The impact of a spinal cord injury on lifestyle will depend primarily on how the injured person is physically affected (for example, the degree of paralysis and the presence of complications such as bladder or bowel problems).

Rehabilitation
Once a person with spinal cord injury has recovered from any immediate risk to their life, rehabilitation can begin. This is when the person learns to adapt to the injury and regain independence and quality of life. It is an ongoing prgramme that takes many months and requires the support of a specialist team of healthcare professionals.

Rehabilitation should include individual therapy, which supports the person when carrying out daily activities such as washing, dressing, eating and apsects of personal care and hygiene. It should also involve coping skills and doing exercises to strengthen the affected muscles. It may be necessary to make certain adaptations in the person’s home or working environment to make it easier for them to move about and perform everyday tasks with as as much independence as possible.

Keeping the skin healthy
People with reduced mobility as a result of spinal cord injury are at risk of developing pressure sores (bed sores or pressure ulcers) [Link: pressure ulcers]. Pressure sores are wounds to the skin and underlying tissue caused when a person has been sitting or lying in the same position for a long time. Static positions reduce the flow of blood to a particular area, blocking the supply of oxygen and vital nutrients that keep the tissue healthy.

Pressure sores can range in severity from redness or discoloration that lasts for more than 30 minutes, to a deep sore that extends to the underlying bone. To avoid pressure sores, sitting and lying positions should be changed as often as possible, and the skin should be kept clean. If redness develops, pressure should be kept off the affected area. If the skin is broken and there are signs of infection – or if redness lasts for a several days – you should consult a healthcare professional.

Exercise and fitness
It’s good for people with spinal cord injury to perform a range of daily stretches and exercises. The benefits of specially tailored exercises include:

• maintenance of muscles in the paralysed limbs
• prevention of pressure sores
• better muscle balance and coordination
• greater range of motion and flexibility
• more stamina and strength
• better blood circulation
• better digestion and bowel health
• improved bladder control

Temperature regulation
Most people with complete spinal cord injuries do not sweat below the level of the injury. This prevents the body from cooling down properly, increasing the likelihood of overheating. In a cold environment, the body of people with spinal cord injury may not be able to tell the brain that the body is cooling down – increasing the risk of becoming hypothermic (too low a body temperature).

A good way for people with spinal cord injury to cool down is to wrap a cold wet towel around the back of their neck and to dampen down the skin - as the water evaporates, the body is cooled. The body can be warmed up by putting on plenty of clothes, moving to a warm place and drinking warm fluids.

Muscle spasticity
Following a spinal cord injury, the nerve cells below the level of injury become disconnected from the brain. This is due to scar tissue forming in the damaged area, preventing messages below the level of the injury from reaching the brain. When an injury occurs to the spinal cord, the body goes into spinal shock. This may last several weeks and during this time, the nerve cells that control muscle activity change. Spasticity does not occur immediately following a spinal cord injury and once spinal shock wears off, our natural reflexes reappear. Spasticity is simply an exaggeration of the body’s normal reflexes.

In an able-bodied person, a stimulus to the skin is recognised and a sensory signal is sent to the reflex arc, where it travels to the brain via the spinal cord. The brain then assesses the stimulant, and if the stimulant is not dangerous, an inhibitory signal is set down the spinal cord. As a result, the reflex does not move the muscle.

In a person with a spinal cord injury, the inhibitory signal is blocked by the structural damage in the cord, and the natural reflex is allowed to continue, resulting in a contraction of the muscle.

Almost anything can trigger spasticity, but certain things can make spasticity more of a problem. A bladder infection or kidney infection will often cause spasticity to increase, and minor stimulation can cause severe spasticity. A skin breakdown may also increase spasms. As muscles and joints become less flexible, it is important to perform regular motion exercises – too little stimulation can cause severe spasticity.

Autonomic dysfunction
Autonomic dysreflexia – also known as hyperreflexia – is a serious complication that may affect people with spinal cord injury. It occurs when the blood pressure in a person with a spinal cord injury above T5-6 becomes excessively high due to the over activity of the autonomic nervous system. Autonomic dysreflexia is usually caused by a painful stimulus below the level of the spinal cord injury and it is potentially life-threatening.

The most common symptoms of autonomic dysreflexia are sweating, a pounding headache, a tingling sensation on the face and neck, blotchy skin around the neck and goose bumps. The number of symptoms and the severity may vary, but if left untreated, extreme cases can lead to a stroke and death.

Sexual function
Male erection is controlled by the nervous system, and so spinal cord injury may lead to erectile dysfunction. Various methods are available to help manage erectile dysfunction (and other problems with sexual function) including devices, drug therapy and counselling.

Leisure activities
Although spinal cord injury requires major adjustments in lifestyle, many people with spinal cord injury find a way to engage in leisure activities, hobbies, sports and travel. Effectively managing the complications associated with spinal cord injury, such as bladder and bowel problems is essential.

Read more
Read about the causes of spinal cord injury, different treatments and treatment products.