Back_on_Track_Promo2016a

BACK on TRACK
A basic
introduction
for those learning
to live with a
spinal cord
injury
Julian Verkaaik
B Design (Industrial)

When you first have a spinal cord injury or impairment
so much of what you have to learn seems like it has come
straight from a medical or a nursing textbook.
Even though most of us aren’t doctors or nurses we ARE
experts about ourselves so what we need is just enough
information for us to start asking questions of the doctors,
nurses and other health professionals who
WORK FOR US!
“<strong>Back</strong> on Track” is NOT the whole answer. It is a basic
introduction to help you start the question-asking process.
People who ask questions are the ones who recover or
rehabilitate the quickest and who succeed the best.
So read this book and start asking lots and lots of questions!
Ben Lucas
Garry Chief Executive Wilson
Chief New Zealand Executive Spinal Trust
ACC
Disclaimer: This publication has been produced with the full medical support of the
Burwood Spinal Unit. It is intended as a guide only and should not be used to replace
the medical opinions of your health professionals. Medical knowledge is constantly
evolving and preferred rehabilitation techniques may differ from region to region.
Readers are strongly advised to confi m that information in this publication conforms
to current standards of practice endorsed by your spinal unit.
Published and Distributed by:
The New Zealand Spinal Trust
Allan Bean Centre, Burwood Hospital, Entrance 3, Mairehau Road,
Private Bag 4708,
Christchurch 8140,
New Zealand
All rights reserved. No part of this publication may be copied, reproduced, stored or transmitted
by any mechanical, photographic or electronic processes or techniques, for public or private
use, without the express written permission of the publisher.
© First edition New Zealand Spinal Trust, December 2004
© Second edition New Zealand Spinal Trust, August 2009
© Third edition New Zealand Spinal Trust, September 2014
To learn more about the New Zealand Spinal Trust go to:
www.nzspinaltrust.org.nz
Third edition printed September 2014 by THE CAXTON PRESS.
ISBN 978-0-473-29020-7
© New Zealand Spinal Trust, 2014

Your rehab will not stop when you leave
the hospital and go home which is why you
must learn to take control.
Edited & Illustrated by
Julian Verkaaik B Des
<strong>Back</strong> on Track provides basic information
which will help you take the bull by the
horns and take control of your future. A
spinal cord injury is not the end of the road.
It may mean hanging up your boots for good
and getting a new set of wheels but there is
no reason to sit on the roadside and watch
life pass you by.
This handbook is designed to help you do
just that - to help you get back into the real
world with a good base of knowledge that
will help keep you out of hospital later. It
is written in everyday language that will
compliment the information you will be
getting from your medical teams. The issues
that surround spinal cord impairment are
complicated but they can be understood
by anyone – it may take a bit of time but it
is worth it.
When you’ve fallen from grace and landed
in a spinal unit you need to begin learning,
right from day one. Rehabilitation is not a
medical process but a process of learning.
You are the most important stakeholder in
the outcome of your rehabilitation. Not the
doctors. Not the Hospital. You.
Nobody else can rehabilitate you
- you must do this for yourself.
In the early days of your recovery there will
be an enormous amount of medical activity
happening around you that you will not
have much control over. This will soon pass
and you will become much more involved
in the process of your rehabilitation.
All you need to do is take life one
day at a time and try to learn one
new thing every day.
Having a spinal cord impairment will not
stop you from having a happy and fulfillin
life. Yes, things have changed and life will
never be quite the same but change is the
only constant we have in life. Don’t fight it,
embrace it and work it to your advantage.
Above all else, keep believing
in yourself!!
Julian Verkaaik
5 © New Zealand Spinal Trust, 2014

Acknowledgements
This third edition of <strong>Back</strong> on Track is dedicated to Richard Smaill,
Chair of the New Zealand Spinal Trust for his enthusiasm,
support and contribution to the work of the NZST.
The editor wishes to acknowledge the tireless efforts of all the
staff and patients of the Burwood Spinal Unit who contributed
to this publication, especially Mr Allan Bean, Dr Angelo
Anthony and Dr Rick Acland. Significant contributions were
made by the following staff; Karen Wilson, Karen Marshall,
Val Sandston, Andrew Hall, Angela Todd, Mark Julian, Barrie
Woods, Denise Brown, Victoria Newcombe, Liz Beaglehole,
David Tieleman, Mike Moss and Ted Templeton. Without their
willingness to share their wealth of knowledge and experience
this publication would not have been possible.
The editor also thanks the late Prof Alan Clarke, Margot
Anderson and the staff of the New Zealand Spinal Trust for
all their support and encouragement, especially Paul Stafford
for his amazing energy with the final layout and design of this
book that brought this project to completion.
The ‘Successful Graduates’ of spinal cord rehabilitation who
contributed the anecdotes and photos that enliven this book
deserve special note. Thank you to Stephen Hannen, Roman
Tua, Daniel Buckingham, Sue Quirk, Keith Jarvie, Robin Paul,
Tim Johnson, Peter O’Flaherty, Sharon Devonshire, James Doak,
Bill Gruar, Ian Popay, Wayne Chapman, Lea Galvin, Roy Dale,
Peter Lush, Warren Bennett, Debbie Henderson, Christine Lawn,
Karen Calder, Dean Hatchard, Rick Fright and Derek Wight.
For the third revised edition, the editorial team wish to thank the
following Burwood Spinal Unit staff for their review of the book
chapters; Rina Pijpker, Maria van den Heuvel, Dr. Lincoln Jansz,
Angela Todd, Kirstie Ross, Lynn Stephen, Kristal Duff as well
as staff of the New Zealand Spinal Trust; Ben Lucas, Bernadette
Cassidy, Paul Stafford, Jharna Das Gupta, and Hans Wouters
The New Zealand Spinal Trust thanks the Ministry of Health
for supporting this publication. The Ministry of Health has
generously supported the New Zealand Spinal Trust design
service over the past years to create high quality educational
publications enhancing the quality of rehabilitation.
6 © New Zealand Spinal Trust, 2014

"What's all this Rehab about anyway?"
By the late Prof. Alan Clarke CMG ChM FRACS
1932 – 2007
The late Prof Clarke
was the Dean of the
Otago University
School of Medicine
when he fell off his
roof. After a long
career as a medical
researcher his rehab
experience taught him
an important lesson –
that rehabilitation is
not a medical process,
it is a learning one.
His advice from his
unique perspective as a
doctor-become-patient
is well worth listening
to.
“When you survive an accident or
an illness, you step immediately
onto a pathway to recovery.”
Getting Started
For you, the person with a spinal cord injury,
and for your family, whanau and friends, the
first part of this pathway goes through a spinal
injuries unit. What happens to you in a spinal
injuries unit is very special. It will enrich
your new beginning and help you achieve
independence and happiness. The good news at
the beginning is that you could have been much
worse off, and things can only get better. However
nobody can predict just how much recovery you
will get or how much impairment and disability
will remain.
The first few days following your accident are
confusing. So much will be happening to you
that you will feel that you have little control. If
you have significant spinal cord injuries with
either tetraplegia or paraplegia you will feel
particularly helpless, unable to move much at
all and very dependent on the people who are
caring for you. It is normal for you to feel afraid
and angry, insecure and powerless. You may
be too numbed by it all to cry but it would not
do you any harm if you did cry. You may be
angry with yourself or with others that this has
happened to you, but at this stage you are not
likely to feel sorry for yourself. More likely you
will get annoyed by other people who seem to
feel sorry for you. For the first week or two in
the spinal unit it helps if you can be accepting
and “go with the flow”, and simply be assured
that whatever happens, there is a really good
life ahead for you.
“This may take a lot of believing,
but it is true!”
If you are a member of the family you will
experience feelings of loss and bewilderment
which are similar to those experienced by the
patient. These feelings are not helped if you are
away from your home and from other family
members, from your friends and from normal
life routines. Things are just about as unfamiliar
for families supporting patients in spinal units
as they are for the patients themselves, even
if families have had a lot to do with hospitals
before. Like patients, families are enormously
in need of information and support. It is OK for
you as a member of the family to suffer grief,
it is OK to cry and it is quite usual for you also
to feel that you are not in control. You may
have feelings that your partner or loved one
has become public property, that there is little
privacy, and that your feelings have become
terribly exposed. However you may also find
that these events bring members of your family
and your friends closer together.
A new “acute admission” to the spinal unit
creates a great deal of work and makes staff
busier. Members of staff are all human and share
your feelings of anxiety, apprehension, sadness
and grief. However nurses, physiotherapists and
other health professionals who directly care for
you need to be careful that they do not identify
too closely with your feelings. They must remain
objective. As a member of the family you may
feel that this professional objectivity is callous.
“Clinical detachment” as it has sometimes been
called is a very important acquired skill of health
professionals. Getting too close to their patient
can cloud their judgement. This is why doctors
should never look after their own loved ones.
No matter how busy your carers are, they are
always accessible and within reason should
always be willing to answer questions. Good
information on the first and second days is gold
7 © New Zealand Spinal Trust, 2014

for you and for your family and whanau. It is
essential for planning your recovery. There is so
much information that you need it to be readily
available to go back to again and again.
Pathway Planning
The quickest way for you to gain control and
rediscover hope is to start planning your
pathway to recovery with the help of your
family, whanau and friends - on the very first
day if possible! In the fir t few days a real
problem for your planning is uncertainty. This
is particularly so with neck injuries, with both
partial and apparently complete tetraplegia. In
a very few cases the doctors may be able to say
with some degree of certainty that recovery is
unlikely to occur to a significant extent but in
most cases they will say that it is not possible
to predict outcome at an early stage and that
things will not become clear for you for several
weeks.
“All survivors of spinal injuries can
achieve independence & happiness - it
just takes a little time.”
In most things you are the person you were before
the accident. However right now you definitel
are the team leader both in the rehabilitation
process and of the health professionals who
work in the spinal unit and who manage the
process for you. All members of the team have
a responsibility to help you achieve the goals
that you have made for yourself. The spinal
unit staff when they work with you will depend
very much on your willingness to lead them.
You must retain a belief in yourself. The first
part of your plan is your discharge plan. This
belongs to you, not the staff, and it assumes that
you are anxious to get out of hospital as soon
as possible.
If at any time you feel that there are undue
and perhaps unnecessary delays with your
rehabilitation, you should ask why. If your
rehabilitation is managed well, your goal
or target date for discharge may be brought
forward. If it is not managed so well, discharge
may be delayed. It will take some days for you
to see clearly your way ahead. As a general rule,
complete paraplegics will be in the unit for eight
to fourteen weeks while complete tetraplegics
will be in the unit from twelve to twenty weeks.
Staff will all know the major milestones and will
help you in a general discussion. However
the planning process is quite specific for each
person as every individual and every injury is
different
You can't help being interested in how other
patients are getting on and that is OK but you
must pace yourself against your own goals and
measure your success by your own progress
towards these goals. If you are a person who
has not been accustomed to setting goals and
planning your life and have up till now rather
just let things happen, this will be a time of
great opportunity for you but it will not be
easy. There are people in the Unit who can
help you with this. Some real “successes” are
people whose accidents have occurred during a
time of personal turmoil, and the tasks of settin
goals and planning recovery has led them into
totally new and exciting lives.
Some people are so devastated by the injury that
has happened to them that they are not able in
the first few days and weeks to take charge of
their discharge planning. It is more difficul for
them if their family is also overwhelmed by the
events. If you and your family feel like this,
unable to cope, there will be staff members in
your spinal unit who are able to help you with
your planning. Talking about these feelings can
help you and there will be someone amongst
the team of therapists who will listen carefully
to you. Social workers, clinical psychologists
and psychiatrists have special training to help
you get back into the “driving seat” of your own
rehabilitation plan.
“Rehabilitation or getting back
on track depends almost
entirely on you.”
It is important that you learn all about your
injury, its consequences, and about both your
medical and general needs. Soon you should
know more about your case than any of your
doctors, nurses or other health professionals.
They rely on your knowledge for you to keep
yourself safe. Before you realise it, you will be
able to look after yourself safely in the big wide
world, and you will be home.
8 © New Zealand Spinal Trust, 2014

Contents
Intro
Spinal 101
Authors Note 5
Acknowledgements 6
Foreword "What’s all this Rehab about anyway?"
Getting Started
Pathway Planning 8
Contents 9-15
A word about medical terms... 18
Spinal Cord Impairment 9
Immediate Treatments 9
Surgery 9
Stabilising 19
Immediate Effects of Injury 20
Get to Know Your Spine! 21
Your Spinal Column 22
Your Spinal Cord & Nerves 23
Peripheral Nerves & Functions 24
Your Nervous System 5
The Somatic Nervous System 5
The Autonomic Nervous System 25
Your Spinal Cord 26
Messages & Signals 7
Sensory Messages 7
Motor Messages 7
Reflex Messages 27
What is Spinal Cord Impairment? 28
What happens to my Nervous System? 29
Spinal Shock, Reflexes & Spasm 30
Spinal Shock 0
Reflexes & Spasm 30
Your Bowel 1
Reflex Bowel 31
Flaccid Bowel 1
Your Bladder 31
Skin & Sensation 32
Hope of Recovery & Cure 3
Recovery 3
Cure 33
Descriptions 4
Lesion 4
Level of Injury 4
Complete 4
Incomplete 4
Central Cord Syndrome 4
Anterior Cord Syndrome 4
Posterior Cord Syndrome 34
Brown-Sequard Syndrome 35
9

Contents
Cauda Equina Lesion 35
Paralysis 35
Paraplegia 35
Tetraplegia / Quadriplegia 35
Neurology 35
Common Terms 36-38
Bladder
Bladder Care 41
Your Urinary System 41
Production 41
Collection & Disposal 41
Your Bladder Following SCI 42
Reflex Bladder 42
Flaccid Bladder 42
Mixed Bladder 42
What is Bladder Management? 43
Immediate Management 43
Weekly Urine Test 43
Cystometry 43
Video Cystometry 44
Flexible Cystoscopy 44
Acidic vs Alkaline 44
Bladder Management Techniques 45
Catheters & Bags 45
Bugs 45
Bladder Management Options 46
Indwelling Urethral Catheter (IDUC's) 47
Advice For Men 47
Long-term care of IDUC's 48
Bladder Washout 48
Catheter Change 48
Clamping a Catheter 48
Suprapubic Catheter (SPC) 49
Inserting 49
Taping 49
Caring for Suprapubics 50
Dressing 50
Bladder Washout 50
Catheter Change 50
Intermittent Self Catheterisation (ISC) 51
Other Options 52
Reflex Bladder 52
Botulinum Toxin (Botox) 52
Uridomes 52
Implants 53
Common Bladder Problems 53
Autonomic Dysreflexia 54
Signs & Symptoms 54
10

Contents
Causes - Bladder 54
Causes - Bowel 54
Causes - Other 54
Treatment 54
At Home 54
Bladder Infections 55
Bladder Infections & Indwelling Catheters 55
Taking a Specimen 55
Bladder Infections & Self Catheterisation 6
Kidney Infections 56
Bladder Stones 57
Reflux
57
Trouble Shooting Guide 58
Urethra Leaking with Suprapubic Catheter 58
Frequently Blocking Catheters 58
Leaking between Intermittent Self-Catheterisation 59
Reflex Bladder Emptying 59
Stones 59
To Prevent Stones Forming 59
Urethral Spasm When Doing Intermittent Catheters 60
Bladder-Neck/Sphincter Spasm 60
Low Urine Output 60
Bowel
Digestion & Bowel Care 63
The Digestive System 64
Digestion & Spinal Cord Impairment 65
Reflex Bowel 65
Flaccid Bowel 65
Bowel Training 65
Diet 65
Regularity 65
Bowel Cares 66
Reflex Bowel Evacuation 66
Inserting Suppositories 66
Flaccid Bowel Evacuation 67
Method 67
Digital Evacuation on Bed Rest 67
Method 67
Bowel Management Medication 68
Laxatives
Bulk Formers
68
68
Faecal Softeners 68
Herbal Alternatives 68
Bowel Accidents 68
Common Causes of Bowel Accidents 68
Common Bowel Problems 9
Autonomic Dysreflexia 69
Signs & Symptoms 69
11
© New Zealand Spinal Trust, 2004

Contents
Causes - Bladder 69
Causes - Bowel 69
Causes - Other 69
Treatment 69
At Home 69
Constipation 70
Managing Constipation 70
Diarrhoea 70
Managing Diarrhoea 70
Rectal Bleeding 70
Screening for Bowel Cancer 71
Skin
WARNING! 74
Your Skin 76
The Epidermis 76
The Dermis 76
The Sebaceous Glands 76
The Sweat Glands 76
Skin & Spinal Cord Impairment 77
Your Early Warning System 77
What is a Pressure Area? 78
The Stages of a Pressure Area 78
What to look for 78
What to feel for 78
Where to look 78
Pressure Risk Areas 79
The Ounces of Prevention 80
In Your Wheelchair 80
Shower & Commode Chairs 80
In Your Bed 80
Your Clothing 80
Your Footwear 81
Vehicle Safety 81
Vehicle Journeys 81
Burns & Scalds 81
Heaters & Fires 81
Ovens & Stoves 81
Other Risk Factors 82
Hot Food & Drinks 82
Baths & Showers 82
Chemical Burns 82
Cuts & Scrapes 82
Cold & Frostbite 82
Diet & Body Weight 82
Zits! 82
Smoking 82
Existing Damage 82
12

Contents
Moisture 82
Fungal Infections 82
Waxing, Tattoos and Piercings 83
Moisturisers and Powders 83
Other health problems and aging 83
Your Feet 83
Tinea 83
Ingrown Toenails 83
Pressure Area Management 84
Home vs Hospitalisation 84
Pillow 85
Getting Up & About 85
Pressure Relief 86
Arm Raise Relief 86
Alternate Lean Relief 86
Forward Lean Relief 86
Mobilisation Chart 87
Nutrition
Nutrition 90
Balanced Diet 91
Fibre 92
The Weighty Issues 3
Overweight Complications 3
Reducing Weight 3
Exercise
Underweight Complications
94
5
Ideas to Gain Weight 5
Fluids 6
Alcohol 6
Drugs 7
Medical
Important Information! 100
Personal Medical Information 100
Medical Complications 101
Autonomic Dysreflexia 101
Signs & Symptoms 101
Causes - Bladder 101
Causes - Bowel 101
Causes - Other 101
Treatment 101
At Home 101
Blood Clots 102
Prevention 102
Signs of a Deep Vein Thrombosis 102
13
© New Zealand Spinal Trust, 2004

Contents
Life
What do I do now?
102
Pressure Areas 102
Body Temperature Control 103
Overheating 103
Heatstroke 103
Heatstroke Prevention 103
Low Body Temperature 103
Hypothermia 104
Frostbite 104
Keeping Warm 104
Chest Infections 104
Bladder & Kidney Infections 104
Bladder Infections 104
Bladder Stones 105
Kidney Infections 105
Fainting & Dizziness 105
In your Bed 105
In the Shower 105
In your Wheelchair 106
Swelling 106
Managing Swelling 106
Spasm 106
Negatives 106
Positives 107
Fragile Bones 107
New Bone Growth 107
Signs & Symptoms 107
Ingrown Toenails 107
Treatment 107
Fungal Infections 107
Living With Pain 108
Types of Pain 109
Root Pain 109
Hypersensitivity 109
Aches & Pains 109
Spasm 109
Pain Treatments 109
Painkiller Drugs 109
Nerve Stimulation 109
Surgical Interventions 109
Effects of Pain 109
Coping with Pain 10
Staying Active 10
Forced Relaxation 110
Massages & Osteopathy 10
Drugs & Alcohol 10
Feelings & Emotions 113
14

Contents
Accepting reality 113
What is Grief? 114
Denial 114
Anger 114
Depression & Sadness 114
Loneliness 115
Fear 115
Anxiety
Vulnerability
115
115
Coping with Grief & Emotions 116
Challenging Perceptions 116
Taking Charge 118
New directions 118
Setting Goals 118
Your disability as a career? 118
Motivation 119
Family adjustment 119
Support 119
The Four Pillars 119
Sex & Relationships 121
The Place of Sex in Life is Affected by 121
Some of the Basics 122
Changes in Function 123
The Facts For Men 123
The Good News 124
The Bad News 124
The Facts For Women 124
The Good News 124
The Bad News 125
The Wonder of the New 125
The Other Half 125
Most Importantly Keep Your Sexuality Alive 126
Roles Within Relationships 126
Intercourse 127
Orgasm 127
Fertility 128
Pregnancy & Childbirth 129
Getting More Information 129
In the Hospital 129
At Home 30
Getting Out and About 31
Getting <strong>Back</strong> to Work 132
Introduction 132
Is Work Good? 133
Financial Reasons for Getting <strong>Back</strong> to Work
Other Reasons for Getting <strong>Back</strong> to Work
133
134
What Work to Do? 134
Step 1, Step 2 134
Step 3, Step 4, Step 5, Step 6 135
Finally 136
The Last Word 137
15
© New Zealand Spinal Trust, 2004

This high quality publication is
available in hard copy and is suitable
for use in a clinical environment.
Order NOW from

A word about
medical terms…
The science of medicine has developed
over many centuries. Many of the terms
and references are based on the Latin
language. The medical language is
designed to be precise and distinctive to
avoid confusion for those who practice
medicine as a profession.
Some of the terms can appear very
impersonal, harsh or even negative.
Disabled, non-functional, incomplete, flaccid,
impairment etc, all of these are terms used to
describe various aspects of your injury.
REMEMBER: You are a person who
happens to have an injury - you are not
"the tetraplegic in Room 5."
If you do not understand any of the medical
jargon do not hesitate to ask the person(s)
to explain those words or terms.
18 © New Zealand Spinal Trust, 2014

Spinal Cord Impairment
You have had an accident or illness that
has resulted in a spinal cord injury or
impairment (SCI). This chapter will begin
to explain how your body works and how
your impairment is affecting the way it
functions. It is only an introduction to
the range of effects your SCI may have on
you. Spinal cord impairments are different
from individual to individual. You may
experience only a few of the effects or the
full range. This book will get you started,
make you hungry for more information, and
raise more questions for you to ask. Talk to
your medical professionals about what may
be relevant for you.
Stabilising
Depending on the nature of your injury the
position of your spine may need to be held
still for some time. If your injury is to your
neck, you may be on bed in traction, that is,
with a small weight atta hed to head tongs.
This helps to keep your bones in proper
alignment while they heal. You would
normally be in traction for six weeks.
Immediate Treatments
Surgery
You may need surgery to stabilise the
damaged bones of your spine. The bones
may not be stable, there may be a noticeable
deformity, or a bone fragment may be
pushing onto the spinal cord. Often metal
plates and screws are used to stabilise the
spine and avoid further damage to the cord.
Please bear in mind that stabilising surgery
will only repair the bones of the spine.
Other neck injuries may need a Halo ring and
jacket, or a hard collar to keep the neck still.
“Once you’ve got to [the unit] listen
to all advice, staff [are] excellent
(indeed marvellous) but very busy.
Be persistent (but polite!) with your
requests. Staff are very pressured,
sometimes answers take a little time.
Save your energy for the big issues.”
Roy Dale L4/5
19
© New Zealand Spinal Trust, 2014

Immediate Effects of Injury
• In the paralysed parts of your body
you cannot feel pressure, and you
cannot move your limbs to relieve
pressure. Your body will have to be
moved or turned every two or three
hours to relieve pressure and prevent
pressure sores from developing.
• You won’t be able to feel when your
bladder is full and you won’t be able
to empty it. Your doctor or nurse will
have to manage it for you until you
learn to do this for yourself.
• You will also need help at first to
empty your bowels.
• As you will not be able to move
paralysed parts of your body, a
physiotherapist will move them for
you to prevent them from becoming
stiff or deformed
• You may also experience spasm -
involuntary movement and twitching
of the paralysed limb.
• Woman may find that their periods
stop for a time, but they will return
sooner or later in the normal way.
• Men may find that they cannot get an
erection, or cannot control it. Most
people with a SCI will be able to enjoy
sexual activity.
• If you are tetraplegic, your body’s
system for regulating temperature may
be disrupted. Your temperature may
be much below normal, and you may
feel shivery or hot, be unable to sweat
or find yourself s eating profusely.
• You won’t be able to sit up unaided,
and to begin with you will be raised
only very gradually and for short
periods. If you are raised too quickly,
especially if yours is a high injury, you
may faint.
• You may suffer from unusually low
blood pressure in the early weeks.
After a month or so, those with a high
level of injury may have attacks of high
blood pressure.
• You may find when you do sit up that
you cannot balance without support.
With your limited movement and
sensation you have to learn all over
again to balance your body.
• You may feel very depressed, and
perhaps angry and guilty. This is
a perfectly natural reaction to your
injury, the shock to your body, the
indignity of having everything done
for you, your uncertainty about the
future and your concern for family and
friends.
• For some weeks you won’t be able to
go home, work, study, make love, look
after children, care for older relatives,
cook meals or play sport. Later, with
some preparation, you will be able to
do most of the things you probably
took for granted in your daily life
before your injury. After a while, you
will be able to do all or most of these
things. Although it will certainly be
more difficul to do them than it was
before your injury, you may find them
just as rewarding, perhaps even more
so.
• Some paraplegics have been able to
go home in 8 - 12 weeks and some
tetraplegics as soon as they become
independent. Most people take longer
and you may not be independent for
6 - 12 months.
Material adapted from Moving Forward: The Guide to
Living with Spinal Cord Injury. Spinal Injury Association
(SIA), United Kingdom, May 1995.
20 © New Zealand Spinal Trust, 2014

Get to Know Your Spine!
The spine is a column of bones, ligaments and
nerves and performs two critical tasks. It is
a physical structure that links most parts of
your body together, and it houses the spinal
cord that connects your brain to every part
of your body.
The spinal column begins in the neck and
ends at the tailbone. The spine is a column
of 33 bones called vertebrae. Individually
each bone is called a vertebra.
The vertebrae are stacked one on top of
the other and are held together by discs,
ligaments and muscles. Ligaments keep
the spine stable and the muscles provide a
limited degree of movement.
The springy discs between each vertebra
keep the bones from rubbing together and
serve as shock absorbers for the spinal
column.
The spinal column is divided into 4 sections.
Each section is given a name and each
vertebra is numbered.
21
© New Zealand Spinal Trust, 2014

Your Spinal Column
22 © New Zealand Spinal Trust, 2014

Your Spinal Cord & Nerves
23
© New Zealand Spinal Trust, 2014

Peripheral Nerves & Functions
At every vertebra in the
spine, nerves branch out in
pairs. In the neck there are
more nerve pairs (8) than
there are vertebrae (7).
In the centre of each
vertebra is a hole and
when the vertebrae are
stacked together they
form a tunnel called the
vertebral canal. This canal
completely surrounds and
protects the spinal cord.
Pairs of peripheral nerves
extend out from the
spinal cord through gaps
between each vertebrae.
Each pair of peripheral
nerves links the brain with
various parts of the body.
The diagram to the right
gives an indication of what
areas of the body each
pair of nerves connect to.
24 © New Zealand Spinal Trust, 2014

Your Nervous System
Your nervous system is made up of your
brain, spinal cord and the nerves branching
off it. Your brain controls every function that
your body performs.
The brain controls some of your functions
automatically, i.e. your heartbeat and
breathing, without you even being aware
of it. Other functions are controlled more
directly and require a conscious thought to
begin, e.g. to pick up an object.
Your nervous system helps to control all of
your body’s functions and can be roughly
divided into two parts. Your brain and
spinal cord together form the central nervous
system. The peripheral nervous system links
your central nervous system to the rest of
your body.
The nervous system can also be divided
by its functional organisation into two
categories, the somatic nervous system and
the autonomic nervous system.
The Somatic Nervous System
The somatic nervous system is your body’s
primary means of communication between
the brain and its moving parts. Its main
function is to transmit sensations to the
brain and, after this information has been
processed and a response decided on, to
control deliberate movements.
Some of the things the somatic nervous
system monitors or controls are:
• Movement
• Sensation
• Reflexe
The Autonomic Nervous System
The autonomic nervous system controls the
background or involuntary functions of your
internal glands and organs. If you have
damaged your spinal cord you probably
have also damaged your autonomic system.
Your level of injury dictates the extent of
the damage.
Some of the things the autonomic nervous
system monitors or controls are:
• Heart rate and blood pressure
• Breathing
• Body temperature
• Sweating
• Shivering
• Digestion
• Bowel & Bladder functions
• Male sexual function
“I was injured in the Cave Creek Tragedy
of 1995. A viewing platform collapsed
and tipped 18 people 35 metres into a
chasm onto the jagged rocks below. I
was one of only four survivors and was
given only a 10% chance of surviving. I
don’t remember anything of the accident
thankfully or the first six weeks of the nine
weeks that I spent in Intensive Care. On
top of my incomplete C6/7 Tetraplegia I
broke 16 bones including my jaw in three
places, ruptured my bowel, had 80 stitches
across the top of my head with minor head
injuries (very minor!!). I then spent the
next 12 months in the Burwood Spinal
attempting to rehab…but rehab didn’t
really start until I was back out in the
real world! “
Stephen Hannen C6/7
25
© New Zealand Spinal Trust, 2014

Your Spinal Cord
Your Spinal Cord is a very
complex 2 way communication
network that allows your brain
to ‘talk’ to specific parts of your
body, and for those parts to
send messages back. The cord is
similar to a telephone cable with
many wires.Your spinal cord is
approximately the diameter of
your little finger and runs from
your brain down the inside of
your spinal column and ends at
the base of L1 - the 1st Lumbar
vertebra. At this point the spinal
cord branches out into a bundle
of nerves called the cauda equina
as it looks like a horse’s tail.
The cord has three protective
layers around it. The outside
dura mater (durable matter)
is very, very tough. The arachnoid mater
(spidersweb matter) is a tightly packed layer
that looks like a woven spidersweb. The pia
mater is very thin but keeps a watertight seal
that holds in your ‘brain fluid’. The fluid
is called cerebro spinal fluid (CSF) and this
cushions and protects the brain and cord
from shock and damage.
The cord itself has a butterfl shape with 2
distinct areas within it, grey matter and white
matter. The main function of your spinal
cord is to relay messages from the body to
your brain, and from your brain to your
body. These messages travel along tracts
in the white matter. Much like escalators,
the tracts have a dedicated direction
of travel. Some tracts are dedicated to
carrying messages to the brain and some
are dedicated to carrying messages from the
brain. The three different types of messages
that travel along your spinal cord are:
1. Feelings: called sensory
2. Movement: called motor
3. Protection: called reflexes
26 © New Zealand Spinal Trust, 2014

Messages & Signals
Sensory Messages
Sensory messages are sent from parts of your
body, i.e. your hand, to your spinal cord.
The spinal cord then relays the message to
the brain. When the message reaches your
brain it is interpreted as a feeling such as
touch, pressure, pain or temperature (hot
or cold). There is another vital sensation
that you may never have been aware of. It
is called proprioception and it subconsciously
keeps track of what position your limbs and
joints are in. Proprioception messages give
the brain information about body position to
help the brain coordinate precise movements
almost unconsciously i.e. that it is time to
move your hand to another position.
1. Pain message sent off
from foot
2. Reflex reactio
bounces off spin
3. Brain checks to see if
danger is cleared and
then limits movement
Motor Messages
Motor messages begin in your brain and
travel down your spinal cord. Spinal nerves
direct these messages to the appropriate
parts of your body. These signals control
most of the muscles in your body.
Reflex Messages
Your body has an amazing defence
mechanism built into it. Not all messages
sent from parts of your body go all the way
to the brain. The spinal cord has the ability
to make some decisions on its own.
For example, if you stepped on a sharp tack,
your skin sends a sensory message to the
spinal cord. If the message is identified as a
‘panic’ signal then the spinal cord will send
a reflex signal to the muscle group where
the message originated. Your foot will jerk
away from the source of pain immediately
without you having to think about it i.e. it
happens automatically.
The original message will still get to the
brain and your brain will limit the reflex
reaction.
27
© New Zealand Spinal Trust, 2014

What is Spinal Cord Impairment?
Spinal cord impairment occurs when
any damage to the spinal cord blocks
communication between your brain and
your body. An injury to the spinal cord, be
it a break, tear, rip or crush that is caused by
physical force is called a traumatic lesion.
This may have resulted from one of the four
common breaks or fractures illustrated on
the facing pages. A spinal cord can also be
damaged through disease such as multiple
sclerosis or from a malignant growth on the
spine.
Your spinal cord injury is related to the nerves
that are damaged but can also be referred to as
your level of bony injury. It is more accurate
however to refer to the actual area of the
spinal cord that is damaged relative to the
vertebra. It is for this reason that your level
of injury may be referred to by two or more
vertebrae ie. C5/C6 Tetraplegia.
“My level of spinal injury,
impairment or lesion is
_________”
“The last thing I remember is getting
back onto the 4-wheeler to turn it round.
We had stopped to admire the view from
the highest point on the Wanganui farm.
It was a hot, sunny February day, and
I didn’t notice, or couldn’t see, the red
light that indicated that I had left the bike
parked in ‘Reverse’. I don’t remember,
but was told later that the bike had set
off backwards and went over a very
steep bluff. Afterwards I was apparently
conscious, but remember nothing except
for some weird dream-like memories
until, two weeks later, I found myself flat
on my back in a little air ambulance.”
Ian Popay T5
28 © New Zealand Spinal Trust, 2014

What happens to my Nervous System?
Motor messages are unable to get past the
damaged area so your brain cannot control
muscles below the level of your impairment.
Likewise, sensory messages from below
the damaged area are unable to reach the
brain and you may not be able to sense
heat and cold, pain or pressure. Ask your
spinal specialist to show you which areas of
your spinal cord have been affected on the
drawing below.
Reflex messages may still be able to loop
or ‘rebound’ from the spinal cord, but your
brain will no longer be able to dampen refle
movements which may result in muscle
spasm. It is important to remember that
motor, sensory and reflex messages never
stop being sent between your brain and your
body, they simply cannot get past the level
of your injury.
Spinal cord impairment does not prevent
the muscles and organs below the level of
injury from receiving blood and nutrients.
You may experience changes in breathing,
temperature control, heart rate and blood
pressure after your injury. You will most
likely have changes to your bowel, bladder
and sexual function. Not knowing how
your injury will affect your sex life, or your
ability to have children, can be a worrying
factor for a new patient.
See the Life chapter for more
information on this area.
29
© New Zealand Spinal Trust, 2014

Spinal Shock, Reflexes & Spasm
Spinal Shock
Immediately following an injury the spinal
cord can go into shock. During this time
reflexes, movement and feeling may be
absent below the level of your injury. Spinal
shock can last for hours for some to months
for others. Spinal shock is why we cannot
determine the exact loss of function in the
early stages. You may experience some
return of lost movement or feeling over the
next few weeks but the results are always
different from individual to individual. Any
return of reflex activity below the level of
your injury indicates that you are coming
out of spinal shock.
area away from the source of discomfort
or pain. Your brain controls the protective
reflex by limiting the reflex action to a
single controlled movement. If your injury
is T12 or above, your protective reflexes are
probably still intact and working. Messages
still bounce off the spinal cord to muscles
but your brain cannot limit or control the
movement. It is this situation that is called
spasm. If your spinal injury is at T12 or
below you probably will not have spasm.
You might not think that “spasm” can be
anything positive but, believe it or not,
spasm can be very useful for people with a
spinal cord impairment. Spasm alerts you
to the fact that something is wrong. Over
time you may learn to interpret different
spasms as signals that tell you exactly what
is happening i.e. your bladder is full. Spasm
can also help maintain muscle tone in limbs,
promote blood circulation and assist bowel
and bladder function.
For example a bladder that is full will send
sensory messages off alerting the brain that
it needs emptying. The signal may not reach
the brain but the message may promote a
reflex signal from the spinal cord that
instructs the bladder muscles to empty.
Reflexes & Spasm
Before your injury a normal function of
the spinal cord was reflex activity. This is a
system that reacts instantly to protect the
body and keep you from hurting yourself
i.e. moving your body away from sources
of heat.
Painful pressure on muscles, or painful
sensations on skin causes sensory messages
to be sent out from the nerves in the area.
Low strength signals travel to the spinal cord
and then on to the brain. Higher strength
signals ‘bounce’ off the spinal cord straight
back to a muscle that is able to move the
“I had a fall at home - cleaning windows while
standing on the carport roof!...I found that
[rehab] went well for me. My advantages were
my age (55), my counselling qualification
which helped me hugely to understand the
grief process and understand what I and
family members were going through. I used
my training to help get through difficult
times. I am also up front, open and honest
- so I asked for the information I needed to
help me get through and asked for a ‘chat’
with senior nurses to sort out any confusion
I had or misunderstanding. I also had huge
support from family and friends.”
Robin Paul T12
30 © New Zealand Spinal Trust, 2014

Your Bowel
Immediately following a spinal cord injury
your bowel will be flaccid, that is, lacking
muscle movement. Your intestines will
still continue to function, processing food
and absorbing nutrients. Depending on
your level of injury you will either develop
a reflex bowel, or your bowel may continue
to be flaccid
Reflex Bowel
If your injury is above T12 your bowel
will probably empty by a reflex action.
With spinal cord impairment the feelings
to indicate that the rectum is full are not
able to reach the brain, but they will reach
the spinal cord. As the rectum gets full
and stretches it pushes on the nerves in
the bowel. This causes a sensory signal to
be sent from the bowel through the sacral
nerves to the spinal cord. The signal then
loops back down along the sacral nerves to
the bowel muscles. At this point you would
have a bowel motion.
Flaccid Bowel
If your lesion is at L1 or below, the bowel
will probably not have a reflex action. This
is because the spinal cord ends at around L1
so any signals from the rectal nerves cannot
loop along the sacral nerves to the spinal
cord. This means that the bowel muscles
will not squeeze and the rectal sphincter
muscle stays loose.
You will probably need to learn differen
ways of managing your food intake
and bowel movements. A good bowel
management program will help you regain
some control and keep you healthier.
See the Bowel chapter for more
information on this area.
Your Bladder
'Taking a pee’ is one of the most common
body care activities we undertake, passing
urine is the end part of a simple but
important body process. The body’s urinary
system spends all of its time monitoring the
amount of water and wastes in your body.
It is the ‘oil filte ’ of the body, keeping your
lifeblood clean and running smoothly.
A spinal cord impairment will affect your
ability to pee in some way. Any impairment,
no matter how minor, will affect part of your
‘chain of command’. However, there are
a number of different bladder management
techniques that will allow you to gain
control over your bladder function.
Learning good bladder management
techniques is important to help keep you
free from infections, bladder and kidney
stones, and other complications both now
and in the long term.
See the Bladder chapter for
more information on this area.
“Don’t let things get in your way
from doing something just because you
don’t think you can do it. Try as many
different ways to do something, in the
end you will find a way to do it that
works well after the 100’s of attempts
that didn’t work. Doing the buttons up
on my jeans took me 30 mins the first
time, 20 the second and now it only
takes about 25 seconds. It took a long
time to figure out how but now it is so
simple. I have struggled initially but
now I can do almost anything.”
Tim Johnson C6/7
31
© New Zealand Spinal Trust, 2014

Skin & Sensation
The pairs of peripheral nerves that branch
off the spinal cord carry sensory messages
from very defined areas of the body to the
brain. When talking about sensation these
areas are called dermatomes and they can be
mapped out quite accurately to help fin
out exactly which parts of your cord have
been damaged. Use the drawing below and
the illustrations on pages 18 and 19 to see
how the dermatomes, neves and vertebrae
all relate to each other.
Each pair of peripheral nerves also sends
motor messages to the muscle groups near
each dermatome area. When talking about
motor messages these areas are called
myotomes.
If your injury is complete, it means there is a
total blockage of messages at the level of your
injury. If your injury is incomplete, it means
there is a partial blockage and some (or all)
feeling and movement may remain below
the level of your
injury. Medical
staff can often
determine the exact
level of your injury
by testing your
muscle function
and sensation.
your body can squeeze shut the tiny blood
vessels that supply tissue with oxygen and
nutrients. This is most likely to occur over
bony areas where your bones are closer to
the surface of your skin. If starved of these
‘fuels’ for too long your tissues will begin
to die and pressure areas will start to form.
A spinal cord impairment means that you
have to consciously take over the task of
looking after your skin. Because you cannot
react to sensations of damage as it occurs,
you now have to predict and prevent that
damage before it occurs. You will need to
learn good habits of pressure relief lifting and
turning to keep your skin in top condition
and to keep you out of hospitals!
See the Skin chapter for more
information on this area.
If you have no
sensation below
the level of your
impairment, your
brain does not get
the alert signals
that areas of your
skin are not getting
enough blood
supply, are too hot
or cold, or are being
cut, punctured or
bruised. If you sit
or lie in the same
position for a long
time the pressure
on small areas of
32 © New Zealand Spinal Trust, 2014

Hope of Recovery & Cure
Recovery
Spinal shock may initially mask the eventual
outcome of your impairment. You may be
tempted to not participate in some aspects of
your rehabilitation in the hope that you will
recover the function as your injury settles.
It is true that there are many different
outcomes from similar levels of impairment,
especially if you have an incomplete injury.
The hope that you will recover lost function
should not stop you from participating in
your rehabilitation. If you work harder
towards your rehabilitation now you will
be able to make better use of any return of
function later. You will also be able to get
out of hospital sooner!
Cure
You may want to know what the likelihood
of a ‘cure’ is. A spinal cord injury is not a
disease, even if it has been caused by one,
and therefore cannot be ‘cured’. As with
any other injury, medical professions treat
the symptoms and effects of the injury as
best as modern medicine allows.
A spinal cord injury is one of the most
complicated injuries the body can sustain.
At the time of this publication there are over
200 research programmes internationally
studying all of the aspects of spinal cord
injury and regeneration. There are many
hopeful advances but none of these
programmes have successfully restored full
function following a complete lesion.
Whilst it is reasonable to assume that the
constant advances in medical technology
will eventually allow surgeons to restore
function to injured spinal cords, it is also
likely that these procedures may initially be
available only for the newly injured. This
is because the body ‘att cks’ the site of the
lesion following injury. It seems that the
first advances in spinal cord injury will be
in preventing the body attacking the injured
area within the first 48 hours
Existing injuries may be more difficul to
repair than ‘new’ ones.
After injury, damaged nerve cells release
Calcium ions and substances that break
down the protective myelin insulation of
nerves and other cell membranes. This chain
reaction damages nerve cells near the site of
injury that could otherwise have recovered.
The damage also seems to be more severe if
there is a lack of oxygen following the injury.
A lot of research is going into preventing this
secondary injury to reduce the overall effec
of the injury. There are many publications
and websites devoted to the advances in
spinal cord research if you are interested in
learning more about this.
“We do not discourage
hope for an eventual ‘cure’
but we do encourage you
to do everything within
your capabilities to have
an active and enjoyable
life now! If you sit and
wait for a ‘maybe’ you may
end up disappointed and
missing out on the many
opportunities available
immediately.”
33
© New Zealand Spinal Trust, 2014

Descriptions
No two spinal cord impairments are the
same. Depending on the cause of the
impairment, there may be some spinal
cord fibres unaffe ted. The following terms
are used to classify the type and extent of
impairment you have received.
Lesion
Any damage to the spinal cord is called a
lesion. If caused by an injury, it is called a
traumatic lesion.
Level of Injury
Spinal cord injuries are classified in the
medical world by the level at which the
spinal cord is damaged. The bony level
describes which vertebrae are damaged
(e.g. cervical vertebrae 6 and 7 = C6/7). The
neurological level describes which nerves
are impaired, followed by a description of
complete or incomplete.
your injury. The amount lost will depend
on how much damage is done to your spinal
cord. There are 5 main types of incomplete
injury:
Central Cord Syndrome
An injury to the cord centre usually occurs
in the neck. You may experience a complete
loss of arm function yet still have some leg
function. The sensation in the hands is
often very disordered. Bladder and bowel
are often partially spared and there may be
recovery, starting in the lower limbs and
progressing upwards.
Complete
A complete injury means there is a total
blockage of messages at your point of injury.
There will be no feeling or movement below
the level of injury.
Anterior Cord Syndrome
Anterior means ‘ the front’. Damage to the
front of your spinal cord will usually result
in partial or complete loss of movement
as well as pain, temperature and touch
sensations below the injury level. You may
still have some pressure sensation and
position sense.
Incomplete
An incomplete injury means there is a
partial blockage and some (or all) feeling
and movement remains below the level of
Posterior Cord Syndrome
Posterior means ‘the back’. Damage to the
back of your cord may leave good power,
pain and temperature sensation but create
difficultie in movement coordination. This
is very rare.
34 © New Zealand Spinal Trust, 2014

Brown-Sequard Syndrome
Where the damage is mainly on one side of
the cord. On the injured side, muscle power
may be reduced or absent and pressure
and position sense are disordered. The
other side experiences loss of, or reduced
sensations of pain and temperature but
movement, pressure and position sense
tend to remain.
Tetraplegia / Quadriplegia
Those who injure their spine in the cervical
region will have partial or complete paralysis
of their arms. They are referred to as people
who have tetraplegia because four limbs are
affected. Quadriplegia describes the same
condition and is more commonly used in
America.
Neurology
Any injury that damages the spinal cord
will be described by medical professionals
as ‘an injury that has neurology’ i.e. it has
neurological damage.
An injury to the spine that does not damage
the spinal cord is referred to by medical
professionals as an ‘injury without having
neurology’. This means that the neurology
(nervous system) is unaffected and normal.
Most patients without any neurology will be
treated by orthopaedic specialists and not
referred to a spinal unit.
Cauda Equina Lesion
The ‘horses tail’ of nerves that spread out
from the base of the spinal cord. An injured
cauda equina may result in a patchy loss
of power and sensation to the lower limbs.
Functional recovery can happen over 12-
18 months if the roots are not completely
crushed. The bowel and bladder are usually
severely affected
Paralysis
Paralysis simply means the inability to feel
or deliberately move parts of your body.
Paraplegia
The term used that describes the condition
of paralysis below the level of the neck
(below T1) is paraplegia. People who have
paraplegia will have partial or total paralysis
of their legs and trunk.
“When I was going through
rehabilitation I learnt a lot off
other para’s and tetras who
came back in the unit for reassessments
etc.
They provided me with a lot of
feedback and helpful tips and
information. I seemed to take
more notice of them because they
had a chair under their bum.
More credibility I suppose?”
Keith Jarvie C4/5
35
© New Zealand Spinal Trust, 2014

Common Terms
The following table contains common terms, slang and jargon that you may hear daily in the
unit. Medical staff get so used to using this ‘code language’ that they sometimes forget to
translate it for you. If you hear a term you don’t know, ask the person to explain it to you. If
that is not practical, look it up in this table - it will give an idea of what is being talked about.
Remember that different spinal units may use different terms to describe similar things. If
the terms do differ, write down or have someone else write down the accepted version next
to the ones listed here.
TERM FULL NAME EXPLANATION
‘Acute’
An Acute Patient
All new patients undergoing the first stage
of their recovery are referred to as ‘acute’
patients
‘BIRD’ Positive Pressure Machine A machine that fills your lungs with air to
full capacity to give them a good stretch out
‘Bloods’ Blood Analysis Refers to the process, or the results of a
blood test
BP Blood Pressure Your blood pressure is measured regularly
and monitored
BWO Bladder Wash Out Refer to Bladder Chapter
COC Change of Catheter Refer to Bladder Chapter
‘Commode’ A Commode Chair A portable toilet chair often used in the
shower as well
CT Scan
Computer Tomography
Scan
Also known as a CAT Scan, these are used
to look at specific organs in your body
‘Cysto’ Cystometry An examination of your bladder function
‘Exam’ Examination Procedures that look for a specific signs or
symptoms are often called ‘exams’
FBC Fluid Balance Chart A way to measure your fluid intake and
output
GP
ICU
General Practitioner
Intensive Care Unit
Doctors who work in private practice
outside of a hospital are known as General
Practitioners, or GP’s
A hospital ward that specialises in caring
for people immediately after an injury
36 © New Zealand Spinal Trust, 2014

Common Terms
TERM FULL NAME EXPLANATION
ISC
Isolation
I/V
IVU
KUB
Ultrasound
MRI
MRSA
NBM
N/G
O2
OT
‘Physio’
‘Physio’
Intermittent Self
Catheterisation
Isolation Room
Intra-Venous
Intra-Venous Urogram
Kidney Ureters Bladder
Ultrasound
Magnetic Resonance
Imaging
Multi-Resistant
Staphylococcus Aureus
Nil By Mouth
Naso-Gastric
Oxygen
Occupational Therapist
1. Physiotherapist
2. Physiotherapy
Refer to Bladder Chapter
New patients may be placed in a room by
themselves until it is known that they are
clear of foreign diseases or bacteria such as
MRSA
A small tube that goes into your vein
that can be used to give you IV fluids or
medication
An x-ray procedure that measures renal
(kidney) and urinary system function
An investigation of your urinary system
Another way of looking at internal organs
in your body
A drug resistant infection commonly known
as ‘the super bug’. People with MRSA are
cared for in room of their own (isolation)
A restricted food and fluid programme that
helps measure some body functions
A method of feeding you through a tube in
your nose that leads to your stomach
You may be provided with additional
oxygen to assist your breathing
A person trained to help people learn new
ways of everyday activities after an injury
A person trained to help you strengthen
your muscles and keep the movement in
your body’s joints
Also used as a term to refer to your
physiotherapy programme
37
© New Zealand Spinal Trust, 2014

Common Terms
TERM FULL NAME EXPLANATION
Restricted Fluids
SAT’s
SCI
TPR
Ultrasound
‘Uro’
VC
Restricted Fluids
Programme
Oxygen Saturation
Spinal Cord Injury
(or impairment)
Temperature Pulse
Respiratory Rate
Ultrasound
Examination
Urodynamics
Vital Capacity
A programme that carefully monitors the
amount of fluids you have each day to help
with your bladder care
Describes the percentage of oxygen in your
blood
A medical description concerning a
particular type of injury or impairment to the
spinal cord
Your ‘vital signs’ are monitored daily and the
results are kept on a ‘TPR Chart’
A visual imaging examination that uses
sound (like radar) to produce pictures of your
‘insides’
The department that specialises in bladder
functions
Measures the volume of your lungs as you
breathe out
‘Video’ Video Cystometry An x-ray ‘movie’ of your bladder working
X-ray
X-ray examination
A still photograph that shows dense objects
in your body, i.e. bones
“It can take me 10mins to do the smallest
thing but hey, I did it myself. I think back
when I first got my car. I could drive by
myself and this meant my independence
really increased. But you still have to be
able to get in and out by yourself. What
I did was make sure no one was around
when I did it. I was out with friends and
then decided to go home by myself. They
watched me get in the car by myself, offering
to help, but I needed to do it myself. Getting
in the car is easy, it is getting out that is
the hard part. So I went home and it took
15-20 mins to get out of the car. Now it
takes 1 minute.”
Tim Johnson C6/7
“I well remember when we arrived at [the
unit] after what seemed a very long and
slow ambulance ride from the airport. All
I could see were the tops of street lights.
My wife was with me and we were left
waiting in a corridor for a very long time,
with no idea of what was happening or
what we were supposed to do. My wife,
who is usually not very emotional, but
was, unknown to us, in the early stages
of pregnancy, was very upset and close
to tears. It was a very bad introduction
to what turned out to be a very caring,
friendly and useful establishment.”
Ian Popay T5
38
© New Zealand Spinal Trust, 2014