This chapter will provide an orientation to spinal cord anatomy and discuss the epidemiology and demographics of spinal cord injuries. Understanding the anatomy and function of the spine and spinal cord will help rehabilitation nurses understand the changes caused by a spinal cord injury. The nurses can use this information to help educate patients and families on the significance of spinal cord injuries on the individual and society.

This chapter will review the mechanisms that lead to spinal cord damage and review the physical and chemical changes that lead to permanent and irreparable damage to the spinal cord. Rehabilitation nurses need to understand how the spinal cord injured person’s functional and rehabilitation potential is linked to this etiology.

Most people understand the terms tetraplegia and paraplegia, but are unaware of all the subtleties that contribute to the diagnosis. Understanding the terminology that explains the damage to the spinal cord will help the rehabilitation nurse identify the injured person’s deficits and assists in predicting functional recovery and rehabilitation.

A number of spinal cord syndromes associated with a traumatic spinal cord injury have specific sensory or motor characteristics. This chapter describes the differentiating features of each of these syndromes so that rehabilitation nurses can craft specific nursing interventions to address these deficits.

The clinical course of an acute spinal cord injury is complex and fraught with challenges. One key focus of this period is to prevent additional damage to the spinal cord by stabilizing the spine through surgical or non-surgical methods. Rehabilitation nurses must understand the rationale behind the fixation method chosen to provide appropriate nursing measures in caring for these individuals.

Assessment instruments are used throughout the continuum of spinal cord injury recovery. These tools provide an objective scale to assist caregivers in diagnosing the extent of the spinal cord damage and assist in identifying improvements in function. Rehabilitation nurses should be familiar with these tools and understand when and how they should be used.

Spinal cord injuries affect every system in the body. Some effects are obvious while others are not. Rehabilitation nurses should understand how these systemic changes affect the person in order to create a holistic plan of care geared toward promoting health and preventing complications.

Spinal cord injuries involve a major insult to the nervous system. The chapter will review the neurologic changes that occur following a spinal cord injury, including those involving motor function and sensory changes. A working knowledge of these changes to the nervous system allows rehabilitation nurses to differentiate between normal and abnormal expected outcomes.

A number of cardiovascular changes occur following a spinal cord injury that are of immediate concern, such as vasodilation and hypotension that can negatively affect the person’s ability sit upright. Other conditions, such as the high risk for blood clots or pulmonary emboli, can be life threatening if not prevented or identified early. Rehabilitation nurses are integral in identifying and treating cardiovascular symptoms.

The loss of normal sympathetic nervous system functioning has implications for blood pressure, heart rate, and temperature regulation. This autonomic dysfunction also puts some people at risk for a life-threatening condition called autonomic dysreflexia. Rehabilitation nurses are key to identifying risk factors and addressing these autonomic system changes that can negatively affect their patients.

This chapter will discuss how spinal cord injury affects the cardiovascular system in particular.

This chapter will discuss the respiratory system and how breathing works.

Sensory deficits and circulatory changes profoundly affect the health of the integumentary system of the person with spinal cord injury and place them at high risk for pressure wounds. The rehabilitation nurse plays a very important role promoting skin health and avoiding pressure injuries through prevention, education, and treatment. This chapter reviews the risk factors brought on by the spinal cord injury that contribute to skin breakdown and addresses preventative measures that nurses should implement.

A number of metabolic changes occur as a result of the spinal cord injury that have implications for the person’s nutritional status. Rehabilitation nurses should partner with dieticians to ensure that patients have the adequate nutritional building blocks required to help the body heal and repair itself. Nursing interventions designed to prevent malnutrition and promote adequate intake will be reviewed in this chapter.

The spinal cord injury’s effect on the individual’s GI system will be dependent on the level and completeness of the injury. This usually involves the ability to voluntarily control bowel emptying, placing the person at risk for incontinence or bowel obstruction. This chapter will discuss the expected changes caused by the spinal cord injury and how medical professionals will use this information to develop and implement bowel management strategies based on the person’s level of injury. Teaching persons with SCI to address and prevent complications is also discussed.

The spinal cord injury’s effect on the individual’s GU system will be dependent on the level and completeness of the injury. This usually involves the ability to control bladder emptying, placing the person at risk for incontinence or retention. This chapter will discuss the expected changes caused by the spinal cord injury and how medical professionals will use this information to develop and implement bladder management strategies based on the person’s level of injury.

The spinal cord injury’s effect on the individual’s GU system will be dependent on the level and completeness of the injury, which will determine the appropriate bladder management technique. The inability to control bladder emptying places the person with a spinal cord injury at risk for potential complications, such as infections and retention. This chapter will review the medical professional’s role in providing education on potential urinary tract complications and discussing strategies to promote a healthy urinary system.

The spinal cord injury’s effect on an individual’s sexual function will depend on the level and completeness of the injury. This usually involves the loss of the ability to control the physical changes and loss of or changes in sensations that occur during sexual activity. This chapter will discuss these alterations caused by the spinal cord injury as well as strategies to overcome these barriers. Medical professionals perform an important role in educating and supporting persons with a spinal cord injury as they seek to regain their sexuality, and the interprofessional team must be current and comfortable to provide this information.

After a spinal cord injury, one of the most important issues to address is spine stabilization and motor changes affecting muscle strength. Several other musculoskeletal concerns, such as spasticity, need to be addressed by the interprofessional team early to minimize problems later in life and improve functional outcomes. This chapter addresses the rehabilitation nurse’s role in the management of these musculoskeletal issues.

Clinicians familiar with spinal cord injuries use their knowledge of neurological levels to predict the person’s probable functional impairments. Rehabilitation nurses partner with other members of the interprofessional team to design a plan of care to address the impairments associated with that neurological level. This chapter reviews the associated deficits related to each neurological level of the spinal cord.

Individuals with a spinal cord injury are likely to have some functional deficits related to self-care, especially those with damage to the cervical spine. The ability to perform self-care is an important quality of life indicator. Rehabilitation nurses partner with other members of the interprofessional team to design a plan of care to address these needs. This chapter addresses the rehabilitation nurse’s role in promoting independence in bathing, dressing, grooming, feeding, and toileting.

The degree to which a spinal cord injury affects a person’s mobility depends on the level and completeness of the insult. Rehabilitation nurses partner with other members of the interprofessional team to design a plan of care to address these needs. This chapter addresses the rehabilitation nurse’s role in promoting bed mobility, transfers, wheelchair mobility, and ambulation.

Assistive technologies can improve the quality of life for some individuals with spinal cord injuries. These technologies range from devices that can assist a patient to ambulate to devices that can control the environment. This chapter explores the rehabilitation nurse’s role in promoting the use of these devices in collaboration with other disciplines within the interprofessional team.

Recovering from a spinal cord injury is often an emotional rollercoaster. This chapter will explore the psychosocial and emotional hurdles that the individual faces as the realization of the extent of their injury is understood.

Recovery from a spinal cord injury is a journey that is most successful with the support of family and friends. This support may come in the form of assisting with physical deficits or addressing emotional needs. This chapter will explore family involvement during the rehabilitation process, adjustment period, and planning for the future.

The recovery from a spinal cord injury can be long, challenging, and filled with hopes of functional recovery. This chapter will discuss the transitions of care facing the patient and family as the spinal cord injured person moves beyond the acute hospitalization phase into their new reality.

The ultimate goal of rehabilitation is to integrate individuals back into the community to lead a productive and meaningful life. This chapter reviews how vocational, financial, and community resources promote community reintegration and assist the patient to move on with his/her life.

Due to advances in medicine, the life expectancy for someone with a spinal cord injury is slightly less than the average non-spinal-cord-injured adult. People are now living 30-plus years post injury, something unheard of in years past. The aging process brings additional medical and physical challenges that the individual needs to overcome. This chapter will address problems that result from the aging process.