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Managing patients with spinal cord injury requires more than addressing the loss of motor and sensory function. Patients with paraplegia or tetraplegia can have a host of autonomic dysfunctions involving their bowel, bladder, lungs, skin, endocrine system and other organs, not to mention behavioral health issues like depression and post-traumatic stress disorder.
“These patients need ongoing care for each organ system for the rest of their lives,” says physiatrist Gregory Nemunaitis, MD, Medical Director of Spinal Cord Injury Rehabilitation at Cleveland Clinic.
Dr. Nemunaitis discusses the latest advances in the management of spinal cord injuries in the newest episode of Cleveland Clinic’s Neuro Pathways podcast. He touches on:
Click the podcast player above to listen to the episode now, or read on for a few short edited excerpts. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.
Dr. Nemunaitis: Twenty years ago, if you had a spinal cord injury and you couldn’t drive, couldn’t walk, couldn’t ride a bike, it really put you behind in life. The redesign of wheelchairs and assistive devices for driving, for standing and for walking has been remarkable and has really improved the health and wellness and participation of our patients with spinal cord injury.
Dr. Nemunaitis: A lot of studies, including STASCIS [Surgical Timing in Acute Spinal Cord Injury Study], looked at early surgery and showed improved outcomes if people went to the OR within the first 24 hours. There also have been studies on early rehabilitation. Instead of starting rehab once the patient leaves the hospital, you start it right there in the acute care hospital. Then post-acute rehabilitation therapies can help enhance function.
Some interesting surgical procedures — with nerve transfers, tendon transfers and electrical stimulation — have enhanced function significantly for these people as well.
We did an interesting study in 2018 using direct-current stimulation of the brain to enhance motor function of people with spinal cord injury. It was a small study with eight patients, but it clearly showed some improvement in motor function, along with therapy. At this time, we are involved in a phase 2 clinical trial with three different centers, looking at a larger volume of patients to assess the effectiveness of direct brain stimulation.