Hesperian Health Guides
Early Care for the Spinal Cord Injured Person
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Early care following spinal cord injury is best done in a hospital, especially if the child is likely to get good nursing care. Family members should stay with the child in the hospital to make sure the child is kept clean and turned regularly, so that bed sores and pneumonia are avoided. (Busy hospital staff with little experience treating spinal cord injuries sometimes let severe bed sores develop—which may threaten the child’s life.)
CAUTION! During the first 6 weeks, or until any breaks in the bone have healed, take great care when turning the child so that the angle of his back, neck, and head does not change. Use the same methods and precautions used in lifting a newly injured person onto a stretcher. When the neck or back has healed, the child can start lying on his stomach, at first for 10 minutes and then longer if there are no problems.
Surgery of the spine may or may not be necessary. After surgery, the person must lie very still for at least 6 weeks. The main purpose of surgery is to prevent more damage— not to cure the paralysis. The damage already done to the spinal cord cannot be corrected with surgery or medicine.
Preventing pressure sores (bed sores)
When feeling has been lost, pressure sores can easily form on the skin over bony areas—especially on the hips and butt. The biggest risk of sores is in the first weeks after the injury. This is because the child must stay very still, and has not yet learned to move or turn over his body. Prevention of pressure sores is extremely important, and needs understanding and continuous care, both by the child and those caring for him.
BE SURE TO READ CHAPTER 24 ON PREVENTION AND TREATMENT OF PRESSURE SORES.
Summary: early prevention of pressure sores (For details, see "Prevention of Pressure Sores".)
- Lie on a soft mattress or thick, firm, foam rubber pad.
- Place pillows and pads to keep pressure off bony areas.
- Change position (turn over from front to back and side to side) every 2 to 3 hours. To avoid pressure sores, lying on the belly is the best position.
- Keep skin and bedclothes clean and dry.
- Eat good food rich in vitamins, iron, and protein.
- Move and exercise a lot to promote good flow of the blood.
- Check skin daily for earliest signs of pressure sores—and keep all pressure off beginning sores until the skin is healthy again.
In the first weeks following a spinal cord injury, when the child is in a lying position, joint contractures (muscles shortening) can easily develop, especially in the feet and elbows. Pillows and pads should be placed to keep the feet supported, the elbows straight, and the hands in a good position. Gentle range-of-motion exercises of the feet, hands, and arms should begin as early as possible, taking care not to move the back until the injury is healed. See further discussion on the prevention of contractures in the spinal cord injured.