, oats, soya bean, eggs, lean meats, fish, and dairy products should be included in the diet.

2. Adequate Fiber Intake

After SCI depending upon the level of injury, many people loose bladder and bowel sensation. Digestion of food and movement of stool towards colon and rectum also slows down resulting in issues such as constipation, incontinence causing bowel accidents and sometimes diarrhea too.

Consuming an adequate amount of dietary fiber, found in fruits, green vegetables, cucumber, carrot, whole grains, and pulses can help soften the stool and hence promote regular bowel movements and prevent constipation.

3. Hydration

Staying hydrated is important for everyone, but it is particularly crucial for individuals with SCI. Proper hydration keeps healthy skin, helps prevent urinary tract infections, supports digestion, aids in regulating body temperature, and promotes overall health. Water, coconut water, and low-sugar beverages should be consumed throughout the day.

In addition, it is also very important to give calculated amount of liquid as suggested by the medical advisor if the person is doing CIC for urination to prevent leakage.

4. Calcium and Vitamin D

Individuals with SCI may have a higher risk of osteoporosis due to inactivity and decreased weight-bearing activities. Adequate calcium and vitamin D intake is important to maintain bone health. Dairy products, green leafy veggies, nuts, and supplements may be recommended to ensure sufficient calcium and vitamin D levels. Vitamin D is mandatory with calcium supplements for better absorption.

5. Antioxidants and Anti-inflammatory Foods

 SCI may lead to an increase in oxidative stress and inflammation in the body. Consuming antioxidant-rich foods, such as berries, leafy greens, nuts, and seeds, can help counteract oxidative stress. Foods with anti-inflammatory properties, such as fatty fish, turmeric, ginger, and olive oil, may also be beneficial.

6. Vitamin and Mineral

Individuals with SCI may have a higher risk of vitamin B12 deficiency due to changes in absorption. Vitamin B12 is essential for nerve function and blood cell production. Including sources of vitamin B12, such as meat, fish, dairy, and fortified foods, or taking supplements if needed, is important.

Furthermore, along with Vitamin B12 person with SCI may also have low phosphorus and sodium level. Mostly quadriplegics have low Blood Pressure causing lethargy and restlessness, so It is advisable to increase salt intake unless they have high blood pressure issues.

Additionally, Vitamin C and zinc intake is also essential as it promote skin health. Vitamin C helps the body absorb iron more effectively and helps fight infections. It also aids in better absorption of protein. Good sources of vitamin C include lemon, orange juice, orange, kiwi, and broccoli. Sources of zinc include lean meat, liver, eggs, legumes, seafood, and milk. Dry fruits not only provide fiber, protein but many essential minerals.

7. Weight Management

Healthy eating can help lower your risk for becoming overweight or obese and for developing other medical complications, such as constipation, diarrhea, diabetes, infections, and limit your muscle loss.

Food choices determine the amount of calories you consume. Extra calories lead to weight gain and affect your daily activities, such as strength, stamina, and transferring. So, it is important to choose foods that are rich in nutrients while staying within your calorie limits. It is advisable to eat more seasonal fruits mainly water melon, mass melon, papaya and raw vegetables fruits, raw vegetables, salad helps in salad of cucumber, radish, turnip, beat root etc. This helps in filling your belly on one hand and very low calories on the other.

The Vital role of Nutrition In SCI: Key Points

Maintaining proper diet and taking enough amount of nutrition can help boost your recovery faster and also help in fighting with other secondary complications.  Here are some key points mentioned below to maintain proper diet:

  • Try to take as much of green leafy vegetables and seasonal fruits as much as possible as they are rich source of nutrients, high in fiber which helps in bowel management and also they are low caloric.
  • Try to take nuts or dry fruits (except cashew because it is high in calorie)  as evening snacks and avoid packaged food, cold drinks, too much of white sugar, sweets to maintain proper weight.
  • Increase vitamin C intake as it helps to prevent Urinary tract infections and any other infections. Also better absorption of iron and protein.
  • It is advisable to consume adequate amount of Salad.
  • Being hydrated is important for every being but comparatively it is more important for person with SCI as it can cause UTI, constipation, and a lot of other health issues.

Key is balanced diet, thrice a day and in moderate quantity. Snacks between two meals should be fresh fruits and dry fruits, A healthy diet will improve your health, but you can increase your health benefits by combining a healthy diet with other lifestyle changes, such as including physical activities, limiting alcohol use and smoking, as well as maintaining good mental health.

By Dr. Virendra Vikram Singh (PT)

 

Transformative Power of Sports: Changing the Lives of SCIs

After Spinal cord injury an individual’s life is significantly altered, making it challenging for them to adjust to the new changes. This can have a profound impact on their mental health, leading to feelings of difficulty adapting and a sense of loss of control. However, there are several positive actions that can be taken to foster a healthy mindset and move forward with life. One of the most effective ways to promote mental well-being is through participation in sports.

International sports person Sakshi Kasana throwing shotput.

Sports can bring sense of positivity and purpose back into an individual’s life, helping them to adapt new circumstances. Additionally, it can provide a source of income for individuals with SCIs, which can be a valuable tool in their recovery. Apart from this participation in sports holds immense transformative potential in enhancing the lives of individuals with SCISs. Here’s how:

  • Physical Rehabilitation and Health Benefits
  • Improved mobility and functionality
  • Reduced secondary health issues
  • Social connection and support
  • Boost in confidence and self-esteem
  • Advocacy and awareness

Numerous Benefits of Sports

1. Physical Benefits

Engaging in adapted sports can significantly enhance the physical fitness of individuals with SCIs, leading to improved strength, endurance, and overall fitness levels. These activities also contribute in better health and vitality.

Moreover, it can improve mobility and functionality by enhancing range of motion, balance, and coordination, resulting in improved mobility and a sense of independence.

Additionally, it can help in minimizing the secondary health complications such as osteoporosis or cardiovascular problems.

2. Psychological and Emotional Benefits


Participating in sports can have a positive impact on psychological well-being and emotional resilience of an individual.

Furthermore, it can boost confidence and self-esteem, leading to a sense of positivity and accomplishment.

Additionally, sports can help reduce stress, anxiety, and depression, which is a significant concern for individuals with SCIs.

3. Improved Social Connection


Involvement in sports programs can also create opportunities for social interaction, friendship, and a sense of belonging within society.

Furthermore, this social connection and support can be particularly important for individuals with SCIs, who may face social isolation and stigma.

4.Advocacy and Awareness


The involvement of SCIs in sports can serve as a platform to advocate for disability rights and accessibility.

Also, by showcasing the capabilities and potential of individuals with disabilities, adapted sports can also help in breaking down stereotypes and promote a more inclusive society.

Adaptive Sports for disabled bodies

Like abled bodies people with disability can also play any sort of games. Some of the games are mentioned below:

  • Archery
  • Athletics
  • Track and field
  • Boccia
  • Shooting
  • Wheelchair Basketball
  • Wheelchair cricket
  • Wheelchair rugby
  • Powerlifting
  • swimming

Classification determines who is eligible to compete in a para sport and it groups the eligible athletes in sport classes according to their activity limitation in a certain sport.

Transformative Power of Sports: Key points

Adapted sports play a crucial role in transforming the lives of individuals with SCI by not only improving their physical health but also nurturing their mental and emotional well-being. These sports create a pathway to empowerment, independence, and a fulfilling life beyond the confines of their injury.

-By Dr. Virendra Vikram Singh(PT)


Spasticity : Causes, Challenges, Benefits and Management

Following a spinal cord injury, Spasticity is a common complication that can impact daily life and overall function. In this article we will discuss spasticity, its underlying causes, challenges and effective strategies for managing and overcoming the condition.

What is Spasticity?

Spasticity refers to the increased muscle tone and involuntary muscle contractions that often accompany spinal cord injury. It is a disruption in muscle movement pattern which is caused due to contraction of many muscles at once (sometimes called co-contraction). Spasticity can also be in the form of jerky muscle movements (spasms) or stiffness.

It is very common in individuals with SCI and gradually depends on the level and impact of injury. Individuals with cervical injury are more likely to have spasticity than individuals with lower level injuries. Spasticity can vary greatly in how it affects someone — it may be as mild as the feeling of tightness of your muscles or may be so severe that it causes painful, uncontrollable stiffness and spasms of your extremities.

Causes of Spasticity

Spinal cord works as a pathway which helps brain to communicate with other parts of the body. Spinal cord helps to send sensory information such as hot , cold, pain, movement, etc. from body to brain and vice-versa. Once the brain receives these sensory signals, it processes the information, and then sends the appropriate signals back down the spinal cord to tell the muscles how to respond.

However, when the spinal cord is injured the communication gets disrupted and due to which sensory information is unable to reach the brain. The lack of proper communication contributes to the hyperexcitability of spinal reflexes, which can results in muscle spasms.

Changes in neurotransmitter levels, particularly a decrease in inhibitory signals, play a role in the development of spasticity. This imbalance contributes to excessive muscle contractions.

The loss of supraspinal (above the spinal cord) control over reflexes results in unregulated muscle activity. The absence of inhibitory signals from the brain contributes to heightened muscle tone.

Challenges and Benefits

There are a lot of challenges or difficulties faces by individuals due to spasticity.

  • Spasticity can significantly impact mobility, making it challenging for individuals with SCI to move freely.
  • Prolonged stiffness or spasticity can limit the range of motion in your joints. This may lead to joint contractures, which can cause structural changes in the affected joints.
  • Sometimes the spasticity can be so severe that it can cause unbearable pain to the individuals.
  • Spasticity can make movement so hard which complicate tasks like dressing, grooming, and bathing, making independent self-care more challenging.
  • Repeated muscle spasms at night can cause difficulty in sleeping which may impact fatigue and mental health.
  • Severe spasm can make individuals fall out of the wheelchair, if not taken care properly.
  • Spasms in bladder can lead to leakage of urine which may results in UTI.

However, there are so many many difficulties faced by people with SCI due to spasticity but it has some benefits as well.

  • The muscle contractions associated with spasticity can enhance blood circulation, reducing the chances of vascular complications. Improved blood flow contributes to overall cardiovascular health.
  • Regular muscle contractions can assist in joint flexibility and reduce the risk of joint immobility.
  • Stiffness causes fingers to bend which helps in holding things and grip objects.
  • Spasticity can provide a degree of postural support, aiding individuals with SCI in maintaining certain positions.
  • It minimizes the risk of pressure sores associated with prolonged immobility.

Strategies for Overcoming Spasticity

There are various ways to overcome spasticity. Though there’s no cure for spasticity, these treatments can help alleviate symptoms and improve quality of life.

1. Physical therapy/ Rehab exercises

Engaging in targeted physical exercises can help manage spasticity. Rehab exercises like weight bearing, prone lying (lying on stomach) help stimulate the nervous system and activate neuroplasticity. Exercising consistently also helps reduce the excitability of hyperactive muscles.

Therapists can design personalized routines to stretch and strengthen muscles, improving overall mobility. It can also help in reducing muscle spasms and getting range of motion over the time.

2. Medications

Muscle spasms can cause severe pain and can be very discomforting at times. There are some medicines which healthcare professionals can prescribe to overcome the pain and discomfort. However, it is advisable to take these medications only when it’s needed and not on regular basis.

For severe spasticity cases, baclofen pumps are used for delivering muscle relaxant directly to the spinal fluid. This targeted approach can effectively reduce spasticity levels.

3. Orthotic Devices

Implementing orthotic devices, such as braces or splints, can aid in supporting joints and controlling spasticity. These devices helps to improve mobility and enhance overall comfort.

Additionally, we can prevent deformities caused by spasticity by using the orthotic devices which helps to maintain range of motion of an individual.

4. Botox Injection and Surgery


Botulinum toxin injections, commonly known as Botox, are a medical treatment option for managing spasticity, particularly in conditions like stroke and spinal cord injury. The injections are injected directly into specific muscles to get temporary relief from spasticity.

Surgical treatment is also a type of treatment for spasticity. Although, we should consider surgical treatments for spasticity only in cases where conservative approaches, such as physical therapy and medications, have not provided sufficient relief.

Additionally, It’s important to note that surgical interventions and Botox treatment for spasticity are typically reserved for cases where other treatments have not been effective, and the decision to undergo surgery should be carefully considered after consulting with consult with a multidisciplinary team of healthcare professionals. The choice of surgery depends on factors such as the underlying cause of spasticity, the severity of symptoms, and the individual’s overall health.

Travel Tips Post SCI

This blog will help SCIs to travel as many places as they want without any hassle.

Travel after a Spinal Cord Injury might seem scary, but it’s entirely possible with the right preparation and mindset. Exploring new places and making memories shouldn’t be limited by spinal cord injury. With few essential tips and a bit of planning, traveling can be enjoyable and fulfilling for individuals with SCI. In this blog we will discuss about the tips which make travelling easier for individuals with SCI.

Pre-Travel Preparation

Before starting your journey, it is crucial to ensure that every aspect of your travel is on point to guarantee a smooth and hassle-free experience. First and foremost, consult with your healthcare provider or physiotherapist for their advice. They can help you identify any potential risks or challenges and provide recommendations for accommodations and transportation that cater to your specific needs.

While searching for accommodations, book properties that are wheelchair accessible and equipped with amenities suitable for individuals with disabilities. Many websites and apps, such as Airbnb and Booking.com, offer filters to help you find accessible properties.

In addition, ensure that your chosen mode of transportation—whether it’s by air, train, or bus—can accommodate your needs. Many airlines and transportation companies provide special services for travelers with disabilities; contact them in advance to make necessary arrangements and arrive airport, railway station or bus stand as early as possible to avoid any further inconvenience.

While travelling in flight request wheelchair assistance before-hand, this can help you navigate through the airport, including security checkpoints and boarding areas. Request this service when booking your flight or contact the airline in advance to make arrangements.

Packing Essentials

Medical Supplies

Carry an ample supply of medications, catheters, medical documents, and any essential medical equipment. It’s advisable to carry extra supplies in case of unexpected delays.

Mobility Aids

Bring your mobility aids—wheelchair, walker, stick—along with any spare parts or tools needed for maintenance. Consider lightweight and portable options for convenience during travel.

Comfort Items

Pack items that provide comfort during the journey, such as pillows, blankets, or specific adaptive seating cushions that help maintain posture and prevent pressure sores. It is advisable to wear stockings while travelling. Pack clothes according to your destination and try to avoid tight clothes as it may cause inconvenience.

Assistance and Communication

Do not hesitate to ask for assistance or help whenever needed. There are many people who are willing to help, whether it’s airport staff, hotel employees, or fellow travelers. While traveling, it is reccomendable to be adaptable and patient throughout the trip as things might not always go as planned. It’s important to embrace the unpredictability of the journey and be prepared for last-minute changes.

Ultimately, enjoy the experience and cherish the unforgettable moments and breathtaking views. By doing so, you’ll be able to fully appreciate the beauty of the world around you and create lasting memories that will enrich your life.

Key Points : Travel tips post SCI

Traveling after a spinal cord injury may require additional planning and considerations, but it should never hinder your sense of adventure and exploration. With the right preparation, accessible destinations, and a positive mindset, you can embark on incredible journeys and create lasting memories.

Remember to plan ahead, research your destinations, and communicate your needs effectively. Take advantage of resources and support available for travelers with disabilities, such as travel forums, disability travel blogs, and local accessibility organizations.

Embrace the freedom of travel and let your post-SCI adventures inspire and empower others. Your experiences can help break down barriers and create a more inclusive travel environment for individuals with disabilities. So pack your bags, and get ready to embark on a journey of a lifetime!

By Virendra Vikram Singh (PT)

Understanding Different Types & Levels of Spinal Cord Injury

Spinal Cord Injury- types & levels

Spinal cord injury are life-altering and can vary in severity. From complete loss of motor and sensory function to partial impairment, each level of injury presents unique challenges to patients. We will explore how these injuries affect mobility, strength, and bodily functions.

By understanding the different levels of SCI, you will gain a clearer picture of the physical and emotional journey faced by those affected. Nevertheless, with this knowledge, you can better support yourself, a loved one, or your patients in coping with the challenges and adjustments that come with a spinal cord injury.

Types and Classifications of SCI

Spinal cord injuries can be classified into two main categories: complete and incomplete. A complete SCI refers to the loss of all motor and sensory function below the level of injury. On the other hand, an incomplete SCI means that there is some degree of motor or sensory function below the level of injury.

Within these categories, there are different levels of spinal cord injury based on where the injury occurs along the spinal cord. The spinal cord is divided into four regions: cervical, thoracic, lumbar, and sacral. Each region controls different parts of the body, and an injury at a specific level can result in varying degrees of impairment.

Understanding the Levels of Spinal Cord Injury

Cervical Spinal Cord Injury

Cervical spinal cord injuries occur in the neck region and can have serious consequences. Higher-level injuries in the cervical region can result in quadriplegia, where all four limbs and the trunk are affected which leads to a loss of function in the arms, hands, and legs, making daily activities challenging. This can impact mobility, balance, and coordination.

Thoracic/Dorsal Spinal Cord Injury

Thoracic spinal cord injuries occur in the upper back region and can lead to high-level paraplegia. The severity of impairment will depend on the specific level of injury. Individuals with thoracic spinal cord injuries may experience difficulty with trunk control, balance, and bowel and bladder function.

Lumbar Spinal Cord Injury

Lumbar spinal cord injuries occur in the lower back region and typically result in paraplegia. The extent of impairment will vary based on the level of injury. Furthermore, Individuals with lumbar spinal cord injuries may face challenges with walking, standing, lower limb function, and bowel and bladder control. In addition, earlier the trunk control is also impacted but with the proper rehabilitation it gets better .

Sacral Spinal Cord Injury

Sacral spinal cord injuries occur in the lowest region of the spine and can lead to varying degrees of impairment. These injuries can affect bowel, bladder, and sexual function, as well as lower limb strength and mobility. Unlike Cervical or Dorsal level, Sacral level doesn’t impact trunk control.

Complications and Long-term Effects of Spinal Cord Injury

Spinal cord injuries can have a range of complications and long-term effects. Some common complications include pressure sores, urinary tract infections, respiratory problems, muscle atrophy, and osteoporosis. Additionally, individuals with spinal cord injuries may also experience psychological effects, such as depression and anxiety.

Moreover, long-term effects can include chronic pain, spasticity, loss of muscle tone, and decreased cardiovascular health. It’s crucial for healthcare professionals to address these complications and provide appropriate interventions to enhance the quality of life for patients with spinal cord injuries.

Conclusion

Understanding the different levels of SCI is essential for healthcare professionals, patients, and individuals seeking knowledge about this topic. By gaining insights into the types, classifications, and levels of SCI, we can better comprehend the challenges faced by those affected. Moreover, being aware of the available treatment options and rehabilitation techniques allows for better support and care for individuals with spinal cord injuries. Let us empower ourselves with knowledge and empathy as we navigate the complexities of SCI.

Bowel Dysfunction and Management In SCI

For individuals living with a spinal cord injury (SCI), maintaining proper bowel function
is a crucial aspect of daily life. An SCI can disrupt the natural neurological control of
the bowel and bladder, leading to challenges like constipation and incontinence. However, with
tailored strategies and support, individuals with SCIs can regain control and enhance
their overall quality of life.


Understanding Bowel Dysfunction in SCI

A spinal cord injury alters the communication between the brain and the nerves
below the level of the injury. This disruption often results in neurogenic bowel
dysfunction, where the muscles and nerves responsible for bowel function no longer
operate as they should. This can give rise to a range of bowel management issues that
significantly impact an individual’s daily life.


Common Bowel Dysfunction Issues in SCI


Constipation: One of the most prevalent problems in neurogenic bowel dysfunction is
constipation. The slowed movement of stool through the colon due to weakened or
paralyzed muscles can lead to infrequent, hard-to-pass bowel movements.
Incontinence: Some individuals with SCI may experience loss of sensation and muscle
control in the rectal area, resulting in involuntary bowel movements. This can be
emotionally distressing and may require extra care and management.
Impaction: In severe cases, stool can become impacted in the rectum, causing
discomfort, pain, and further complications. This condition may necessitate more
intensive interventions to resolve.


Risk Factors and Severity

The extent of bowel dysfunction in SCI can vary widely depending on factors such as
the level and severity of the injury, as well as the individual’s overall health. Those with injuries higher up on the spinal cord (closer to the head) typically experience more pronounced bowel dysfunction, as the nerves controlling bowel function originate higher up in the spinal cord.


Management and Treatment

Diet and Hydration: A balanced diet rich in fiber, along with sufficient water intake, is
crucial in managing bowel dysfunction. Fiber helps regulate bowel movements, while
staying hydrated softens stool, making it easier to pass.
Scheduled Bowel Care: Establishing a regular bowel care routine can help train the
body to have predictable bowel movements. This often involves techniques like digital
stimulation, suppositories, or enemas.
Medications and Supplements: Depending on the specific needs of the individual,
healthcare providers may recommend medications or supplements to regulate bowel
function.
Adaptive Equipment: Specialized tools and equipment, like bidets or assistive devices,
can assist with bowel management and improve comfort and hygiene.
Physical Activity: Engaging in regular, safe physical activity within one’s abilities can
help maintain overall health and support bowel regularity.
Consultation with Healthcare Providers: Working closely with healthcare
professionals, including specialists in SCI care and dietitians, is essential. They can
provide personalized guidance and address any complications or concerns.

Bowel dysfunction is a common and significant aspect of life for individuals with SCI.
However, with proper care, management, and support, it’s possible to mitigate its
impact and lead a fulfilling life.

By Virendra Vikram Singh(PT)

Bed Sores Causes and Prevention

Spinal cord injury patients are at a higher risk for developing bed sores, also known as pressure ulcers or pressure sores, due to decreased mobility, sensation, and blood flow. The main cause of bed sores in SCI patients is prolonged pressure on the skin and soft tissues, which leads to tissue damage and skin breakdown. Here are some specific causes of bed sores in SCI patients:

Immobility: Individuals with SCI often have limited mobility, which can cause pressure on specific areas of the body and increase the risk of developing bed sores. This is especially true for those who are unable to shift their weight or change positions independently.

Lack of sensation: SCI patients may have decreased or absent sensation in certain areas of the body, making it difficult to detect early signs of skin breakdown. This can lead to delayed treatment and increased risk of developing bed sores.

Incontinence: SCI patients may experience bowel or bladder incontinence, which can lead to skin irritation, maceration, and increased risk of developing bed sores.

Shearing forces: SCI patients who are repositioned or moved frequently may experience shearing forces on the skin, which can lead to tissue damage and increased risk of developing bed sores.

Poor nutrition: SCI patients may have difficulty maintaining a healthy diet, which can lead to malnutrition and weakened skin, increasing the risk of developing bed sores.

Certain medical conditions: SCI patients with certain medical conditions, such as diabetes or circulatory problems, may be at higher risk of developing bed sores due to impaired blood flow to the skin and soft tissues.

Stages of Bed sores

In individuals with SCI, pressure sores often occur in areas where there is prolonged pressure, such as the sacrum, buttocks, and heels. It is important to catch pressure sores in the early stages to prevent progression to more severe stages. There are four stages of pressure sores, each with increasing severity:

Stage 1: This is the mildest stage of pressure sores, where the skin may appear red, but it is not broken. The affected area may feel warm or spongy to the touch, and the person may experience itching or pain.

Stage 2: In this stage, the skin is broken and there may be a shallow open wound or blister. The area around the sore may be red and inflamed, and there may be some drainage or pus.

Stage 3: At this stage, the sore has extended through the skin and into the underlying tissues, such as muscle or fat. The wound may be deeper and appear as a crater-like hole, and there may be signs of infection such as redness, warmth, and pus.

Stage 4: This is the most severe stage of pressure sores, where the wound has become very deep, extending into the muscle, bone, or joint. There may be necrosis or dead tissue, and the wound may have a foul odor. Infection is very likely at this stage, and there is a risk of complications such as sepsis.

Prevention of Bed Sores

Preventing bed sores is very important for individuals with spinal cord injury, as it has a great impact on the patient’s rehabilitation and also they are painful and may increase the risk of infection, which can be especially dangerous for individuals with spinal cord injuries.Here are some specific prevention strategies for SCI patients:

Regular repositioning: SCI patients should be repositioned at least every two hours to relieve pressure on the skin. This can be done manually by a caregiver or with the help of specialized equipment, such as a tilt table or turning frame.

Pressure relief devices: There are various pressure relief devices that can be used to help prevent bed sores in SCI patients, such as cushions, mattresses, and overlays. These devices work by distributing pressure over a larger surface area and reducing the risk of skin breakdown.

Skin care: Keeping the skin clean and dry is important for preventing bed sores. SCI patients should be washed with mild soap and water, and moisturizers can be used to keep the skin hydrated. Any areas of redness or irritation should be addressed promptly.

Nutrition: A healthy diet with adequate protein intake is important for promoting skin health and preventing bed sores. SCI patients may also benefit from nutritional supplements, such as vitamins and minerals.

Exercise: Regular exercise can help improve circulation and prevent bed sores. SCI patients should work with a physical therapist to develop an exercise program that is safe and appropriate for their level of injury.

Manage moisture: Excessive moisture on the skin can increase the risk of developing bed sores. Incontinence should be managed promptly, and moisture-wicking fabrics can be used to keep the skin dry.

Regular skin checks: SCI patients and caregivers should regularly check the skin for any signs of redness, irritation, or pressure sores. Early detection and treatment can prevent bed sores from developing or worsening.

So, it is very important to seek medical advice as soon as possible to prevent progression of bed sores to more severe stages, which can result in complications such as infection and sepsis.

By Virendra Vikram Singh(PT)

Bed Sore and It’s Impact On SCIs

Bed sores, also known as pressure ulcers or pressure sores, are a common complication of spinal cord injury. They occur when a person is immobilized or confined to bed or wheelchair for a longer period of time, leading to pressure and friction on the skin. In SCI patients, bed sores often occurs in areas of the body that are subject to more pressure such as the hips, elbows, tailbone and heels. These sores can range in severity from mild redness and irritation to deep wounds that expose muscle and bone.

These sores can have a significant impact on the patients as well as on their rehabilitation process. Here are some ways bed sores can affect SCI patients:

Pain and Discomfort: Bed sores can be really painful and uncomfortable, making it difficult for the patients to participate in their daily as well as rehabilitation activities such as physical therapy and mobility exercises.

Delayed healing: Bed sore can take a long time to heal, which can delay a person’s rehabilitation progress and hence they may need to spend some extra time in their rehabilitation center in order to become independent, which can be emotionally and financially draining for them as well as their family.

Increased risk of infection: bed sores are open wounds and hence they can become infected, which may leads to sepsis and sometimes the infection get may worsen and reached to the bones which will be a life threating condition for SCIs.And if not treated at the right time this can lead to prolong hospitalization.

Limited mobility: In severe cases, bed sores can restrict a patient’s mobility, making it difficult to sit, stand, or move. This can make it challenging for patients to participate in rehabilitation activities and hinder their overall recovery.

Emotional Impact: Bed sores can be emotionally distressing for SCI patients, affecting their self-esteem and confidence. It can also be frustrating for patients to feel like their progress is being hindered by a preventable complication.

By Virendra Vikram Singh(PT)

Bladder Management After SCI

After spinal cord injury due to severe nerves damage the bladder and bowel movement got impacted. Before SCI a message sent from the brain travelling along the spinal cord and sacral nerves to allow the bladder to get empty. But after spinal cord injury sometimes the communication between the brain and the nerves in the spinal cord that control bladder and bowel function got interrupted. This can cause bladder and bowel dysfunction known as neurogenic bladder or neurogenic bowel.

So some of the ways of Bladder management after SCI are mentioned below:

Intermittent Catheterization

It is one of the ways to empty the bladder without keeping the catheter in the bladder all the time. In this a catheter is inserted into the bladder to drain out the urine from the bladder. The urine is drained out from the other end of the catheter. Remove the catheter once done and you are good to go for your normal activities. It is usually done 4-6 times a day to avoid leakage. It is advised to drain out the urine after every four hours so that catheterization volumes less than 500 ml. So you may have to catheterize often depending on how much you drink.

Indwelling Catheterization

Indwelling catheterization uses a catheter and a urine collection bag that stays in place all the time. The catheter has a balloon at the tip of the catheter which sits in your bladder. Once the catheter is in your bladder, the balloon can be inflated to keep the catheter from falling out or deflating when it’s time to change the catheter.

There are two types of indwelling catheters: urethral catheters and suprapubic catheters. Most urethral catheters that are kept in place by filling up a balloon. People might call your indwelling catheter a Foley’s catheter.

Reflex Voiding 

This technique works best for male patients but it can be used in female patients. For males, try to train the bladder to urinate just by reflex so when the bladder reaches a certain set point it causes the bladder muscles to contract and squeezes the urine out. For male patients, the urine can be captured by applying a condom to the penis which is then collected to a drainage bag. This is a method that has a less chance of developing infection and it is sometimes less labor intensive for the patient and caregiver because care is just application of a new condom every day, the condom is removed and the penis is cleaned and allow to dry for about 20 minutes before the next condom is applied then it is connected to the leg bag or bed  bag and the only care during the day is that the bags  have to be emptied when they get to a certain level of fullness.

Urinary Tract Infections

But proper bladder management is a must for a SCI patient because as we discussed above spinal cord injury can affect the ability to control the bladder, leading to an increased risk of urinary tract infections (UTIs). UTIs are common in people with SCI, and can cause many symptoms such as frequent urination, pain or discomfort during urination, and fever. These symptoms can mild or severe depending upon the impact of infection.

In individuals with SCI, UTIs can occur more frequently and may lead to more serious complications such as kidney damage and sepsis if it is not treated well.in people with SCI, the infection can be more serious and harder to treat than in general population. This is because the spinal cord injury can interfere with the body’s immune system, making it harder to fight infections.

Preventing UTIs in people with spinal cord injury involves maintaining good hygiene practices, such as washing the genital area daily and cleaning the catheter insertion site regularly. It is also important to ensure that catheters are changed regularly and that the bladder is fully emptied during each catheterization.

If a UTI is suspected, it is important to seek medical attention promptly. Treatment typically involves antibiotics to clear the infection, as well as measures to manage any associated symptoms. In severe cases, hospitalization may be necessary.

By Virendra Vikram Singh(PT)