WATCHING the late actor, Christopher Reeve, soar into the sky in his starring role as Superman, was a defining moment for many. Reeve became synonymous with the Man of Steel.
Years later, seeing him paralysed from the neck down after a horse riding accident and requiring a ventilator to breathe, was a distressing image to many of his fans.
Yet, Reeve proved he was still a "superhero". Despite the severity of his condition, he became an advocate for spinal cord injury (SCI) and research, and established the Christopher and Dana Reeve Foundation to support research into SCI and provide resources and support for individuals and families affected by SCI.
To lose one's mobility suddenly in life is hugely challenging. The most common cause of SCI is trauma, explains Aurelius Hospital Nilai neurosurgeon Dr Rajendra Rao Ramalu.
This trauma can result from motor vehicle accidents, falls from ladders or roofs, knife wounds or stabbings or even a sports injury from contact or extreme sports.
Non-traumatic causes can also result in SCI and these include spinal tumours, degenerative disorders, spinal stroke, inflammatory or autoimmune conditions and complications from post spinal surgery.
In Malaysia, vehicular accidents are the most common cause, accounting for 66 per cent of SCI cases according to a 2013 study done by Dr Asiah Ibrahim from Hospital Kuala Lumpur, followed by falls (28 per cent). However, not every spinal cord injury leads to paralysis (total loss of muscle power).
"An injury to the spinal cord can result in a range of symptoms and disabilities, and paralysis is just one possible outcome," says Dr Rajendra.
In a complete injury, there is total loss of function below the level of injury. Patients won't be able to feel, move and control their bladder and bowel movements.
In an incomplete injury, some functions may still be present. For example, in some cases, an incomplete SCI may cause only minor, temporary symptoms.
"Depending on the injury sustained, some patients would be able to walk again."
PICKING UP THE PIECES
Most people with minor SCI (incomplete injury) regain some functions between three weeks and six months after injury, but the likelihood of recovery diminishes after six months, explains Dr Rajendra.
For patients with complete spinal cord injury, the chances of a full neurological recovery are slim.
"Although there is some promising research pertaining to stem cell and spinal cord stimulation to enable patients with complete spinal cord injury to walk again, these are still in preliminary studies."
Proper rehabilitation strategies with a rehabilitation physician, physiotherapist and occupational therapist can minimise long-term disability.
Rehabilitation programmes focus on strengthening and conditioning muscles, improving balance and coordination.
The rehabilitation process after SCI can be long and challenging, requiring significant resources, support and dedication from the individual, his family and healthcare team.
Given that SCI can be extremely stressful and life changing, besides physical and occupational therapy, the mental wellbeing of the patient must also be taken into account in the process to help him rebuild his life.
Stages of Rehabilitation
Acute Rehabilitation
• Treatment is administered immediately after the injury, usually in hospital.
• The spine is immobilised and realigned if necessary (via surgery) to prevent further damage. Medications may be administered early.
• Respiratory aid is provided if there has been sufficient spinal cord damage in the upper neck (cervical).
Inpatient Rehabilitation
• A wide array of intensive therapies will be conducted in hospital to improve two key areas — function and strength in legs and arms as well as communication skills.
• Also addresses issues such as mobility, bowel and bladder training, diet and nutrition, exercise and general daily living.
Outpatient Rehabilitation
• Patients undergo continuous therapy after leaving hospital, either at home or in a rehabilitation centre or both.
• The number of rehabilitation sessions depends on the patient's personal situation and may be weekly, daily or even several times a day.
• Integrate patients into the community. Adaptations to the individual's home or workplace may be required and ongoing support from caregivers and follow-up care as needed.