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Nervous system: Brain and spinal cord injuries

Notes

Transcript

Content Reviewers:

Lisa Miklush, PhD, RNC, CNS

Damage to the head or spine that causes the brain or spinal cord to stop working properly is called a brain or spinal cord injury, respectively.

In most cases, these are traumatic, meaning that they result from an external, physical force, like a fall, a car crash, or a gunshot wound.

They can also be non-traumatic, which is the case when the brain or spinal cord are not receiving enough oxygen, such as when breathing or heart problems prevent enough oxygen from reaching the brain or spinal column or when blood vessels supplying the brain or spinal cord are compressed by something like a tumor.

Now, the symptoms of a brain or spinal cord injury can show up at the time of the injury or even hours to days later. In general, these vary depending on the region damaged and the severity of the injury.

Starting with brain injuries, symptoms may include confusion, headaches, nausea, vomiting, weakness, numbness, and vision or auditory problems.

More serious cases can even result in death. Clients can also experience life-long effects, and these may involve the motor function, causing muscle weakness or paralysis; various mental functions, causing thinking, memory, language, behavior, or emotional problems; or the level of consciousness, resulting in a coma.

This is a state like deep sleep but without a sleep-wake cycle. There’s a profoundly decreased alertness or responsiveness to their environment, like sound or touch.

Duration of a coma may vary from weeks to months, or rarely, go on for several years. After that time, the client might gradually come out of a coma or progress to a persistent vegetative state.

In this case, there’s a sleep-wake cycle, but the client still remains unaware and unresponsive to their surroundings and is unable to speak or follow commands.

They might show signs of movement, like opening the eyes or grimacing; however, these are only involuntary actions that are not a response to the environment.

Now, in a spinal cord injury, nerve signals can’t be transmitted between the brain and the rest of the body. The higher the level of injury, the more function is lost.

So, an injury at the lumbar region, which is in the lower back, will result in paralysis or an inability to move anything below the waist, including the legs and lower trunk.

This type of paralysis is called paraplegia. In contrast, an injury at the level of the neck will cause tetraplegia, previously known as quadriplegia, which is paralysis below the neck, meaning in the arms, legs, and trunk.

Both paraplegia and tetraplegia can be partial, meaning that some movement is preserved, or complete, meaning that all movement is lost.

Both cases can also be accompanied by a loss of sensation in the same regions of the body as well as a loss of bladder and bowel control.

Most clients with a brain or spinal cord injury will need emergency care, such as surgery or medications, to minimize the damage on the brain or spinal cord.

Depending on their needs, this might be followed by physical therapy to improve their posture, balance, and range of motion; speech therapy to limit speech and swallowing difficulties; as well as total care or assistance with all activities of daily living.

Now, when caring for clients with brain or spinal cord injuries, there are some common care considerations to keep in mind. The kind and amount of care will vary a lot depending on the client’s needs and abilities.