Introduction
A spinal cord injury is when the spinal cord gets cut, bruised, stretched, or poked. It can change the way the body moves, feels, and functions.
Right after an injury, doctors don’t always know what a person’s long-term outlook will be. A trained medical team can help someone with a spinal cord injury get the medical care they need for their best recovery.
Signs and symptoms
Spinal cord injuries are most often caused by physical trauma, including:
- motor vehicle accidents
- falls
- injuries from physical activity like sport
- child abuse or violence.
Signs and symptoms of spinal cord injury in children will depend on how severe the injury is, and where it is located.
Spinal shock may occur immediately after physical trauma and will normally subside over a few days. Signs of spinal shock include:
- loss of feeling
- loss of muscle movement and reflexes
- swelling
- bruising.
Signs of more severe spinal cord injury include:
- muscle weakness
- partial or complete loss of feeling and/or movement in the chest, arms and legs
- breathing difficulties
- loss of bowel and bladder function.
Spinal cord injuries can be severe and potentially life threatening. If you think your child has experienced a spinal cord injury, call triple zero (000) and do not move them unless they are in immediate danger.
Diagnosis
After physical trauma, your child may experience:
- neck pain
- loss of consciousness (not being awake)
- obvious signs of weakness or injury to the brain and spine.
The paramedics (ambulance) and doctors looking after your child will check for movement and sensation (loss feeling in a part of your body) and ask some questions about the accident.
Doctors may order medical tests including x-rays, CT scan and MRI to check the brain and spine.
A few days after injury, if some of the swelling has subsided, your child's doctor will conduct a more detailed exam to figure out the level of injury.
This involves testing muscle strength and ability to feel a light touch.
Treatment
Spinal cord injury treatment focuses on preventing further injury, and empowering people with a spinal cord injury to return to an active and productive life.
Your medical team will work closely with you and your child to create a treatment plan to help manage day-to-day life with a spinal cord injury. This includes plans for physical activity, bladder and bowel management, and pain and pressure relief.
Management
Physical activity
Physical activity is vital for children living with a spinal cord Injury. Try a variety of activities that are fun and suit your child’s interests, skills and abilities.
Physical activity will help to develop and improve healthy growth and development including:
- posture
- self-esteem
- fitness
- balance and co-ordination skills
- flexibility
- strong bones and muscles
- mood and relaxation.
Physical activity can also help with supporting a healthy weight and preventing bowel issues like constipation.
People living with a spinal cord injury will often need to build strength in their arms and torso to help with:
- balance
- moving and transferring from their wheelchair
- travelling in their wheelchair
- using walking equipment (in some situations).
Bladder management
Children living with a spinal cord injury can have a neurogenic bladder. This means that the brain and bladder do not work together as they should, and your child will not get the normal sensation to tell them when it's time to go to the toilet.
Intermittent catheterisation is used to improve bladder control, prevent infection and relieve pressure on the kidneys.
A disposable catheter (plastic tube) is inserted into the bladder to empty it. Once the catheter has drained as much urine from the bladder as possible, it is slowly removed. This technique is usually repeated regularly, up to six times a day. It is important for children to drink plenty of fluids to avoid urinary tract infections (UTIs) and support good bladder health.
It is important for children with bladder issues to remain clean and dry to prevent odour and infection. Some medication can be useful to improve urine storage and reduce leakage - this will be advised by your treating doctor and/or nurse.
Bowel management
Children living with a spinal cord injury can have a neurogenic bowel. This means that the brain and bowel do not work together as they should, and your child will not get the normal sensation to tell them when it's time to go to the toilet.
A bowel program and regular toileting routine is essential for children with spinal cord injury. Your child's doctor can help develop a suitable bowel program that may include things like:
- consistent toileting
- position
- medication
- exercise and a standing programs
- monitoring regular stool consistency (diet and fluids)
- strategies to avoid constipation and accidents.
Some children require surgery to enable them to empty their bowels. Surgery is only recommended when non-surgical methods have been unsuccessful. Your health professional will discuss these procedures.
Foot care
Children with a spinal cord injury need to give their feet special attention. To help your child have happy, healthy feet, you should:
- arrange for them to see a podiatrist regularly
- wipe and dry between their toes after a bath shower
- treat cuts and sores as soon as they appear
- keep your child’s feet covered and protected
- buy socks that are loose around the top and do not leave on the legs (often branded as diabetes friendly socks)
- seek medical advice before buying shoes
- look for shoes with a wide toe, non-slip sole, and that are easy to get on and off.
Pressure relief
Pressure from lying and/or sitting for too long can stop blood from flowing to the skin. This restricts oxygen flow and can cause the skin to breakdown. It is important for children with spinal cord injury to develop a daily habit of moving their weight as often as possible. This is called pressure relief.
To help relieve pressure (every 20-30 minutes) your child can:
- lean forward onto a table, bed, chair, desk, or their knees
- lean from side-to-side
- shift their legs one at a time to re-position
- do a lift, holding the armrests to lift their bottom off the seat.
Remember to always check your child’s skin for pressure sores at morning and at night, especially their feet and bottom. Talk with your child's occupational therapist about equipment for pressure relief.