What Happens in a Spinal Cord Injury?

A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into the spinal cord tissue. Most injuries to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery, others will result in complete paralysis.

Spinal Cord Injury Care Continuum

Brackenridge Hospital is the only Level II Trauma facility in the Austin and Central Texas area. Their program follows the Spinal Cord Injury Care Continuum.

Step 1: Acute Care Hospitalization

The first step is acute care for the patient. Immediate stabilization helps ensure survival, prevention of complications, the highest level of function possible, and rapid transfer to the rehabilitation process. This includes dedicated rooms, consistent and specialized nursing care, and dedicated therapy services.

Step 2: Inpatient Rehabilitation

This is an adaptive phase where the patient begins to learn how to function. This includes

  • Basic therapy
  • Activities of daily living
  • Equipment
  • Family training

Step 3: Outpatient Rehabilitation

There are two phases to outpatient rehabilitation.

Phase 1:

This is traditional outpatient therapy to continue working on goals initiated during the inpatient rehabilitation and hopefully continues the progression of adaptive skills. The services include physical therapy, occupational therapy, case management social work, nutrition. Access for counseling, wound management, speech pathology, urology, etc. will be assessed on an individual basis.

Phase 2:

This phase of rehabilitation is an advanced community skills program that allows the patient with a spinal cord injury to be as active as possible in the community. This is not currently available in any focused environment. The emphasis is on neuromuscular retraining and activities such as driving. The focus is on advanced skills necessary for a higher quality of life and improved functionality including:

  • Uneven transfers
  • Difficult terrain
  • Floor to chair transfers
  • "Wheelie" skills for stairs, curbs, etc.
  • Orthotics/splints
  • Spasticity management
  • Neuro re-education
  • Assisted gait
  • Standing readiness
  • Pain management
  • Sensory stimulation/retraining
  • Bowel and bladder issues

Step 4: Recovery

It is important to continue exercising and networking post-rehabilitation.

There are two phases to the recovery phase.

Phase 1: Community Program

The Brain and Spinal Cord Injury Community Wellness Program's exercise facility is designed for the person with disabilities with accessible equipment and equipment that meets specific needs. The focus is on weight training, cardiovascular workout, and functional development programs.

Phase 2: Advanced Recovery Program

This phase of the recovery process is an intense exercise and neuromuscular retraining program to allow maximal increase in function. The focus is on physical and sensory function recovery and will include:

  • Progressive strengthening
  • Progression to weight bearing
  • Facilitated function
  • Neuro re-education
  • Assisted gait
  • Cardiovascular exercise programs