++
++
Chapter 3 presents information on medical, surgical, and orthotic interventions as well as education and training following spinal cord injury.
++
Chapter 3 presents information on the unique medical, surgical, and orthotic interventions necessary after a spinal cord injury. Key components of the education and training to prevent secondary complications across the continuum of care following spinal cord injury will also be reviewed.
++
Following an injury to the vertebral column or spinal cord, specialized management is imperative to ensure stabilization of the spine and preserve neurological function. Quick and effective mitigation of the primary trauma to the vertebral column and spinal cord is necessary to minimize the secondary effects of inflammation at the injury site. A multidisciplinary approach is required to address the sequelae associated with spinal shock and maintain the patient's hemodynamic stability in the weeks to months after the initial injury. Without appropriate fracture management and medical care, a cycle of worsening impairments in body function and structure is virtually inevitable, resulting in unnecessary financial burden, disability, or death. Box 3-1 provides information on ongoing research addressing interventions that could enhance neurological functioning after spinal cord injury.
++
Box 3-1 Research on Interventions for Optimizing Neurological Outcomes
Research is ongoing for other interventions that could enhance neurological functioning after spinal cord injury. They are a mixture of pharmacological, physiological, cellular, and rehabilitative treatments. Blood volume augmentation and elevation of patients’ mean arterial blood pressure (MAP) through IV fluids and vasopressors to 85 to 90 mm Hg for the first 5 to 7 days1 after injury (depending on level of injury) may improve outcomes by enhancing blood flow to the spinal cord, thus reducing posttraumatic ischemia of the neural tissue.2-4 Some authors also explore the effects of elevations in MAP with cerebrospinal fluid (CSF) drainage to improve blood flow to the spinal cord.5 A variety of pharmacological therapies aimed at reducing secondary tissue destruction and enhancing axonal regeneration within the spinal cord through growth factors, antiapoptotic molecules, hormones, antibodies for inflammatory cells, or growth-inhibiting factors are also under investigation.6-10 After promising animal research on the effects of local and systemic hypothermia, clinical trials are now emerging in adults with spinal cord injury. These initial trials suggest the beneficial effects in adults with acute spinal cord injury. However, future research is still needed to define its parameters.11-14 Another area of research is cellular transplantation: Tissues or cells are inserted into or near the damaged portion of the cord. Depending on the type of transplantation performed, the transplanted material can provide a bridge for axonal regeneration, create chemical and mechanical conditions conducive to this regeneration, create conditions beneficial to surviving neurons, and even provide new neurons to the damaged portion of the cord.7,15,16 The effects of transcranial magnetic stimulation, spinal cord electrical stimulation, and locomotor training with powered robotic exoskeletons on functional ...