Admission / Early Rehabilitation

The first contact you may have with health services after a spinal cord injury is often with paramedics. Once assessed at the scene of your injury, you will be brought to your local trauma unit where you are further assessed. Typically, this involves scans of your back and neck to establish the cause of your difficulties with movement or sensation. You will also have a medical examination and decisions will be made as to the best course of action.

Depending on the nature of your injuries, you may spend a short period of time in critical care or another ward before coming to the National Spinal Injuries Unit. On average, people are admitted to the Unit a few days post injury, but this can vary depending on an individual's other injuries.

Once in the Unit, you will be assessed by one of the Unit’s consultants.

All new patients are cared for in our high dependency ward, Edenhall. Here, the doctors and expert nurses regularly monitor and observe your progress. The nurses work closely with the doctors to manage both medical and personal care needs. After a spinal injury, it is common to have difficulties with bowel and bladder function. The nurses will help you to manage any initial difficulties in a dignified and professional manner.

When medical fitness allows, the doctors will carry out a physical examination and establish the degree to which the spinal cord and nervous system has been affected by the spinal cord injury. This largely involves establishing which areas of the body have normal or abnormal feeling (sensation) and strength (power). They may also request more detailed scans of your back and neck.

Those who have damaged the spinal cord in their neck may have damaged the nerves that move the muscles in our chest and help us breathe. As a result, some people may require support from a ventilator for a period of time to help their breathing. If this applies to you, our consultants will instruct the support of our colleagues in anaesthetics and together they will create a plan to manage your breathing difficulties.

The medical consultants have a ward round twice per day in Edenhall: once at 9:00am and once in the late afternoon around 3:30pm.

While each individual has has an allocated medical consultant, all of the consultants who work in the Unit have a familiarity with everyone. Ward rounds are typically not a good time to catch the medical consultants, however it is possible to arrange a time to meet with a consultant via their secretaries, who are based at the entrance to the Unit. You can also find their details in the medical staff section of this app.

1. It promotes fracture healing, often with the spine in better alignment
2. It may prevent further damage to the spinal cord or nerves
3. It allows you to move onto the rehabilitation phase at an earlier stage

As you become medically well, it becomes more appropriate for other members of the rehabilitation team to get involved. The timing and rate at which the rehabilitation team gets involved can vary from person to person and depends on your needs.

Once you have profiled in bed and become accustomed to sitting up, the physiotherapists and occupational therapists will arrange for a wheelchair and a cushion and plans will be made for you to get up out of bed. In the vast majority of cases, this is typically in a wheelchair in the first instance. As was the case with profiling, the team will keep an eye on blood pressure but some will still feel a little faint.

In the early stages of going to the gym, you will now sitting upright and often be hoisted into your wheelchair. Because of this, there can be a tendency for some people's bowels to move at an inopportune moment. The staff are familiar with managing any such complications in a professional and dignified manner. While bowel accidents can be common in the early stages of recovery, across rehabilitation your management of bowel and bladder function typically improves to the point of being continent.

Other Team Members

Depending on the nature of the spinal injury, you may see professionals such as speech and language therapists or dieticians. For some, the ability to safely swallow food can be affected by the spinal injury. This can mean that rather than going to the stomach, some food or liquid can enter the lungs by mistake, often without your awareness. This raises the risk of chest infection, which may be a serious condition. The Unit is well supported by speech and language therapists who assess and advise on such matters. Likewise, the Unit has regular input from dieticians. Many people find that the number of calories burned off after injury can alter significantly and the dietician can help regulate this and keep your intake within healthy limits.

Although still early on in your stay, after a few weeks of admission it is likely that you will meet your discharge coordinator. While the average length of stay in the unit is 3-5 months, the discharge coordinator’s role is more about coordinating rehabilitation, guiding you and your family through the process and facilitating a successful discharge. It’s an unfortunate job title for those who do so much to support and coordinate your stay in rehabilitation from start to finish.

It is common that people who have sustained a spinal cord injury may also notice that there are changes to their thinking skills such as memory or concentration. Collectively, our thinking skills are referred to as cognition.

There are often several reasons as to why people may experience cognitive difficulties following a spinal injury. This can include:

• It may be that during an accident which damaged the spinal cord, the brain was also damaged. This is quite common if someone has fallen from a height, struck their head, or been in an accident involving speed. Brain injuries can range from mild concussions which resolve quickly and entirely to a more severe brain injuries which may require assessment and additional rehabilitation.

If there is a concern that there is also a brain injury, the units neuropsychologist will be involved more in your care. There is lots of useful information about brain injury available from Headway.

  Headway - the brain injury association | Headway

For some, the cause of their cognitive difficulties can be much less specific and may be attributable to a combination of factors such as:

• Mental health
• Poor sleep
• Pain
• Medication
• Prior significant drug and alcohol use

Some people may have been experiencing mild changes to their cognition prior to their spinal injury. This may have been related to normal ageing or in some cases, may have been due to conditions which become worse over the course of time such as dementia.

The stresses of sustaining a spinal injury may mean those with underlying weaknesses in their cognition are more prone to worsening difficulties during their hospital stay, particularly if they should become unwell of have an infection.

Delirium

Delirium refers to the rapid onset of altered mental functions. During a period of delirium, a person typically presents as confused, agitated, and finds it difficult to remember from one moment to the next. They may act in a very different way to normal and may do or say things which are out of character. At times they may see or hear things we cannon which can be distressing for both the individual and for relatives watching on.

The onset of delirium can be rapid and it can last from a few days to several weeks. Following spinal injury, delirium is often secondary to infection, but there are several risk factors which include:

• Older age
• Existing cognitive weakness
• Immobility
• Infection
• Sensory impairment
• Low levels of stimulation
• Being sedated / ventilated / on a high dependency ward

Most people recover well from delirium. However, for some, it may be that they do not quite return to their prior level of function.

There is a useful handout below which explains more about delirium and how it is managed in hospital settings.

   NHSGGC delirium leaflet