Spinal Cord Injuries

Plain-language definition

Spinal cord damage causing paraplegia or tetraplegia. Rehabilitation to maximize independence.

Signs and points requiring attention

• Motor paralysis below injury level: paraplegia (lower limb involvement) or tetraplegia (all four limbs involved). Deficit extent depends on spinal level affected and whether injury is complete or incomplete.
• Variable sensory disorders: loss of tactile, thermal and pain sensitivity below injury level. Sphincter disorders (bladder, bowel) requiring urological management and specific rehabilitation.
• Spasticity (muscle hypertonia with exaggerated reflexes) or flaccidity depending on injury type. Spasticity can be painful and bothersome but sometimes useful for certain transfers. Its treatment is integral to rehabilitation.
• Risk of multiple secondary complications: pressure sores, urinary infections, venous thrombosis, muscle contractures, osteoporosis, neuropathic pain. Prevention is essential.

• Fever or signs of urinary infection (cloudy urine, burning, abdominal pain): urinary infections are common and can become complicated. Prompt medical consultation necessary.
• Persistent skin redness on pressure points (buttocks, heels, sacrum): sign of early pressure sore requiring immediate pressure relief and appropriate care. Prevention is crucial.
• Autonomic dysreflexia (injuries above T6): violent headaches, sweating, facial flushing, sudden high blood pressure. Medical emergency requiring immediate search for cause (distended bladder, fecal impaction, ingrown nail).

Assessment and care

• Intensive strengthening of muscles preserved above the injury: upper limb work for paraplegics, respiratory and neck muscles for tetraplegics. Development of strength necessary for transfers and wheelchair propulsion.
• Transfer and independence training: bed-to-wheelchair, wheelchair-to-car, floor-to-wheelchair transfers. Manual or electric wheelchair mastery, obstacle negotiation, slope management.
• Active prevention of pressure sores (positioning, regular pressure relief), muscle contractures (daily stretching) and thromboembolic complications (mobilizations, compression stockings).
• Progressive verticalization and gait rehabilitation if neurological potential permits: parallel bar work with adapted bracing (orthoses), use of assistive devices (canes, walker).

This information does not replace diagnosis or medical consultation.