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BACK on TRACK<br />

A basic<br />

introduction<br />

for those learning<br />

to live with a<br />

spinal cord<br />

injury<br />

Julian Verkaaik<br />

B Design (Industrial)


When you first have a spinal cord injury or impairment<br />

so much of what you have to learn seems like it has come<br />

straight from a medical or a nursing textbook.<br />

Even though most of us aren’t doctors or nurses we ARE<br />

experts about ourselves so what we need is just enough<br />

information for us to start asking questions of the doctors,<br />

nurses and other health professionals who<br />

WORK FOR US!<br />

“Back on Track” is NOT the whole answer. It is a basic<br />

introduction to help you start the question-asking process.<br />

People who ask questions are the ones who recover or<br />

rehabilitate the quickest and who succeed the best.<br />

So read this book and start asking lots and lots of questions!<br />

Ben Lucas<br />

Garry Chief Executive Wilson<br />

Chief New Zealand Executive Spinal Trust<br />

ACC<br />

Disclaimer: This publication has been produced with the full medical support of the<br />

Burwood Spinal Unit. It is intended as a guide only and should not be used to replace<br />

the medical opinions of your health professionals. Medical knowledge is constantly<br />

evolving and preferred rehabilitation techniques may differ from region to region.<br />

Readers are strongly advised to confi m that information in this publication conforms<br />

to current standards of practice endorsed by your spinal unit.<br />

Published and Distributed by:<br />

The New Zealand Spinal Trust<br />

Allan Bean Centre, Burwood Hospital, Entrance 3, Mairehau Road,<br />

Private Bag 4708,<br />

Christchurch 8140,<br />

New Zealand<br />

All rights reserved. No part of this publication may be copied, reproduced, stored or transmitted<br />

by any mechanical, photographic or electronic processes or techniques, for public or private<br />

use, without the express written permission of the publisher.<br />

© First edition New Zealand Spinal Trust, December 2004<br />

© Second edition New Zealand Spinal Trust, August 2009<br />

© Third edition New Zealand Spinal Trust, September 2014<br />

To learn more about the New Zealand Spinal Trust go to:<br />

www.nzspinaltrust.org.nz<br />

Third edition printed September 2014 by THE CAXTON PRESS.<br />

ISBN 978-0-473-29020-7<br />

© New Zealand Spinal Trust, 2014


Your rehab will not stop when you leave<br />

the hospital and go home which is why you<br />

must learn to take control.<br />

Edited & Illustrated by<br />

Julian Verkaaik B Des<br />

Back on Track provides basic information<br />

which will help you take the bull by the<br />

horns and take control of your future. A<br />

spinal cord injury is not the end of the road.<br />

It may mean hanging up your boots for good<br />

and getting a new set of wheels but there is<br />

no reason to sit on the roadside and watch<br />

life pass you by.<br />

This handbook is designed to help you do<br />

just that - to help you get back into the real<br />

world with a good base of knowledge that<br />

will help keep you out of hospital later. It<br />

is written in everyday language that will<br />

compliment the information you will be<br />

getting from your medical teams. The issues<br />

that surround spinal cord impairment are<br />

complicated but they can be understood<br />

by anyone – it may take a bit of time but it<br />

is worth it.<br />

When you’ve fallen from grace and landed<br />

in a spinal unit you need to begin learning,<br />

right from day one. Rehabilitation is not a<br />

medical process but a process of learning.<br />

You are the most important stakeholder in<br />

the outcome of your rehabilitation. Not the<br />

doctors. Not the Hospital. You.<br />

Nobody else can rehabilitate you<br />

- you must do this for yourself.<br />

In the early days of your recovery there will<br />

be an enormous amount of medical activity<br />

happening around you that you will not<br />

have much control over. This will soon pass<br />

and you will become much more involved<br />

in the process of your rehabilitation.<br />

All you need to do is take life one<br />

day at a time and try to learn one<br />

new thing every day.<br />

Having a spinal cord impairment will not<br />

stop you from having a happy and fulfillin<br />

life. Yes, things have changed and life will<br />

never be quite the same but change is the<br />

only constant we have in life. Don’t fight it,<br />

embrace it and work it to your advantage.<br />

Above all else, keep believing<br />

in yourself!!<br />

Julian Verkaaik<br />

© New Zealand Spinal Trust, 2014<br />

4


Acknowledgements<br />

This third edition of Back on Track is dedicated to Richard Smaill,<br />

Chair of the New Zealand Spinal Trust for his enthusiasm,<br />

support and contribution to the work of the NZST.<br />

The editor wishes to acknowledge the tireless efforts of all the<br />

staff and patients of the Burwood Spinal Unit who contributed<br />

to this publication, especially Mr Allan Bean, Dr Angelo<br />

Anthony and Dr Rick Acland. Significant contributions were<br />

made by the following staff; Karen Wilson, Karen Marshall,<br />

Val Sandston, Andrew Hall, Angela Todd, Mark Julian, Barrie<br />

Woods, Denise Brown, Victoria Newcombe, Liz Beaglehole,<br />

David Tieleman, Mike Moss and Ted Templeton. Without their<br />

willingness to share their wealth of knowledge and experience<br />

this publication would not have been possible.<br />

The editor also thanks the late Prof Alan Clarke, Margot<br />

Anderson and the staff of the New Zealand Spinal Trust for<br />

all their support and encouragement, especially Paul Stafford<br />

for his amazing energy with the final layout and design of this<br />

book that brought this project to completion.<br />

The ‘Successful Graduates’ of spinal cord rehabilitation who<br />

contributed the anecdotes and photos that enliven this book<br />

deserve special note. Thank you to Stephen Hannen, Roman<br />

Tua, Daniel Buckingham, Sue Quirk, Keith Jarvie, Robin Paul,<br />

Tim Johnson, Peter O’Flaherty, Sharon Devonshire, James Doak,<br />

Bill Gruar, Ian Popay, Wayne Chapman, Lea Galvin, Roy Dale,<br />

Peter Lush, Warren Bennett, Debbie Henderson, Christine Lawn,<br />

Karen Calder, Dean Hatchard, Rick Fright and Derek Wight.<br />

For the third revised edition, the editorial team wish to thank the<br />

following Burwood Spinal Unit staff for their review of the book<br />

chapters; Rina Pijpker, Maria van den Heuvel, Dr. Lincoln Jansz,<br />

Angela Todd, Kirstie Ross, Lynn Stephen, Kristal Duff as well<br />

as staff of the New Zealand Spinal Trust; Ben Lucas, Bernadette<br />

Cassidy, Paul Stafford, Jharna Das Gupta, and Hans Wouters<br />

The New Zealand Spinal Trust thanks the Ministry of Health<br />

for supporting this publication. The Ministry of Health has<br />

generously supported the New Zealand Spinal Trust design<br />

service over the past years to create high quality educational<br />

publications enhancing the quality of rehabilitation.<br />

© New Zealand Spinal Trust, 2014<br />

5


"What's all this Rehab about anyway?"<br />

By the late Prof. Alan Clarke CMG ChM FRACS<br />

1932 – 2007<br />

The late Prof Clarke<br />

was the Dean of the<br />

Otago University<br />

School of Medicine<br />

when he fell off his<br />

roof. After a long<br />

career as a medical<br />

researcher his rehab<br />

experience taught him<br />

an important lesson –<br />

that rehabilitation is<br />

not a medical process,<br />

it is a learning one.<br />

His advice from his<br />

unique perspective as a<br />

doctor-become-patient<br />

is well worth listening<br />

to.<br />

“When you survive an accident or<br />

an illness, you step immediately<br />

onto a pathway to recovery.”<br />

Getting Started<br />

For you, the person with a spinal cord injury,<br />

and for your family, whanau and friends, the<br />

first part of this pathway goes through a spinal<br />

injuries unit. What happens to you in a spinal<br />

injuries unit is very special. It will enrich<br />

your new beginning and help you achieve<br />

independence and happiness. The good news at<br />

the beginning is that you could have been much<br />

worse off, and things can only get better. However<br />

nobody can predict just how much recovery you<br />

will get or how much impairment and disability<br />

will remain.<br />

The first few days following your accident are<br />

confusing. So much will be happening to you<br />

that you will feel that you have little control. If<br />

you have significant spinal cord injuries with<br />

either tetraplegia or paraplegia you will feel<br />

particularly helpless, unable to move much at<br />

all and very dependent on the people who are<br />

caring for you. It is normal for you to feel afraid<br />

and angry, insecure and powerless. You may<br />

be too numbed by it all to cry but it would not<br />

do you any harm if you did cry. You may be<br />

angry with yourself or with others that this has<br />

happened to you, but at this stage you are not<br />

likely to feel sorry for yourself. More likely you<br />

will get annoyed by other people who seem to<br />

feel sorry for you. For the first week or two in<br />

the spinal unit it helps if you can be accepting<br />

and “go with the flow”, and simply be assured<br />

that whatever happens, there is a really good<br />

life ahead for you.<br />

“This may take a lot of believing,<br />

but it is true!”<br />

If you are a member of the family you will<br />

experience feelings of loss and bewilderment<br />

which are similar to those experienced by the<br />

patient. These feelings are not helped if you are<br />

away from your home and from other family<br />

members, from your friends and from normal<br />

life routines. Things are just about as unfamiliar<br />

for families supporting patients in spinal units<br />

as they are for the patients themselves, even<br />

if families have had a lot to do with hospitals<br />

before. Like patients, families are enormously<br />

in need of information and support. It is OK for<br />

you as a member of the family to suffer grief,<br />

it is OK to cry and it is quite usual for you also<br />

to feel that you are not in control. You may<br />

have feelings that your partner or loved one<br />

has become public property, that there is little<br />

privacy, and that your feelings have become<br />

terribly exposed. However you may also find<br />

that these events bring members of your family<br />

and your friends closer together.<br />

A new “acute admission” to the spinal unit<br />

creates a great deal of work and makes staff<br />

busier. Members of staff are all human and share<br />

your feelings of anxiety, apprehension, sadness<br />

and grief. However nurses, physiotherapists and<br />

other health professionals who directly care for<br />

you need to be careful that they do not identify<br />

too closely with your feelings. They must remain<br />

objective. As a member of the family you may<br />

feel that this professional objectivity is callous.<br />

“Clinical detachment” as it has sometimes been<br />

called is a very important acquired skill of health<br />

professionals. Getting too close to their patient<br />

can cloud their judgement. This is why doctors<br />

should never look after their own loved ones.<br />

No matter how busy your carers are, they are<br />

always accessible and within reason should<br />

always be willing to answer questions. Good<br />

information on the first and second days is gold<br />

© New Zealand Spinal Trust, 2014<br />

6


for you and for your family and whanau. It is<br />

essential for planning your recovery. There is so<br />

much information that you need it to be readily<br />

available to go back to again and again.<br />

Pathway Planning<br />

The quickest way for you to gain control and<br />

rediscover hope is to start planning your<br />

pathway to recovery with the help of your<br />

family, whanau and friends - on the very first<br />

day if possible! In the fir t few days a real<br />

problem for your planning is uncertainty. This<br />

is particularly so with neck injuries, with both<br />

partial and apparently complete tetraplegia. In<br />

a very few cases the doctors may be able to say<br />

with some degree of certainty that recovery is<br />

unlikely to occur to a significant extent but in<br />

most cases they will say that it is not possible<br />

to predict outcome at an early stage and that<br />

things will not become clear for you for several<br />

weeks.<br />

“All survivors of spinal injuries can<br />

achieve independence & happiness - it<br />

just takes a little time.”<br />

In most things you are the person you were before<br />

the accident. However right now you definitel<br />

are the team leader both in the rehabilitation<br />

process and of the health professionals who<br />

work in the spinal unit and who manage the<br />

process for you. All members of the team have<br />

a responsibility to help you achieve the goals<br />

that you have made for yourself. The spinal<br />

unit staff when they work with you will depend<br />

very much on your willingness to lead them.<br />

You must retain a belief in yourself. The first<br />

part of your plan is your discharge plan. This<br />

belongs to you, not the staff, and it assumes that<br />

you are anxious to get out of hospital as soon<br />

as possible.<br />

If at any time you feel that there are undue<br />

and perhaps unnecessary delays with your<br />

rehabilitation, you should ask why. If your<br />

rehabilitation is managed well, your goal<br />

or target date for discharge may be brought<br />

forward. If it is not managed so well, discharge<br />

may be delayed. It will take some days for you<br />

to see clearly your way ahead. As a general rule,<br />

complete paraplegics will be in the unit for eight<br />

to fourteen weeks while complete tetraplegics<br />

will be in the unit from twelve to twenty weeks.<br />

Staff will all know the major milestones and will<br />

help you in a general discussion. However<br />

the planning process is quite specific for each<br />

person as every individual and every injury is<br />

different<br />

You can't help being interested in how other<br />

patients are getting on and that is OK but you<br />

must pace yourself against your own goals and<br />

measure your success by your own progress<br />

towards these goals. If you are a person who<br />

has not been accustomed to setting goals and<br />

planning your life and have up till now rather<br />

just let things happen, this will be a time of<br />

great opportunity for you but it will not be<br />

easy. There are people in the Unit who can<br />

help you with this. Some real “successes” are<br />

people whose accidents have occurred during a<br />

time of personal turmoil, and the tasks of settin<br />

goals and planning recovery has led them into<br />

totally new and exciting lives.<br />

Some people are so devastated by the injury that<br />

has happened to them that they are not able in<br />

the first few days and weeks to take charge of<br />

their discharge planning. It is more difficul for<br />

them if their family is also overwhelmed by the<br />

events. If you and your family feel like this,<br />

unable to cope, there will be staff members in<br />

your spinal unit who are able to help you with<br />

your planning. Talking about these feelings can<br />

help you and there will be someone amongst<br />

the team of therapists who will listen carefully<br />

to you. Social workers, clinical psychologists<br />

and psychiatrists have special training to help<br />

you get back into the “driving seat” of your own<br />

rehabilitation plan.<br />

“Rehabilitation or getting back<br />

on track depends almost<br />

entirely on you.”<br />

It is important that you learn all about your<br />

injury, its consequences, and about both your<br />

medical and general needs. Soon you should<br />

know more about your case than any of your<br />

doctors, nurses or other health professionals.<br />

They rely on your knowledge for you to keep<br />

yourself safe. Before you realise it, you will be<br />

able to look after yourself safely in the big wide<br />

world, and you will be home.<br />

© New Zealand Spinal Trust, 2014<br />

7


Contents<br />

Intro<br />

Spinal 101<br />

© New Zealand Spinal Trust, 2014<br />

Authors Note 4<br />

Acknowledgements 5<br />

Foreword "What’s all this Rehab about anyway?"<br />

Getting Started<br />

Pathway Planning 7<br />

Contents 8-14<br />

A word about medical terms... 16<br />

Spinal Cord Impairment 7<br />

Immediate Treatments 7<br />

Surgery 7<br />

Stabilising 17<br />

Immediate Effects of Injury 18<br />

Get to Know Your Spine! 19<br />

Your Spinal Column 20<br />

Your Spinal Cord & Nerves 21<br />

Peripheral Nerves & Functions 22<br />

Your Nervous System 23<br />

The Somatic Nervous System 3<br />

The Autonomic Nervous System 23<br />

Your Spinal Cord 24<br />

Messages & Signals 25<br />

Sensory Messages 5<br />

Motor Messages 5<br />

Reflex Messages 25<br />

What is Spinal Cord Impairment? 26<br />

What happens to my Nervous System? 27<br />

Spinal Shock, Reflexes & Spasm 28<br />

Spinal Shock 8<br />

Reflexes & Spasm 28<br />

Your Bowel 9<br />

Reflex Bowel 29<br />

Flaccid Bowel 9<br />

Your Bladder 29<br />

Skin & Sensation 30<br />

Hope of Recovery & Cure 1<br />

Recovery 31<br />

Cure 31<br />

Descriptions 2<br />

Lesion 2<br />

Level of Injury 2<br />

Complete 2<br />

Incomplete 2<br />

Central Cord Syndrome 2<br />

Anterior Cord Syndrome 2<br />

Posterior Cord Syndrome 32<br />

Brown-Sequard Syndrome 33<br />

8


Contents<br />

Cauda Equina Lesion 33<br />

Paralysis 33<br />

Paraplegia 33<br />

Tetraplegia / Quadriplegia 33<br />

Neurology 33<br />

Common Terms 34-36<br />

Bladder<br />

B owel<br />

Skin<br />

Nutrition<br />

Medical<br />

Life<br />

© New Zealand Spinal Trust, 2014<br />

9


A word about<br />

medical terms…<br />

The science of medicine has developed<br />

over many centuries. Many of the terms<br />

and references are based on the Latin<br />

language. The medical language is<br />

designed to be precise and distinctive to<br />

avoid confusion for those who practice<br />

medicine as a profession.<br />

Some of the terms can appear very<br />

impersonal, harsh or even negative.<br />

Disabled, non-functional, incomplete, flaccid,<br />

impairment etc, all of these are terms used to<br />

describe various aspects of your injury.<br />

REMEMBER: You are a person who<br />

happens to have an injury - you are not<br />

"the tetraplegic in Room 5."<br />

If you do not understand any of the medical<br />

jargon do not hesitate to ask the person(s)<br />

to explain those words or terms.<br />

© New Zealand Spinal Trust, 2014<br />

16


Spinal Cord Impairment<br />

You have had an accident or illness that<br />

has resulted in a spinal cord injury or<br />

impairment (SCI). This chapter will begin<br />

to explain how your body works and how<br />

your impairment is affecting the way it<br />

functions. It is only an introduction to<br />

the range of effects your SCI may have on<br />

you. Spinal cord impairments are different<br />

from individual to individual. You may<br />

experience only a few of the effects or the<br />

full range. This book will get you started,<br />

make you hungry for more information, and<br />

raise more questions for you to ask. Talk to<br />

your medical professionals about what may<br />

be relevant for you.<br />

Stabilising<br />

Depending on the nature of your injury the<br />

position of your spine may need to be held<br />

still for some time. If your injury is to your<br />

neck, you may be on bed in traction, that is,<br />

with a small weight atta hed to head tongs.<br />

This helps to keep your bones in proper<br />

alignment while they heal. You would<br />

normally be in traction for six weeks.<br />

Immediate Treatments<br />

Surgery<br />

You may need surgery to stabilise the<br />

damaged bones of your spine. The bones<br />

may not be stable, there may be a noticeable<br />

deformity, or a bone fragment may be<br />

pushing onto the spinal cord. Often metal<br />

plates and screws are used to stabilise the<br />

spine and avoid further damage to the cord.<br />

Please bear in mind that stabilising surgery<br />

will only repair the bones of the spine.<br />

Other neck injuries may need a Halo ring and<br />

jacket, or a hard collar to keep the neck still.<br />

“Once you’ve got to [the unit] listen<br />

to all advice, staff [are] excellent<br />

(indeed marvellous) but very busy.<br />

Be persistent (but polite!) with your<br />

requests. Staff are very pressured,<br />

sometimes answers take a little time.<br />

Save your energy for the big issues.”<br />

Roy Dale L4/5<br />

© New Zealand Spinal Trust, 2014<br />

17


Immediate Effects of Injury<br />

• In the paralysed parts of your body<br />

you cannot feel pressure, and you<br />

cannot move your limbs to relieve<br />

pressure. Your body will have to be<br />

moved or turned every two or three<br />

hours to relieve pressure and prevent<br />

pressure sores from developing.<br />

• You won’t be able to feel when your<br />

bladder is full and you won’t be able<br />

to empty it. Your doctor or nurse will<br />

have to manage it for you until you<br />

learn to do this for yourself.<br />

• You will also need help at first to<br />

empty your bowels.<br />

• As you will not be able to move<br />

paralysed parts of your body, a<br />

physiotherapist will move them for<br />

you to prevent them from becoming<br />

stiff or deformed<br />

• You may also experience spasm -<br />

involuntary movement and twitching<br />

of the paralysed limb.<br />

• Woman may find that their periods<br />

stop for a time, but they will return<br />

sooner or later in the normal way.<br />

• Men may find that they cannot get an<br />

erection, or cannot control it. Most<br />

people with a SCI will be able to enjoy<br />

sexual activity.<br />

• If you are tetraplegic, your body’s<br />

system for regulating temperature may<br />

be disrupted. Your temperature may<br />

be much below normal, and you may<br />

feel shivery or hot, be unable to sweat<br />

or find yourself s eating profusely.<br />

• You won’t be able to sit up unaided,<br />

and to begin with you will be raised<br />

only very gradually and for short<br />

periods. If you are raised too quickly,<br />

especially if yours is a high injury, you<br />

may faint.<br />

• You may suffer from unusually low<br />

blood pressure in the early weeks.<br />

After a month or so, those with a high<br />

level of injury may have attacks of high<br />

blood pressure.<br />

• You may find when you do sit up that<br />

you cannot balance without support.<br />

With your limited movement and<br />

sensation you have to learn all over<br />

again to balance your body.<br />

• You may feel very depressed, and<br />

perhaps angry and guilty. This is<br />

a perfectly natural reaction to your<br />

injury, the shock to your body, the<br />

indignity of having everything done<br />

for you, your uncertainty about the<br />

future and your concern for family and<br />

friends.<br />

• For some weeks you won’t be able to<br />

go home, work, study, make love, look<br />

after children, care for older relatives,<br />

cook meals or play sport. Later, with<br />

some preparation, you will be able to<br />

do most of the things you probably<br />

took for granted in your daily life<br />

before your injury. After a while, you<br />

will be able to do all or most of these<br />

things. Although it will certainly be<br />

more difficul to do them than it was<br />

before your injury, you may find them<br />

just as rewarding, perhaps even more<br />

so.<br />

• Some paraplegics have been able to<br />

go home in 8 - 12 weeks and some<br />

tetraplegics as soon as they become<br />

independent. Most people take longer<br />

and you may not be independent for<br />

6 - 12 months.<br />

Material adapted from Moving Forward: The Guide to<br />

Living with Spinal Cord Injury. Spinal Injury Association<br />

(SIA), United Kingdom, May 1995.<br />

© New Zealand Spinal Trust, 2014<br />

18


Get to Know Your Spine!<br />

The spine is a column of bones, ligaments and<br />

nerves and performs two critical tasks. It is<br />

a physical structure that links most parts of<br />

your body together, and it houses the spinal<br />

cord that connects your brain to every part<br />

of your body.<br />

The spinal column begins in the neck and<br />

ends at the tailbone. The spine is a column<br />

of 33 bones called vertebrae. Individually<br />

each bone is called a vertebra.<br />

The vertebrae are stacked one on top of<br />

the other and are held together by discs,<br />

ligaments and muscles. Ligaments keep<br />

the spine stable and the muscles provide a<br />

limited degree of movement.<br />

The springy discs between each vertebra<br />

keep the bones from rubbing together and<br />

serve as shock absorbers for the spinal<br />

column.<br />

The spinal column is divided into 4 sections.<br />

Each section is given a name and each<br />

vertebra is numbered.<br />

© New Zealand Spinal Trust, 2014<br />

19


Your Spinal Column<br />

© New Zealand Spinal Trust, 2014<br />

20


Your Spinal Cord & Nerves<br />

© New Zealand Spinal Trust, 2014<br />

21


Peripheral Nerves & Functions<br />

At every vertebra in the<br />

spine, nerves branch out in<br />

pairs. In the neck there are<br />

more nerve pairs (8) than<br />

there are vertebrae (7).<br />

In the centre of each<br />

vertebra is a hole and<br />

when the vertebrae are<br />

stacked together they<br />

form a tunnel called the<br />

vertebral canal. This canal<br />

completely surrounds and<br />

protects the spinal cord.<br />

Pairs of peripheral nerves<br />

extend out from the<br />

spinal cord through gaps<br />

between each vertebrae.<br />

Each pair of peripheral<br />

nerves links the brain with<br />

various parts of the body.<br />

The diagram to the right<br />

gives an indication of what<br />

areas of the body each<br />

pair of nerves connect to.<br />

© New Zealand Spinal Trust, 2014<br />

22


Your Nervous System<br />

Your nervous system is made up of your<br />

brain, spinal cord and the nerves branching<br />

off it. Your brain controls every function that<br />

your body performs.<br />

The brain controls some of your functions<br />

automatically, i.e. your heartbeat and<br />

breathing, without you even being aware<br />

of it. Other functions are controlled more<br />

directly and require a conscious thought to<br />

begin, e.g. to pick up an object.<br />

Your nervous system helps to control all of<br />

your body’s functions and can be roughly<br />

divided into two parts. Your brain and<br />

spinal cord together form the central nervous<br />

system. The peripheral nervous system links<br />

your central nervous system to the rest of<br />

your body.<br />

The nervous system can also be divided<br />

by its functional organisation into two<br />

categories, the somatic nervous system and<br />

the autonomic nervous system.<br />

The Somatic Nervous System<br />

The somatic nervous system is your body’s<br />

primary means of communication between<br />

the brain and its moving parts. Its main<br />

function is to transmit sensations to the<br />

brain and, after this information has been<br />

processed and a response decided on, to<br />

control deliberate movements.<br />

Some of the things the somatic nervous<br />

system monitors or controls are:<br />

• Movement<br />

• Sensation<br />

• Reflexe<br />

The Autonomic Nervous System<br />

The autonomic nervous system controls the<br />

background or involuntary functions of your<br />

internal glands and organs. If you have<br />

damaged your spinal cord you probably<br />

have also damaged your autonomic system.<br />

Your level of injury dictates the extent of<br />

the damage.<br />

Some of the things the autonomic nervous<br />

system monitors or controls are:<br />

• Heart rate and blood pressure<br />

• Breathing<br />

• Body temperature<br />

• Sweating<br />

• Shivering<br />

• Digestion<br />

• Bowel & Bladder functions<br />

• Male sexual function<br />

“I was injured in the Cave Creek Tragedy<br />

of 1995. A viewing platform collapsed<br />

and tipped 18 people 35 metres into a<br />

chasm onto the jagged rocks below. I<br />

was one of only four survivors and was<br />

given only a 10% chance of surviving. I<br />

don’t remember anything of the accident<br />

thankfully or the first six weeks of the nine<br />

weeks that I spent in Intensive Care. On<br />

top of my incomplete C6/7 Tetraplegia I<br />

broke 16 bones including my jaw in three<br />

places, ruptured my bowel, had 80 stitches<br />

across the top of my head with minor head<br />

injuries (very minor!!). I then spent the<br />

next 12 months in the Burwood Spinal<br />

attempting to rehab…but rehab didn’t<br />

really start until I was back out in the<br />

real world! “<br />

Stephen Hannen C6/7<br />

© New Zealand Spinal Trust, 2014<br />

23


Your Spinal Cord<br />

Your Spinal Cord is a very<br />

complex 2 way communication<br />

network that allows your brain<br />

to ‘talk’ to specific parts of your<br />

body, and for those parts to<br />

send messages back. The cord is<br />

similar to a telephone cable with<br />

many wires.Your spinal cord is<br />

approximately the diameter of<br />

your little finger and runs from<br />

your brain down the inside of<br />

your spinal column and ends at<br />

the base of L1 - the 1st Lumbar<br />

vertebra. At this point the spinal<br />

cord branches out into a bundle<br />

of nerves called the cauda equina<br />

as it looks like a horse’s tail.<br />

The cord has three protective<br />

layers around it. The outside<br />

dura mater (durable matter)<br />

is very, very tough. The arachnoid mater<br />

(spidersweb matter) is a tightly packed layer<br />

that looks like a woven spidersweb. The pia<br />

mater is very thin but keeps a watertight seal<br />

that holds in your ‘brain fluid’. The fluid<br />

is called cerebro spinal fluid (CSF) and this<br />

cushions and protects the brain and cord<br />

from shock and damage.<br />

The cord itself has a butterfl shape with 2<br />

distinct areas within it, grey matter and white<br />

matter. The main function of your spinal<br />

cord is to relay messages from the body to<br />

your brain, and from your brain to your<br />

body. These messages travel along tracts<br />

in the white matter. Much like escalators,<br />

the tracts have a dedicated direction<br />

of travel. Some tracts are dedicated to<br />

carrying messages to the brain and some<br />

are dedicated to carrying messages from the<br />

brain. The three different types of messages<br />

that travel along your spinal cord are:<br />

1. Feelings: called sensory<br />

2. Movement: called motor<br />

3. Protection: called reflexes<br />

© New Zealand Spinal Trust, 2014<br />

24


Messages & Signals<br />

Sensory Messages<br />

Sensory messages are sent from parts of your<br />

body, i.e. your hand, to your spinal cord.<br />

The spinal cord then relays the message to<br />

the brain. When the message reaches your<br />

brain it is interpreted as a feeling such as<br />

touch, pressure, pain or temperature (hot<br />

or cold). There is another vital sensation<br />

that you may never have been aware of. It<br />

is called proprioception and it subconsciously<br />

keeps track of what position your limbs and<br />

joints are in. Proprioception messages give<br />

the brain information about body position to<br />

help the brain coordinate precise movements<br />

almost unconsciously i.e. that it is time to<br />

move your hand to another position.<br />

1. Pain message sent off<br />

from foot<br />

2. Reflex reactio<br />

bounces off spin<br />

3. Brain checks to see if<br />

danger is cleared and<br />

then limits movement<br />

Motor Messages<br />

Motor messages begin in your brain and<br />

travel down your spinal cord. Spinal nerves<br />

direct these messages to the appropriate<br />

parts of your body. These signals control<br />

most of the muscles in your body.<br />

Reflex Messages<br />

Your body has an amazing defence<br />

mechanism built into it. Not all messages<br />

sent from parts of your body go all the way<br />

to the brain. The spinal cord has the ability<br />

to make some decisions on its own.<br />

For example, if you stepped on a sharp tack,<br />

your skin sends a sensory message to the<br />

spinal cord. If the message is identified as a<br />

‘panic’ signal then the spinal cord will send<br />

a reflex signal to the muscle group where<br />

the message originated. Your foot will jerk<br />

away from the source of pain immediately<br />

without you having to think about it i.e. it<br />

happens automatically.<br />

The original message will still get to the<br />

brain and your brain will limit the reflex<br />

reaction.<br />

© New Zealand Spinal Trust, 2014<br />

25


What is Spinal Cord Impairment?<br />

Spinal cord impairment occurs when<br />

any damage to the spinal cord blocks<br />

communication between your brain and<br />

your body. An injury to the spinal cord, be<br />

it a break, tear, rip or crush that is caused by<br />

physical force is called a traumatic lesion.<br />

This may have resulted from one of the four<br />

common breaks or fractures illustrated on<br />

the facing pages. A spinal cord can also be<br />

damaged through disease such as multiple<br />

sclerosis or from a malignant growth on the<br />

spine.<br />

Your spinal cord injury is related to the nerves<br />

that are damaged but can also be referred to as<br />

your level of bony injury. It is more accurate<br />

however to refer to the actual area of the<br />

spinal cord that is damaged relative to the<br />

vertebra. It is for this reason that your level<br />

of injury may be referred to by two or more<br />

vertebrae ie. C5/C6 Tetraplegia.<br />

“My level of spinal injury,<br />

impairment or lesion is<br />

_________”<br />

“The last thing I remember is getting<br />

back onto the 4-wheeler to turn it round.<br />

We had stopped to admire the view from<br />

the highest point on the Wanganui farm.<br />

It was a hot, sunny February day, and<br />

I didn’t notice, or couldn’t see, the red<br />

light that indicated that I had left the bike<br />

parked in ‘Reverse’. I don’t remember,<br />

but was told later that the bike had set<br />

off backwards and went over a very<br />

steep bluff. Afterwards I was apparently<br />

conscious, but remember nothing except<br />

for some weird dream-like memories<br />

until, two weeks later, I found myself flat<br />

on my back in a little air ambulance.”<br />

Ian Popay T5<br />

© New Zealand Spinal Trust, 2014<br />

26


What happens to my Nervous System?<br />

Motor messages are unable to get past the<br />

damaged area so your brain cannot control<br />

muscles below the level of your impairment.<br />

Likewise, sensory messages from below<br />

the damaged area are unable to reach the<br />

brain and you may not be able to sense<br />

heat and cold, pain or pressure. Ask your<br />

spinal specialist to show you which areas of<br />

your spinal cord have been affected on the<br />

drawing below.<br />

Reflex messages may still be able to loop<br />

or ‘rebound’ from the spinal cord, but your<br />

brain will no longer be able to dampen refle<br />

movements which may result in muscle<br />

spasm. It is important to remember that<br />

motor, sensory and reflex messages never<br />

stop being sent between your brain and your<br />

body, they simply cannot get past the level<br />

of your injury.<br />

Spinal cord impairment does not prevent<br />

the muscles and organs below the level of<br />

injury from receiving blood and nutrients.<br />

You may experience changes in breathing,<br />

temperature control, heart rate and blood<br />

pressure after your injury. You will most<br />

likely have changes to your bowel, bladder<br />

and sexual function. Not knowing how<br />

your injury will affect your sex life, or your<br />

ability to have children, can be a worrying<br />

factor for a new patient.<br />

See the Life chapter for more<br />

information on this area.<br />

© New Zealand Spinal Trust, 2014<br />

27


Spinal Shock, Reflexes & Spasm<br />

Spinal Shock<br />

Immediately following an injury the spinal<br />

cord can go into shock. During this time<br />

reflexes, movement and feeling may be<br />

absent below the level of your injury. Spinal<br />

shock can last for hours for some to months<br />

for others. Spinal shock is why we cannot<br />

determine the exact loss of function in the<br />

early stages. You may experience some<br />

return of lost movement or feeling over the<br />

next few weeks but the results are always<br />

different from individual to individual. Any<br />

return of reflex activity below the level of<br />

your injury indicates that you are coming<br />

out of spinal shock.<br />

area away from the source of discomfort<br />

or pain. Your brain controls the protective<br />

reflex by limiting the reflex action to a<br />

single controlled movement. If your injury<br />

is T12 or above, your protective reflexes are<br />

probably still intact and working. Messages<br />

still bounce off the spinal cord to muscles<br />

but your brain cannot limit or control the<br />

movement. It is this situation that is called<br />

spasm. If your spinal injury is at T12 or<br />

below you probably will not have spasm.<br />

You might not think that “spasm” can be<br />

anything positive but, believe it or not,<br />

spasm can be very useful for people with a<br />

spinal cord impairment. Spasm alerts you<br />

to the fact that something is wrong. Over<br />

time you may learn to interpret different<br />

spasms as signals that tell you exactly what<br />

is happening i.e. your bladder is full. Spasm<br />

can also help maintain muscle tone in limbs,<br />

promote blood circulation and assist bowel<br />

and bladder function.<br />

For example a bladder that is full will send<br />

sensory messages off alerting the brain that<br />

it needs emptying. The signal may not reach<br />

the brain but the message may promote a<br />

reflex signal from the spinal cord that<br />

instructs the bladder muscles to empty.<br />

Reflexes & Spasm<br />

Before your injury a normal function of<br />

the spinal cord was reflex activity. This is a<br />

system that reacts instantly to protect the<br />

body and keep you from hurting yourself<br />

i.e. moving your body away from sources<br />

of heat.<br />

Painful pressure on muscles, or painful<br />

sensations on skin causes sensory messages<br />

to be sent out from the nerves in the area.<br />

Low strength signals travel to the spinal cord<br />

and then on to the brain. Higher strength<br />

signals ‘bounce’ off the spinal cord straight<br />

back to a muscle that is able to move the<br />

“I had a fall at home - cleaning windows while<br />

standing on the carport roof!...I found that<br />

[rehab] went well for me. My advantages were<br />

my age (55), my counselling qualification<br />

which helped me hugely to understand the<br />

grief process and understand what I and<br />

family members were going through. I used<br />

my training to help get through difficult<br />

times. I am also up front, open and honest<br />

- so I asked for the information I needed to<br />

help me get through and asked for a ‘chat’<br />

with senior nurses to sort out any confusion<br />

I had or misunderstanding. I also had huge<br />

support from family and friends.”<br />

Robin Paul T12<br />

© New Zealand Spinal Trust, 2014<br />

28


Your Bowel<br />

Immediately following a spinal cord injury<br />

your bowel will be flaccid, that is, lacking<br />

muscle movement. Your intestines will<br />

still continue to function, processing food<br />

and absorbing nutrients. Depending on<br />

your level of injury you will either develop<br />

a reflex bowel, or your bowel may continue<br />

to be flaccid<br />

Reflex Bowel<br />

If your injury is above T12 your bowel<br />

will probably empty by a reflex action.<br />

With spinal cord impairment the feelings<br />

to indicate that the rectum is full are not<br />

able to reach the brain, but they will reach<br />

the spinal cord. As the rectum gets full<br />

and stretches it pushes on the nerves in<br />

the bowel. This causes a sensory signal to<br />

be sent from the bowel through the sacral<br />

nerves to the spinal cord. The signal then<br />

loops back down along the sacral nerves to<br />

the bowel muscles. At this point you would<br />

have a bowel motion.<br />

Flaccid Bowel<br />

If your lesion is at L1 or below, the bowel<br />

will probably not have a reflex action. This<br />

is because the spinal cord ends at around L1<br />

so any signals from the rectal nerves cannot<br />

loop along the sacral nerves to the spinal<br />

cord. This means that the bowel muscles<br />

will not squeeze and the rectal sphincter<br />

muscle stays loose.<br />

You will probably need to learn differen<br />

ways of managing your food intake<br />

and bowel movements. A good bowel<br />

management program will help you regain<br />

some control and keep you healthier.<br />

See the Bowel chapter for more<br />

information on this area.<br />

Your Bladder<br />

'Taking a pee’ is one of the most common<br />

body care activities we undertake, passing<br />

urine is the end part of a simple but<br />

important body process. The body’s urinary<br />

system spends all of its time monitoring the<br />

amount of water and wastes in your body.<br />

It is the ‘oil filte ’ of the body, keeping your<br />

lifeblood clean and running smoothly.<br />

A spinal cord impairment will affect your<br />

ability to pee in some way. Any impairment,<br />

no matter how minor, will affect part of your<br />

‘chain of command’. However, there are<br />

a number of different bladder management<br />

techniques that will allow you to gain<br />

control over your bladder function.<br />

Learning good bladder management<br />

techniques is important to help keep you<br />

free from infections, bladder and kidney<br />

stones, and other complications both now<br />

and in the long term.<br />

See the Bladder chapter for<br />

more information on this area.<br />

“Don’t let things get in your way<br />

from doing something just because you<br />

don’t think you can do it. Try as many<br />

different ways to do something, in the<br />

end you will find a way to do it that<br />

works well after the 100’s of attempts<br />

that didn’t work. Doing the buttons up<br />

on my jeans took me 30 mins the first<br />

time, 20 the second and now it only<br />

takes about 25 seconds. It took a long<br />

time to figure out how but now it is so<br />

simple. I have struggled initially but<br />

now I can do almost anything.”<br />

Tim Johnson C6/7<br />

© New Zealand Spinal Trust, 2014<br />

29


Skin & Sensation<br />

The pairs of peripheral nerves that branch<br />

off the spinal cord carry sensory messages<br />

from very defined areas of the body to the<br />

brain. When talking about sensation these<br />

areas are called dermatomes and they can be<br />

mapped out quite accurately to help fin<br />

out exactly which parts of your cord have<br />

been damaged. Use the drawing below and<br />

the illustrations on pages 18 and 19 to see<br />

how the dermatomes, neves and vertebrae<br />

all relate to each other.<br />

Each pair of peripheral nerves also sends<br />

motor messages to the muscle groups near<br />

each dermatome area. When talking about<br />

motor messages these areas are called<br />

myotomes.<br />

If your injury is complete, it means there is a<br />

total blockage of messages at the level of your<br />

injury. If your injury is incomplete, it means<br />

there is a partial blockage and some (or all)<br />

feeling and movement may remain below<br />

the level of your<br />

injury. Medical<br />

staff can often<br />

determine the exact<br />

level of your injury<br />

by testing your<br />

muscle function<br />

and sensation.<br />

your body can squeeze shut the tiny blood<br />

vessels that supply tissue with oxygen and<br />

nutrients. This is most likely to occur over<br />

bony areas where your bones are closer to<br />

the surface of your skin. If starved of these<br />

‘fuels’ for too long your tissues will begin<br />

to die and pressure areas will start to form.<br />

A spinal cord impairment means that you<br />

have to consciously take over the task of<br />

looking after your skin. Because you cannot<br />

react to sensations of damage as it occurs,<br />

you now have to predict and prevent that<br />

damage before it occurs. You will need to<br />

learn good habits of pressure relief lifting and<br />

turning to keep your skin in top condition<br />

and to keep you out of hospitals!<br />

See the Skin chapter for more<br />

information on this area.<br />

If you have no<br />

sensation below<br />

the level of your<br />

impairment, your<br />

brain does not get<br />

the alert signals<br />

that areas of your<br />

skin are not getting<br />

enough blood<br />

supply, are too hot<br />

or cold, or are being<br />

cut, punctured or<br />

bruised. If you sit<br />

or lie in the same<br />

position for a long<br />

time the pressure<br />

on small areas of<br />

© New Zealand Spinal Trust, 2014<br />

30


Hope of Recovery & Cure<br />

Recovery<br />

Spinal shock may initially mask the eventual<br />

outcome of your impairment. You may be<br />

tempted to not participate in some aspects of<br />

your rehabilitation in the hope that you will<br />

recover the function as your injury settles.<br />

It is true that there are many different<br />

outcomes from similar levels of impairment,<br />

especially if you have an incomplete injury.<br />

The hope that you will recover lost function<br />

should not stop you from participating in<br />

your rehabilitation. If you work harder<br />

towards your rehabilitation now you will<br />

be able to make better use of any return of<br />

function later. You will also be able to get<br />

out of hospital sooner!<br />

Cure<br />

You may want to know what the likelihood<br />

of a ‘cure’ is. A spinal cord injury is not a<br />

disease, even if it has been caused by one,<br />

and therefore cannot be ‘cured’. As with<br />

any other injury, medical professions treat<br />

the symptoms and effects of the injury as<br />

best as modern medicine allows.<br />

A spinal cord injury is one of the most<br />

complicated injuries the body can sustain.<br />

At the time of this publication there are over<br />

200 research programmes internationally<br />

studying all of the aspects of spinal cord<br />

injury and regeneration. There are many<br />

hopeful advances but none of these<br />

programmes have successfully restored full<br />

function following a complete lesion.<br />

Whilst it is reasonable to assume that the<br />

constant advances in medical technology<br />

will eventually allow surgeons to restore<br />

function to injured spinal cords, it is also<br />

likely that these procedures may initially be<br />

available only for the newly injured. This<br />

is because the body ‘att cks’ the site of the<br />

lesion following injury. It seems that the<br />

first advances in spinal cord injury will be<br />

in preventing the body attacking the injured<br />

area within the first 48 hours<br />

Existing injuries may be more difficul to<br />

repair than ‘new’ ones.<br />

After injury, damaged nerve cells release<br />

Calcium ions and substances that break<br />

down the protective myelin insulation of<br />

nerves and other cell membranes. This chain<br />

reaction damages nerve cells near the site of<br />

injury that could otherwise have recovered.<br />

The damage also seems to be more severe if<br />

there is a lack of oxygen following the injury.<br />

A lot of research is going into preventing this<br />

secondary injury to reduce the overall effec<br />

of the injury. There are many publications<br />

and websites devoted to the advances in<br />

spinal cord research if you are interested in<br />

learning more about this.<br />

“We do not discourage<br />

hope for an eventual ‘cure’<br />

but we do encourage you<br />

to do everything within<br />

your capabilities to have<br />

an active and enjoyable<br />

life now! If you sit and<br />

wait for a ‘maybe’ you may<br />

end up disappointed and<br />

missing out on the many<br />

opportunities available<br />

immediately.”<br />

© New Zealand Spinal Trust, 2014<br />

31


Descriptions<br />

No two spinal cord impairments are the<br />

same. Depending on the cause of the<br />

impairment, there may be some spinal<br />

cord fibres unaffe ted. The following terms<br />

are used to classify the type and extent of<br />

impairment you have received.<br />

Lesion<br />

Any damage to the spinal cord is called a<br />

lesion. If caused by an injury, it is called a<br />

traumatic lesion.<br />

Level of Injury<br />

Spinal cord injuries are classified in the<br />

medical world by the level at which the<br />

spinal cord is damaged. The bony level<br />

describes which vertebrae are damaged<br />

(e.g. cervical vertebrae 6 and 7 = C6/7). The<br />

neurological level describes which nerves<br />

are impaired, followed by a description of<br />

complete or incomplete.<br />

your injury. The amount lost will depend<br />

on how much damage is done to your spinal<br />

cord. There are 5 main types of incomplete<br />

injury:<br />

Central Cord Syndrome<br />

An injury to the cord centre usually occurs<br />

in the neck. You may experience a complete<br />

loss of arm function yet still have some leg<br />

function. The sensation in the hands is<br />

often very disordered. Bladder and bowel<br />

are often partially spared and there may be<br />

recovery, starting in the lower limbs and<br />

progressing upwards.<br />

Complete<br />

A complete injury means there is a total<br />

blockage of messages at your point of injury.<br />

There will be no feeling or movement below<br />

the level of injury.<br />

Anterior Cord Syndrome<br />

Anterior means ‘ the front’. Damage to the<br />

front of your spinal cord will usually result<br />

in partial or complete loss of movement<br />

as well as pain, temperature and touch<br />

sensations below the injury level. You may<br />

still have some pressure sensation and<br />

position sense.<br />

Incomplete<br />

An incomplete injury means there is a<br />

partial blockage and some (or all) feeling<br />

and movement remains below the level of<br />

Posterior Cord Syndrome<br />

Posterior means ‘the back’. Damage to the<br />

back of your cord may leave good power,<br />

pain and temperature sensation but create<br />

difficultie in movement coordination. This<br />

is very rare.<br />

© New Zealand Spinal Trust, 2014<br />

32


Descriptions<br />

Brown-Sequard Syndrome<br />

Where the damage is mainly on one side of<br />

the cord. On the injured side, muscle power<br />

may be reduced or absent and pressure<br />

and position sense are disordered. The<br />

other side experiences loss of, or reduced<br />

sensations of pain and temperature but<br />

movement, pressure and position sense<br />

tend to remain.<br />

Tetraplegia / Quadriplegia<br />

Those who injure their spine in the cervical<br />

region will have partial or complete paralysis<br />

of their arms. They are referred to as people<br />

who have tetraplegia because four limbs are<br />

affected. Quadriplegia describes the same<br />

condition and is more commonly used in<br />

America.<br />

Neurology<br />

Any injury that damages the spinal cord<br />

will be described by medical professionals<br />

as ‘an injury that has neurology’ i.e. it has<br />

neurological damage.<br />

An injury to the spine that does not damage<br />

the spinal cord is referred to by medical<br />

professionals as an ‘injury without having<br />

neurology’. This means that the neurology<br />

(nervous system) is unaffected and normal.<br />

Most patients without any neurology will be<br />

treated by orthopaedic specialists and not<br />

referred to a spinal unit.<br />

Cauda Equina Lesion<br />

The ‘horses tail’ of nerves that spread out<br />

from the base of the spinal cord. An injured<br />

cauda equina may result in a patchy loss<br />

of power and sensation to the lower limbs.<br />

Functional recovery can happen over 12-<br />

18 months if the roots are not completely<br />

crushed. The bowel and bladder are usually<br />

severely affected<br />

Paralysis<br />

Paralysis simply means the inability to feel<br />

or deliberately move parts of your body.<br />

Paraplegia<br />

The term used that describes the condition<br />

of paralysis below the level of the neck<br />

(below T1) is paraplegia. People who have<br />

paraplegia will have partial or total paralysis<br />

of their legs and trunk.<br />

“When I was going through<br />

rehabilitation I learnt a lot off<br />

other para’s and tetras who<br />

came back in the unit for reassessments<br />

etc.<br />

They provided me with a lot of<br />

feedback and helpful tips and<br />

information. I seemed to take<br />

more notice of them because they<br />

had a chair under their bum.<br />

More credibility I suppose?”<br />

Keith Jarvie C4/5<br />

© New Zealand Spinal Trust, 2014<br />

33


Common Terms<br />

The following table contains common terms, slang and jargon that you may hear daily in the<br />

unit. Medical staff get so used to using this ‘code language’ that they sometimes forget to<br />

translate it for you. If you hear a term you don’t know, ask the person to explain it to you. If<br />

that is not practical, look it up in this table - it will give an idea of what is being talked about.<br />

Remember that different spinal units may use different terms to describe similar things. If<br />

the terms do differ, write down or have someone else write down the accepted version next<br />

to the ones listed here.<br />

TERM FULL NAME EXPLANATION<br />

‘Acute’<br />

An Acute Patient<br />

All new patients undergoing the first stage<br />

of their recovery are referred to as ‘acute’<br />

patients<br />

‘BIRD’ Positive Pressure Machine A machine that fills your lungs with air to<br />

full capacity to give them a good stretch out<br />

‘Bloods’ Blood Analysis Refers to the process, or the results of a<br />

blood test<br />

BP Blood Pressure Your blood pressure is measured regularly<br />

and monitored<br />

BWO Bladder Wash Out Refer to Bladder Chapter<br />

COC Change of Catheter Refer to Bladder Chapter<br />

‘Commode’ A Commode Chair A portable toilet chair often used in the<br />

shower as well<br />

CT Scan<br />

Computer Tomography<br />

Scan<br />

Also known as a CAT Scan, these are used<br />

to look at specific organs in your body<br />

‘Cysto’ Cystometry An examination of your bladder function<br />

‘Exam’ Examination Procedures that look for a specific signs or<br />

symptoms are often called ‘exams’<br />

FBC Fluid Balance Chart A way to measure your fluid intake and<br />

output<br />

GP<br />

ICU<br />

General Practitioner<br />

Intensive Care Unit<br />

Doctors who work in private practice<br />

outside of a hospital are known as General<br />

Practitioners, or GP’s<br />

A hospital ward that specialises in caring<br />

for people immediately after an injury<br />

© New Zealand Spinal Trust, 2014<br />

34


Common Terms<br />

TERM FULL NAME EXPLANATION<br />

ISC<br />

Isolation<br />

I/V<br />

IVU<br />

KUB<br />

Ultrasound<br />

MRI<br />

MRSA<br />

NBM<br />

N/G<br />

O2<br />

OT<br />

‘Physio’<br />

‘Physio’<br />

Intermittent Self<br />

Catheterisation<br />

Isolation Room<br />

Intra-Venous<br />

Intra-Venous Urogram<br />

Kidney Ureters Bladder<br />

Ultrasound<br />

Magnetic Resonance<br />

Imaging<br />

Multi-Resistant<br />

Staphylococcus Aureus<br />

Nil By Mouth<br />

Naso-Gastric<br />

Oxygen<br />

Occupational Therapist<br />

1. Physiotherapist<br />

2. Physiotherapy<br />

Refer to Bladder Chapter<br />

New patients may be placed in a room by<br />

themselves until it is known that they are<br />

clear of foreign diseases or bacteria such as<br />

MRSA<br />

A small tube that goes into your vein<br />

that can be used to give you IV fluids or<br />

medication<br />

An x-ray procedure that measures renal<br />

(kidney) and urinary system function<br />

An investigation of your urinary system<br />

Another way of looking at internal organs<br />

in your body<br />

A drug resistant infection commonly known<br />

as ‘the super bug’. People with MRSA are<br />

cared for in room of their own (isolation)<br />

A restricted food and fluid programme that<br />

helps measure some body functions<br />

A method of feeding you through a tube in<br />

your nose that leads to your stomach<br />

You may be provided with additional<br />

oxygen to assist your breathing<br />

A person trained to help people learn new<br />

ways of everyday activities after an injury<br />

A person trained to help you strengthen<br />

your muscles and keep the movement in<br />

your body’s joints<br />

Also used as a term to refer to your<br />

physiotherapy programme<br />

© New Zealand Spinal Trust, 2014<br />

35


Common Terms<br />

TERM FULL NAME EXPLANATION<br />

Restricted Fluids<br />

SAT’s<br />

SCI<br />

TPR<br />

Ultrasound<br />

‘Uro’<br />

VC<br />

Restricted Fluids<br />

Programme<br />

Oxygen Saturation<br />

Spinal Cord Injury<br />

(or impairment)<br />

Temperature Pulse<br />

Respiratory Rate<br />

Ultrasound<br />

Examination<br />

Urodynamics<br />

Vital Capacity<br />

A programme that carefully monitors the<br />

amount of fluids you have each day to help<br />

with your bladder care<br />

Describes the percentage of oxygen in your<br />

blood<br />

A medical description concerning a<br />

particular type of injury or impairment to the<br />

spinal cord<br />

Your ‘vital signs’ are monitored daily and the<br />

results are kept on a ‘TPR Chart’<br />

A visual imaging examination that uses<br />

sound (like radar) to produce pictures of your<br />

‘insides’<br />

The department that specialises in bladder<br />

functions<br />

Measures the volume of your lungs as you<br />

breathe out<br />

‘Video’ Video Cystometry An x-ray ‘movie’ of your bladder working<br />

X-ray<br />

X-ray examination<br />

A still photograph that shows dense objects<br />

in your body, i.e. bones<br />

“It can take me 10mins to do the smallest<br />

thing but hey, I did it myself. I think back<br />

when I first got my car. I could drive by<br />

myself and this meant my independence<br />

really increased. But you still have to be<br />

able to get in and out by yourself. What<br />

I did was make sure no one was around<br />

when I did it. I was out with friends and<br />

then decided to go home by myself. They<br />

watched me get in the car by myself, offering<br />

to help, but I needed to do it myself. Getting<br />

in the car is easy, it is getting out that is<br />

the hard part. So I went home and it took<br />

15-20 mins to get out of the car. Now it<br />

takes 1 minute.”<br />

Tim Johnson C6/7<br />

“I well remember when we arrived at [the<br />

unit] after what seemed a very long and<br />

slow ambulance ride from the airport. All<br />

I could see were the tops of street lights.<br />

My wife was with me and we were left<br />

waiting in a corridor for a very long time,<br />

with no idea of what was happening or<br />

what we were supposed to do. My wife,<br />

who is usually not very emotional, but<br />

was, unknown to us, in the early stages<br />

of pregnancy, was very upset and close<br />

to tears. It was a very bad introduction<br />

to what turned out to be a very caring,<br />

friendly and useful establishment.”<br />

Ian Popay T5<br />

© New Zealand Spinal Trust, 2014<br />

36

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