After being discharged home, people with spinal cord injuries need to watch out for some common medical complications such as blood clots and spasticity. In this installment of the Living With a Spinal Cord Injury series, we review signs and symptoms and prevention strategies for these potential medical complications.
The Living With a Spinal Cord Injury series is made possible by a gift from David and Barbara Loeb.
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Marlyn Ramos Lamboy, MD: Once the patient goes home, he or she might experience new challenges at home and in the community that they were not expecting. Also their body will continue to change, they will continue to make progress and, in addition to that, they may experience common medical complications that are long-term for the spinal cord injury population. The patient may experience deep venous thrombosis - also known as DVT, spasticity, heterotopic ossification - also named as HO, and contractures. The rehabilitation physician and the team are the most educated providers that can provide early recognition and treatment to these conditions.
Narrator: Deep vein thrombosis or DVT is a blood clot often caused by lack of movement in your arms or legs. Some individuals will develop a DVT during their acute inpatient hospitalization or inpatient rehab that requires blood thinning medications for several months to reduce the risk of the clot dislodging and becoming a potential life-threatening situation. The risk of developing a DVT after discharge can be greatly reduced with daily exercise, getting out of bed each day and staying active. Special elastic stockings called TEDs can also help to reduce your risk by improving circulation and minimizing swelling or discomfort in your legs. If you experience swelling, warmth, redness or pain in your arms and legs, you need to report it right away to your family and/or rehab doctor. They will be able to assess your specific situation and order any treatment you might need.
Narrator: Frequently when you are first injured your body goes into what is called spinal shock. This is when there are no reflexes connecting your spine and brain to allow your body to adjust to neurologic changes that occur. Over time, spinal shock wears off and your body's natural reflexes will return. When this happens for some individuals uncontrolled movement or muscle tightness may develop in your arms or legs. This is called spasticity. Sometimes the muscle tightness created by spasticity can actually help you to move and reposition yourself, an important activity to prevent you from getting pressure injuries. But it can also be severe, requiring routine exercise and medication.
Ramos: Simple interventions such as being compliant with their home exercise program, which include daily range of motion and daily stretching, can minimize or improve the stiffness that they experience as a result of spasticity. If spasticity is not well controlled it can lead to progressive loss of the range of motion and function, it can interfere with their bed mobility and their transfers and their mobilization either walking or at wheelchair level and it can impede their activities of daily living. In addition to that spasticity can be painful so we want to address that before it gets worse. For some patients spasticity can be an alarm system. If they have anything that is going wrong below their level of injuries in areas that they are not feeling as well or they have decreased sensation, such as a urinary tract infection or a pressure injury, their spasticity may exacerbate or become worse or more intense.
Stephen: Well, spasticity has been a major problem in my life and it's varied over the years. Initially, I had substantial spasticity but that seemed to decrease and I was doing fairly well for a few years. Over the last year or two the spasticity has increased and it may be related to certain skin issues - ulcers that I've had over the last year or two - and may also be related to - my bladder is very sensitive and that may also increase the spasticity.
I have a stretching regimen that I have in the morning and evening and I think that that helps. And also just moving around, particularly pushing the wheelchair for long distances. I've spent many years studying the martial arts using the Japanese sword and I try to do some activities with that each morning. I've always been pretty athletic and always tried to maintain strength and flexibility. I think it's important to maintain flexibility just so you don't injure yourself and also if you have good range of motion that you'll be able to perform the activities that you would like to do as efficiently as possible.
Ramos: One of the possible side effects of spasticity if not treated aggressively is a permanent loss of the range of motion of the joint also known as contracture. Once a contracture develops it is very difficult to treat. We can do specials splints or serial casting and sometimes the patient needs surgery.
Ramos: HO is an abnormal bone formation that occurs in the joints below the neurological level of injury. So the areas of the body that are weak you can develop abnormal bone around those joints. Initially it might not be significant. A lot of spinal cord injuries have heterotopic ossification but 20 percent of them can develop severe heterotopic ossification in which the joint becomes inflamed and they lose range of motion. So if we monitor the evolution of how much bone is being put there if its aggressive we can start the patient on medication and follow through the evolution to see if the patient in the future might need surgery or not.
Ramos: The communication between a patient and the spinal cord injury team is extremely important not only because we took care of the patient on the inpatient setting but because we're going to be following this patient for the rest of their lives.
Wayne: My C2 vertebra was injured so I go routinely when I'm supposed to go, every six months. And my doctors ask me questions like am in pain, have there been any changes or anything and I just tell them. Typically with me like it usually don't be any pain or nothing but it's mostly all gains that I've been acquiring over the past six months. But certain stuff they can see what you can't see because they got the eye for it. Just go be as honest as possible. It's for your benefit. I mean if you want to get better, you'll do better.
Narrator: Listening, learning, asking questions and following up with your rehabilitation doctor and the rehab team will provide you with the best education and recommendations to assure you stay healthy and limit the potential complications you might experience as someone living with an SCI.