Health Issues

Some of the clients at Project Walk come to us shortly after they are discharged from the hospital or a rehabilitation facility. Because of the traumatic nature of a spinal cord injury, there are numerous health issues and problems commonly seen in this population. It is important that our Specialists take into account any acute or chronic problems and modify programs if necessary. There are few barriers to entry into our program but program modifications may be necessary.
“The goal of the program is to improve each client’s
quality of life, not to slow their progress.”
Common Health Issues, Project Walk and You
Safely and responsibly pushing clients to the height of their abilities is the nature of Project Walk. Some activities we do challenge our clients in ways their  bodies may not be accustomed to, and may cause some of the following issues to arise from time to time. That is why it is critical for clients to understand these potential health problems and their symptoms. It is our belief that with consistent work and nervous system stimulation, these issues will become less of a factor in our clients’ lives.
Pressure Sores
A pressure sore is any redness or break in the skin caused by too much pressure on the skin for too long a period of time. The pressure prevents blood from getting to your skin so the skin dies. Normally the nerves send messages of pain or feelings of discomfort to the brain to let you know that you need to change position, but damage to the spinal cord keeps these messages from reaching the brain.

spinal cord injury, spinal cord injury recovery, what is a spinal cord injury, spinal anatomyTraditionally there are three instances that will result in a pressure sore. The first is prolonged direct pressure to a region. The next is a shearing effect that happen when the skin moves in the opposite direction of the bone. Finally an abrasion or friction injury may result when the skin is pulled across a surface instead of lifting.  
Skin breakdown is a major complication associated with spinal cord injuries and is can ultimately result in an infection, amputation and even death.  There are several factors that can prevent pressure sores. Those factors include increased blood flow, muscle tone, frequently changing body position, and frequently checking high-risk areas. Clients who are affected by a pressure sore should be aware there are three degrees of severity. All of which should be treated immediately and clients should consult with their physician. 
Urinary and Gastrointestinal System
Following a spinal cord injury, damage can occur to the nerves that allow a person to control their urinary system and bowel movements. A spinal cord injury usually does not affect kidney function or urine collection in the bladder but it does affect bladder and sphincter muscles. After a spinal cord injury, messages can no longer travel normally between the bladder or sphincter muscles and the brain. The biggest problem is that clients usually cannot feel when the bladder is full or they do not have the "urge" to urinate.

In regards to bowel movements, there are varying degrees of function that are dependent on whether the injury is above or below the T12 vertebrae. Management of bowel programs will vary between clients as some will defecate when the rectum is full while others may need to additional resources to encourage bowel movements. Clients can manage both scenarios with planned bowel programs.
Circulatory and Pulmonary System
Hypotension (low blood pressure)
Clients with a spinal cord injury may have low blood pressure due to a loss of neural signals to muscles which normally constrict blood vessels. Sitting or standing up suddenly may cause a further drop in blood pressure because blood tends to pool in leg veins and feet rather than be pushed back towards the heart through muscular action. As leg muscle activity/function increases, this condition may improve.
spinal cord injury, spinal cord injury recovery, what is a spinal cord injury, patientNOTE: It is very common for spinal cord injury clients taking part in a demanding exercise regime to become dizzy or faint. This often occurs when clients change position or when they perform upright activities such as kneeling, stationary biking, standing or gait training. Clients are closely monitored and spotted during these types of activities.
Autonomic Dysreflexia (AD)
Also known as hyperreflexia, AD is a potentially dangerous complication of spinal cord injury. In AD, an individual's blood pressure may rise to dangerous levels and if not treated, can lead to stroke and possibly death. Individuals with injuries at the T6 level or above are at greater risk. AD usually occurs because of a noxious stimulus below the level of the injury such as a full bladder or obstructed catheter flow. Symptoms include headache, facial flush, perspiration, and/or stuffy nose.

Muscle weakness in the extremities may cause swelling due to excess fluids leaving blood vessels and going into interstitial spaces. Many clients wear compression stockings and/or abdominal binders to prevent blood pooling in the legs. Elevation, range of motion and increased activity will help to alleviate edema.
Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis, DVT, spinal cord injury complicationsDVT or pulmonary embolism is a potentially severe complication of a spinal cord injury. As mentioned above, there are changes in the normal neurological control of blood vessels that can result in stasis or pooling. Deep vein thrombosis in the lower leg is almost universal during the early phases of recovery and rehabilitation.

Thromboses in the thigh, however, are a great concern because clots may become dislodged and pass through the vascular tree to the lungs. A major obstruction of the arteries leading to the lungs can potentially be fatal. Therapeutic measures to reduce or eliminate the risk for deep vein thrombosis include pneumatic compression stockings and Ace wrapping.
The Skeletal System
Generally, following a spinal cord injury is some degree of bone loss. For many clients this bone loss can occur quickly after injury. Once bones become brittle, they fracture easily and may take longer to heal. Bone density is normally increased through regular muscle activity and weight bearing. When muscle activity is decreased or eliminated and the legs no longer bear the body’s weight, the bones begin to lose calcium and phosphorus and become weak and brittle. Load bearing may help to reduce bone loss, so clients should to do as much load bearing as possible through the use of a standing frame or a standing wheelchair. Functional electrical stimulation of the leg muscles may also increase bone density.
The Muscular System
Joint Weakness
The loss of innervation to muscles that support major joints such as the shoulders, hips and knees in addition to flaccid paralysis leaves spinal cord injury clients at great risk for further injury. Poor transfer and lift techniques can result in shoulder dislocation and subluxation as ligaments and tendons that support joints may be stretched or torn during these movements.  

Muscle Spasticity
Following a spinal cord injury, the nerve cells below the level of injury cannot communicate properly with the brain. Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated in certain ways. Muscle spasms can occur any time the body is stimulated below the level of injury. This is particularly noticeable when muscles are stretched or when there is a painful stimulus below the injury. Because of the disconnection, these sensations cause the muscles to contract or spasm. Additional information on muscle spasticity and Project Walk is talked about in the Muscle Spasticity section of this site.
San Diego, CA