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| Division of Occupational Therapy - OT Connect Spinal Cord Injury
Spinal cord injury (SCI) can be defined as any traumatic event that results in damage to the spinal cord (Neistadt & Crepeau, 1998). Common Symptoms/Course of Disease Damage to the spinal cord can be a result of trauma, disease processes, or congenital defects. Spinal shock may occur 30 to 60 minutes after spinal cord injury. It is identified by flaccid paralysis and absence of reflexes below the level of spinal injury. It may last 24 hours to 6 weeks (Umphred, 2001). The effects of the injury vary depending on the location and degree of the damage to the spinal cord. However, general impairments occur in sensation, neuromusculoskeletal performance and motor. (Umphred, 2001). The most common cause of SCI is motor vehicle accident (37.2%) (Umphred, 2001). There are three categories of spinal cord injury. Complete injury results in total paralysis and/or lost of sensation below the lowest segment of the cord. With an incomplete injury there is some preservation of sensory and/or motor function in the lowest sacral segment (Pedretti & Early, 2001). Transient injuries are caused by compression that is a result of a fracture or localized edema. Function is most likely to return when compression has decreased (Neistadt & Crepeau, 1998). Incomplete injuries are characterized by distinct symptoms and categorized by anatomy of the spine:
Age of Onset: Spinal cord injury can occur throughout the lifespan. There are currently 183,000 to 230,000 cases in the United States. Fifty-five percent of SCIs occur in individuals between the ages of 16 and 30 years of age (Umphred, 2001). Sex Biases: It is more common for males to experience a SCI (81.8%) than females (18.2%) (Umphred, 2001). Cultural Biases: There have been no reports of any correlation with ethnicity or culture and injury occurrence. Current Medial Treatment: Spine stabilization is the first medical intervention that is applied to prevent further damage (Umphred, 2001). Anti-inflammatory and steroidal drugs may be administered to reduce the neurological damage. To identify the specific area of damage the physician may order a CT scan or MRI (Pedretti & Early, 2001). One who has sustained a SCI may be referred to Occupational Therapy (OT) to prevent deformity, strengthen remaining motor function, remediate psychosocial dysfunction, address activities of daily living (ADLs) dysfunction, community and work reintegration, provide environmental adaptations and achieve overall maximum level of independence (Umphred, 2001 and Neistadt & Crepeau, 1998). Common OT evaluations analyze level of independence with ADLs, physical status as in range of motion (ROM) and manual muscle testing (MMT), sensation testing, integumentary integrity, pain rating, assess cognition, psychosocial evaluations and measurement of reflexes (Umphred, 2001). Goals of OT may include, but are not limited to, achieve/maintain full ROM in joints, achieve maximal strength in intact muscles, achieve maximal respiratory capacity, provide appropriate wheelchair, achieve safe transfers, increase/stabilize postural control, integrate adaptive equipment to increase independence, reach maximum level of independence with ADLs and IADLs (housework, cooking etc.), educate family/caregivers, reach a successful community and/or work re-entry, recommend home or environmental modifications, educate client on secondary issues such as skin breakdown, bowel & bladder management and sexual issues (Umphred, 2001 and Neistadt & Crepeau, 1998). Prognosis: Those experiencing a SCI can expect to live a full life following injury despite secondary complications such as skin maintenance, respiratory issues, cognitive/emotional functioning, osteoporosis, spasticity and urinary tract infections (Neistadt & Crepeau, 1998). Return of function is highly variable in which it is difficult to predict recovery (Pedretti & Early, 2001). Glossary:
References
How OT Makes a Difference: Evidence-Based Practice This article focuses on the use of self-care as an area that most occupational therapists address in rehabilitation. The researchers attempt to identify specific strategies utilized by occupational therapists during self-care training. It also attempts to identify which strategies provide participants with the most success and life satisfaction. The twelve participants in the study were those who have had a stroke or spinal cord injury. Twelve occupational therapists interviewed these clients to discuss approaches used when focusing on self-care. Data was collected and analyzed by using the Empirical, Phenomenological, Psychological (EPP) method that attempts to describe the essence, organization, and nature of the strategies being investigated. All of the participants were given the opportunity to use different strategies while performing self-care tasks. Findings revealed that the approaches in which the clients considered to be valuable were those that provided motivation, trust, and support. Compensatory and technical strategies were concluded to be unsuccessful and frustrating. When given the opportunity to perform self-care tasks and explore techniques, the clients discovered own unique strategy to meet their physical and emotional needs. It was supported that the goal of occupational therapy is for clients to achieve maximum functioning potential and have control of their lives. In this study, the unique quality of individualistic treatment by occupational therapists was represented. Guidetti, S. (2002, January). Therapeutic strategies used by occupational therapists in self-care training: a qualitative study. Occupational Therapy International, 9, 257-276. In 2000, “Joey,” a 19-year-old male, experienced a motor vehicle accident resulting in a spinal cord injury (SCI) at level T3 of the spine. An injury at T3, left “Joey” paralyzed from the chest and below. Having to deal with the injury as well as the death of his girlfriend seemed to take its toll on “Joey” physically and emotionally. “Joey” reported, “I wish it was me that had died that day in the car.” “We have a 2-year-old daughter and it scares me.” However, once the initial shock of the incident was over, “Joey” decided he must do his best to live for himself and his daughter. At an inpatient rehabilitation facility, “Joey” received occupational therapy in order to reach his maximum level of independence. “If it wasn’t for my occupational therapist I wouldn’t have been able to even feed myself,” he stated. While attending occupational therapy services, he worked on ADLs such dressing, feeding, and personal hygiene. Adaptations and compensations were made so that “Joey” could perform these activities independently. “After I finished the first day of occupational therapy I was ready to give up.” With determination and practice, each day “Joey” acquired more skills. A big encouragement he reported that the day he received his electric wheelchair. “I could move around and it felt great.” Occupational therapy worked with “Joey” on transfers concerning to and from the toilet, bath, and bed. Everything was starting to fall into place. After being in the inpatient facility for two months, “Joey” was ready to go home in the care of his parents. It was a hard transition because the “security blanket” he had the facility was now gone. Even though, he still received outpatient services it was less intense. Though physical challenges were being addressed, emotional issues were not forgotten by the occupational therapists. “Of course, I have my down moments,” he states. I worry about dating and if anyone will even accept me now that I’m in a wheelchair. I also worry what my daughter thinks. She lives with her maternal grandmother but is still a big part of “Joey’s” life. The relationship that was established with the therapists, both inpatient and outpatient,was a source of encouragement. Presently, “Joey” reports that nothing stops him from enjoying life. He goes to the mall and movies with friends just like any teenage would do on the weekend. When asked what advice to give to others who have a SCI or disability, “Joey” stated, “You have to look to the future and keep a positive attitude.” We can all learn a lesson from this young man about determination and motivation. “Joey” concluded with these thoughts, “Don’t take things for granted!” “Live for each day!”
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