Injury characteristics

Type and level of injury

The following sections detail many of the characteristic problems that are present as a result of spinal cord injury. The presence of each will depend on the type and level of injury. The descriptions that follow are intended to be a reference resource to apply to your particular situation.

Temperature regulation

Spinal cord injury affects two of the processes required for temperature regulation – sweating and shivering. As a result those who have suffered spinal cord injury require careful management of their environment temperature to prevent body temperature rising or falling outside usual levels.

Bladder management

The changes that usually take place after a spinal cord injury relate to how the bladder and sphincter muscles work. After a spinal cord injury, impulses can no longer travel normally between the bladder or sphincter muscles and the brain. Individuals usually cannot sense that their bladder is full. Following injury, this process is usually managed by the process of catheterisation.

Bowel management

Bowel management is required for the same reasons as bladder management. It is vital for a bowel management routine to be implemented that suits the needs of all involved. The primary purpose of this is to minimise the risk of bowel accidents, and plan an acceptable time for the bowel to be emptied in a safe manner.

Muscle spasticity

Following spinal injury, changes occur in the nerve cells that control muscle activity. Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated in certain ways. After spinal cord injury, when nerves below the injury become disconnected from those above, these responses become exaggerated.

Muscle spasms occur when body is stimulated below the level of injury. This can be particularly when the muscles are stretched. Pain, stretch, or other sensations from the body are transmitted to the spinal cord. Because of the disconnection, these sensations will cause the muscles to contract or spasm.

Autonomic Dysreflexia

Autonomic dysreflexia is an over-activity of the autonomic nervous system. It can occur when a stimulus is introduced to below the level of spinal cord injury, such as an overfull bladder. The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury. A reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure. Nerve receptors in the heart and blood vessels detect this rise in blood pressure and send a message to the brain. The brain sends a message to the heart, causing the heartbeat to slow down and the blood vessels above the level of injury to dilate. However, the brain cannot send messages below the level of injury, due to the spinal cord lesion, and therefore the blood pressure cannot be regulated.

Respiratory complications

The effect on the respiratory system is dependant on the level of injury. Those sustaining injuries at C4 and higher, will require a ventilator to control their breathing pattern. To produce a cough reflex, the person will require help from another individual. If the injury is between the level of C4 and T6, the person will be able to breath on their own. However, breathing may be mainly completed by the action of the diaphragm.