How Can You Help Prevent Medical Complications?


It is very important that you learn about the changes that have taken place in your body and how to prevent complications. You must learn to speak up for yourself and ask questions. It is important for you to actively participate in your care.

Communication

The ability to communicate is important to all of us. Often patients with spinal cord injuries report feelings of lack of control. The more you are able to communicate your needs, feelings, concerns, or thoughts, the more control you will have.

Communicating after a spinal cord injury may be different if you have a breathing tube or trach. However, it is very important that a way to communicate is established as soon as possible.

Other methods of communication that can be used if you are unable to speak include:

  • Communication Board: This is a picture/word board. You can blink or raise an eyebrow or respond in an agreed upon way to indicate which letter has been chosen. The board also has pictures of basic needs with the word above the picture.
  • Computerized Communication: This is a computer with responses that are chosen by moving your mouth, eyes, arms, jaw, or shoulder.

Keep Your Lungs Clear

You should take deep breaths and cough often. Use your incentive spirometer hourly while awake. Also, you and your family may be instructed on how to do a "quad cough." This is done by using an upward force by the heel of the hand to push in and up on your diaphragm while you try to cough.

Skin Care

Because of changes in sensation, you will need to make sure there is regular repositioning and turning, as well as thorough cleaning after bowel or bladder incontinence. Extra attention to your skin is very important to prevent problems. Use of heating pads and cold packs must be closely checked. Frequent skin checks can also help prevent problems. Specialty mattresses, wheelchair pads (Roho cushions), and other skin care items may be used.

Signs of skin breakdown (bedsores or pressure ulcers):

  • Red areas that do not go away
  • Blisters
  • White skin after the pressure source is removed
  • Skin spots that turn black or brown
  • Tear, cut, or "rug burn" look to the top layer of skin

To help prevent skin problems, you will be fitted for your wheelchair. This fitting process will likely occur while you are in rehabilitation. Even in a personalized wheelchair, you should have your weight shifted frequently.

Deep Vein Thrombosis (DVT) Prevention

You should wear your anti-embolism stockings (TEDs) and sequential compressive devices (SCD's or Kendall's) or foot pumps. Also, your family can help with range of motion exercises for your arms and legs and turning as directed by the healthcare team.

Nutrition

Nutrition plays an important role in healing and keeping the skin healthy. When under stress or during illness, the body requires more calories. A hospital dietician will help you to figure the calories needed for optimal healing and skin protection.

Bowel and Bladder Control

You need to follow the recommendations of the healthcare team on your diet and fluid intake, and their recommendations regarding your bowel and bladder program.

Bladder training will be started to help with bladder control. This may involve catheterizations every 4-6 hours, depending on the amount of urine in the bladder. The goal is to keep your bladder from being too full. Depending on the level of your injury, you may learn to perform catheterizations.

Muscle Maintenance

A program to keep your joints and muscles moving is called "range of motion". Physical and Occupational Therapists will work with you to keep your current strength and range of motion. Gentle stretching of the muscles helps to do this. In spite of therapy, there may be a decrease in range of motion. If that occurs, changes in therapy, medication, or surgery may be necessary.

Heterotopic Ossification

This term means that bone spurs have developed around joints. It is important that you seek early treatment when signs develop to prevent or limit complications. (Fig. 26)

You should report changes in your joints:

  • Sudden loss of joint motion or decrease in range of motion
  • Warmth
  • Redness
  • Pain with movement or touch
  • Swelling

Spasticity

This refers to uncontrolled muscle spasms in your arms and legs. Spasms can be caused by touching or by rapid movements, tight clothing, and pain. Exercises and medicine can help to control spasms. Hand/finger splints and ankle splints may also be used to keep muscles and tendons in the hands, lower arms, feet, and lower legs from shortening.

Prevention of Autonomic Hyperreflexia

If your injury is at T6 or above, you are at risk for autonomic hyperreflexia. If your injury is incomplete or lower than T6, it can still occur, but with milder symptoms. You should prevent conditions that may lead to autonomic hyperreflexia. (See page 20 for conditions and symptoms that may result).

The main cause of autonomic hyperreflexia usually is a full bladder. The second and third most common causes, in order, are constipation (a full bowel) and skin irritation or skin breakdown.

Other examples that can lead to autonomic hyperreflexia are:

  • Straps on splints that are too tight
  • Wearing shoes that are too small
  • Wearing tight clothes, belts (ie. wearing jeans when you have been used to wearing sweat pants)
  • Not bringing needed supplies for bladder or bowel care when away from home
  • Small items that may be in your shoes (ie. paper that comes in the toes of new shoes), or in your seating cushion (ie. small toys)
  • Sitting on a wallet
  • Seating cushion out of position
  • Caffeine or alcohol intake that can increase urine volume
  • Drinking too much alcohol or taking sedatives that make you too drowsy to care for yourself
  • Being in an accident or emergency and not being able to tell anyone about your risk for autonomic hyperreflexia. (A medical ID warning of risk for autonomic hyperreflexia may be advised.)

Ask questions about autonomic hyperreflexia and
report any signs to the healthcare team immediately.

This may be a serious medical emergency.

Choosing the Right Rehabilitation Facility

It is important to choose a rehabilitation facility that will best meet your needs. A social worker will be assisting you and your family with this. Family members can play a vital role in gathering information on different facilities that are available. (Appendix III)


Publication of this educational booklet is made possible in part by the generous support of the following sponsors:

  • Metronic
  • Stryker
  • DePuy Spine
  • Fraternal Order of Eagles