According to the Christopher and Dana Reeve Foundation, there are about 5.6 million people in the United States with a spinal cord injury. When the spinal cord is damaged, the patient undergoes profound physical and psychological changes. These changes depend largely on the spinal level of injury and the extent of spinal cord damage. Advances in physical medicine and rehabilitation have improved the behavioral outcomes for spinal cord injury patients.
Sensory and Motor
The most profound result of spinal cord injury is the affect on the patient's sensory and voluntary motor systems. The range of dysfunctions can vary greatly, and largely depend on the spinal level of injury as well as the extent of nervous tissue damage. In general terms, the patient loses voluntary motor function and sensory abilities below the spinal level of injury. Above that level of injury, sensory and motor functions are preserved.
Spasticity and Dysreflexia
Paralysis often results in spasticity, which is characterized by involuntary muscle contractions. Depending on the extent of neural damage, the spasticity can range from mild muscle stiffness and twitches to forceful movements and exaggerated tendon reflexes. Another consequence of spinal cord injury is autonomic dysreflexia. This is a very serious and potentially deadly condition requiring immediate medical attention. It occurs when the autonomic nervous system becomes overactive, and can result in high blood pressure, slow heart rate, nausea, headache and sweating.
Bladder and Bowel
Spinal cord injury affects the bladder in two general ways. First, the bladder may become spastic. This is when the bladder can empty reflexively but not voluntarily. A flaccid bladder is when the muscles of the bladder are weak or completely nonfunctional, and no reflexes exist. The common treatment is catheterization. The bowels of spinal cord injured patients are also affected greatly. Above the T-12 spinal level, the patient may defecate reflexively even though the feeling of a full rectum may not be present. Below the T-12 spinal level, the patient may lose reflex defecation. This is called a flaccid bowel.
Depression
Millions of people are affected by clinical depression, but according to the Northwest Regional Spinal Cord Injury System, the rate of depression is many fold greater in persons with spinal cord injury. Both psychological and physical symptoms of depression include feelings of hopelessness, sleepiness, diminished energy, altered appetite, loss of interest in activities and people, feelings of worthlessness, difficulty concentrating and thoughts of suicide and death.
Sexuality
The degree of sexual impairment in spinal cord injury patients depends on the level of injury and amount of spinal cord tissue that is damaged. The expression of sexuality in women usually is not as greatly affected by the spinal cord injury as in men. Women's sexual dysfunction is more closely associated with the psychological experience of sex and their interaction with their sexual partner. Libido may be unaffected although the level of sexual activity may be diminished. This is likely associated to the fewer sexual partners disabled women have compared to men. In men, the primary sexual behavioral alterations are erectile dysfunction, loss of orgasm and impaired libido.
