A Short Review of the History of Spinal Cord Injury

A Short Review of the History of Spinal Cord Injury

Posted by AskNurseLinda on Dec 31, 2018 2:16 pm

Welcome to the new year. As a way of looking forward, let’s pause and look back over some of the history of treatment of spinal cord injury. There are many diseases that lead to spinal cord injury. In fact, that is the cause of most spinal cord injuries. People do not often think about the consequences of disease as spinal cord injury but focus on the disease itself. Because of this, some individuals tend to overlook the SCI ramifications.

With disease, spinal cord injury can progress slowly. In trauma, spinal cord injury can develop in a second. The trajectories of disease onset compared to trauma onset are typically opposite. Disease takes time. Trauma happens in an instant. With either onset, the effects of spinal cord injury or any paralysis are life altering.

Treatments have been developing for paralysis for thousands of years. Due to the pooling of information and cooperation of scientists, coordination of research findings has been crossing diagnostic boundaries. What is discovered in one neurologic disease has been translated into other neurologic diseases. Information from research of one diagnosis is often applied to other unrelated diagnoses with successful outcomes and certainly knowledge building.

Spinal cord injury has been recorded in the hieroglyphs of Egypt. You can imagine the trauma that might have been sustained by workers of the great pyramids. This would be one of the first recorded industrial accidents. Pictorial evidence of urinary catheterization has been recorded by these early historians. It seems that spinal cord injury and other paralysis have been with us since the dawn of mankind.

In some of the remains of the Native American culture in the United States, vertebrae bones with arrows going through them have been found. One arrow pierced vertebra can be seen at Cahokia Mounds in Southern Illinois. This exhibited specimen is of a human vertebra with the arrow and tip through the bone. The human tissue is long gone but the injury that would have been sustained would clearly have been a traumatic spinal cord injury.

War and trauma were the common sources of SCI for years mostly because people did not live long enough to see much effect of SCI from disease. Because of the large numbers of injured soldiers from each battle, techniques to save lives were developed over time. The more soldiers that could be saved would mean more soldiers that could return to the battlefield.

One of the first rehabilitation nurses was Florence Nightingale who suggested novel treatments such as hand washing, cleanliness in providing care and pressure release treatments. Florence thought patients should be turned to avoid pressure injury about every two hours-sound familiar? We still aim for the two hour turn in hospitals today, even though scientific evidence indicates that pressure releases should be accomplished as frequently as every 10 minutes.

Fast forward to World War II. The intervention of antibiotics and field hospitals with quick treatments resulted in a significant survival of wounded soldiers. Regenerative techniques were developed to improve vascular function and spare nerve damage. Medical doctors and surgeons continued with development of treatments after the war since many soldiers lived to return home. Today, military and other researchers continue with advancing treatments for rehabilitation care.

Paralysis treatment was extensively developed with the polio epidemic in the United States. Other countries had been conducting research for neurological conditions as well. Some of these techniques were further developed for the treatment of polio. These included providing activity to affected parts of the body, aquatic or water therapy and ventilation with iron lungs.

In polio treatment centers, those affected were provided range of motion by volunteers for hours at a time. This constant movement provided the body with the necessary activity that was not being provided internally. Aquatic therapy, in warm water, relaxed muscles and provided the buoyancy to help support limbs. Moving a body part on your own might be too difficult due to gravity but the added buoyancy of the water reduced the difficulty of overcoming gravity with movement. Another essential element for treatment was ensuring oxygenation for those who had difficulty breathing. This allowed individuals a chance to survive until enough strength was regained to participate in additional therapies. There were other treatments as well, but these were the mainstays of the program.

There were ‘spas’ that were developed around the country to provide treatments. Whole communities would take part in providing this time intensive therapeutic treatment. One famous spa is in Warm Springs, Georgia. This was developed by President Franklin D. Roosevelt for his and other’s treatment. He continued with this therapy throughout his life.

Another proponent of therapy for polio was Sister Kenny who created a novel treatment. The Sister designation was from her origin of Australia, although she did not have formal training as a nurse. Her treatment consisted of reducing spasms, so limbs could be put through range of motion.  At the time, this practice was controversial as it was not the state of the art. However, her unusual thinking changed the way treatments were conducted.

In the 1990’s, much more about the workings of nervous system had been proposed. A new idea was conceived: hope. There was a wave of movement that it would be possible for individuals with spinal cord injury to improve. It was due to several discoveries such as nervous system plasticity where it is acknowledged that the nervous system can adapt to injury and reroute itself.

Previously, the nervous system was thought that only one particular nerve could connect to another particular nerve. If you think of a pony tail hair do, it was thought that if the pony tail was cut, each single hair would have to be reattached to its original hair. This was the same thinking that spinal cord injury could be repaired, each nerve reattaching to its original nerve. The concept of plasticity changed this idea. The body can adapt and adjust to injury.

There were several other major discoveries about the nervous system which when combined created a new vision of recovery from spinal cord injury. The major proponent of these discoveries was Christopher Reeve who developed what is now called the Christopher and Dana Reeve Paralysis Foundation to expand and develop these new ideas about the nervous system. His motto, Forward, indicates the need to look toward these new ideas of hope and recovery rather than to cling to old ideas that we now know did not encompass spinal cord injury recovery.

Many researchers and health care professionals have embraced the new concept of recovery for spinal cord injury. Similar therapies like those instituted for the treatment of polio have been adapted and revised for the current use. The explosion in the development of technology has been utilized to develop equipment that can replace the large numbers of people needed to deliver the therapies as well as to deliver treatments in less time allowing the recipient to have time for other pursuits in life.

As time moves on, these therapies have been refined and tested with positive results. Knowing which therapy to be provided for the best results and the length and number of treatments is being considered. Further advances in technology have allowed some of the external cumbersome equipment to be reduced to microscopic size which can actually be transplanted into the body. This is beneficial and convenient for the person with spinal cord injury.

Future research will make these technologies more encompassing and available for everyone with spinal cord injury. One of the prime features is that these technologies will benefit individuals with new spinal cord injures and those that have injuries from years ago.

My feeling is that one day, one hour or even one second is too long to have the effects of spinal cord injury. The future is wide open for improvement, treatment and even cure.

Keeping your body in shape will be the key to participating in these approaching therapies. Following a healthy diet to keep your body well, providing movement either actively by moving your body where you can and passively by moving your body parts where challenged will keep you in optimum condition for the future. -- Nurse Linda

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