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Understanding SCI
Aging
Bladder changes with age
How does aging affect the bladder with SCI?
Bowel changes with age
How does aging with SCI affect the bowel?
Pain and aging
How does aging affect pain after SCI?
Staying physically active
How does aging affect physical activity after SCI?
Spinal Cord Injury
Spinal cord anatomy
What is the spine?
What is the spinal cord?
How does the spinal cord work?
Injury types and causes
What is non-traumatic SCI?
What causes non-traumatic SCI?
Who gets non-traumatic SCI?
How does non-traumatic SCI present?
How is non-traumatic SCI treated?
What causes spinal cord injury?
Injury levels and classification
What are “complete” and “incomplete” spinal cord injuries?
What is the “neurological level of injury”?
What is the International Standards for Neurological Classification of Spinal Cord Injury exam?
What are “upper” and “lower” motor neuron injuries?
Changes after injury and early recovery
What is spinal cord injury?
What are the signs and symptoms of spinal cord injury?
How common is spinal cord injury?
Understanding Health Care
Emergency and hospital care
What is “acute care”?
What happens in acute care right after a spinal cord injury?
What are the early symptoms of spinal cord injury?
How are spinal cord injuries diagnosed?
What emergency treatments are used after spinal cord injury?
What complications can develop after a spinal cord injury?
What other health issues may be present in the hospital?
What emotional reactions do people have after an SCI?
What are the roles of the health providers in acute care?
What is the equipment at the bedside for?
How long do people stay in the acute care hospital?
Where do people go after acute care?
Understanding rehabilitation and the care team
What is rehabilitation?
What types of rehabilitation are there?
What testing is done in rehabilitation?
Why is goal setting important in rehabilitation?
What activities may happen in rehabilitation?
How are medical problems addressed in rehabilitation?
What is done to support adjustment and coping during rehab?
What mobility and independent living activities are done in rehab?
How do you plan for return to community living in rehab?
Who works in rehabilitation?
How long do people stay in rehabilitation?
Where do people go after rehabilitation?
Rehabilitation length of stay and discharge
The SCI care pathway
Typical rehabilitation length of stay around the world
How has rehabilitation length of stay changed over the years?
Injury/demographic factors influencing rehab LOS
Healthcare system factors determining rehab LOS
Socio-Cultural factors determining rehab LOS
Does greater rehab length of stay improve outcomes?
Working with a primary care provider
What is a primary care provider?
When should I see my primary care provider?
When do I need to go to urgent care or emergency?
How do I prepare for appointment?
What should I ask my primary care provider to check?
How can my PCP improve their knowledge of SCI?
Research
Understanding study designs
What types of research studies are there?
Understanding results and strength of evidence
What is “research evidence”?
Why do we need research evidence?
How do you determine the quality of the evidence?
What are the limitations of research evidence?
Making decisions using research evidence?
Applying research to care decisions
Spinal cord injury research
What if there is no research on something?
Body & Function
Bladder Health
How the bladder changes after SCI
How does the bladder work?
How does the bladder change after SCI?
What are “spastic” and “flaccid” bladder?
Urinary catheters
Bladder assessment and monitoring
How are bladder changes diagnosed?
Bladder routines and catheters
How are bladder changes managed?
Reflex voiding
What are urinary catheters?
Why are urinary catheters used?
What types of catheterization are there?
How effective are urinary catheters for managing bladder problems after SCI?
Medications, injections and surgery
Medications and injections
Bladder surgery and stents for bladder management
Other treatments
Urinary infections and other complications
What other complications are related to bladder changes?
What are the risks and side effects of using urinary catheters?
What are urinary tract infections?
What do urinary tract infections look and feel like?
Why do urinary tract infections happen?
How are urinary tract infections diagnosed?
How are urinary tract infections treated?
What can be done to prevent urinary tract infections?
Bone Health
Bone changes and osteoporosis
What is osteoporosis?
What is osteoporosis after SCI?
Why does osteoporosis happen after SCI?
Who is at risk for osteoporosis and fractures after SCI?
Bisphosphonates
Risk factors, screening and diagnosis
How is osteoporosis after SCI diagnosed and measured?
Preventing bone loss and fractures
How is osteoporosis after SCI treated?
Physical therapy
Osteoporosis treatment options
Bowel Health
How the bowel changes after SCI
How does the bowel work?
How does bowel function change after SCI?
What are “spastic” and “flaccid” bowel?
What bowel problems can happen after SCI?
Hands-on bowel techniques
Diet and fluids
Bowel assessment and complications
How are bowel changes diagnosed?
Building a bowel routine
What is a bowel routine?
Medications, procedures and surgery
Medications and suppositories
Other treatments
Breathing
How breathing changes after SCI
How does the respiratory system work?
How does an SCI affect the respiratory system?
What secondary respiratory issues occur with acute SCI?
Respiratory infections and complications
What happens to the respiratory system after SCI?
What is the immune system?
What happens to the immune system after SCI?
Why are people with SCI at higher risk for respiratory infections?
What infectious respiratory conditions should I be aware of?
What can you do to prevent infectious respiratory conditions?
What are the risks and side effects of using inspiratory muscle training?
How can respiratory complications be managed acutely?
Breathing exercises and assisted techniques
What is ‘inspiratory muscle training’?
How is inspiratory muscle training done?
Why is inspiratory muscle training used?
Are there restrictions or precautions for using inspiratory muscle training?
Does inspiratory muscle training work for people with SCI?
Equipment, ventilation and other treatments
How can mechanical ventilation be used to help breathing?
How are respiratory problems managed and prevented long term?
What is the emerging research on processes to help with breathing?
Skin Health
Understanding pressure injuries
What are pressure injuries?
Why is it important to know about pressure injuries?
Recognizing and assessing skin damage
What are the stages of pressure injuries?
How are pressure injuries diagnosed?
Daily prevention and pressure relief
What can be done to prevent pressure injuries?
How can I find the time and resources to do prevention?
Seating and pressure mapping
What is pressure mapping?
Why is pressure mapping used?
How is pressure mapping done?
What are the limitations to the use of pressure mapping?
How effective is pressure mapping?
Wound care and treatment options
What causes pressure injury?
How are pressure injuries treated?
Spasticity
Understanding spasticity and its triggers
What is spasticity?
What does spasticity feel or look like?
Why does spasticity happen?
Assessment and effects on daily life
How is spasticity diagnosed?
Physical approaches and self-management
Should spasticity be treated?
How is spasticity treated?
Medications, injections and surgery
Staying Healthy
Autonomic and Cardiovascular Health
Autonomic dysreflexia: signs and emergency care
What are the signs and symptoms of autonomic dysreflexia?
Autonomic dysreflexia: triggers and prevention
What is autonomic dysreflexia?
What can happen if autonomic dysreflexia goes untreated?
What can trigger autonomic dysreflexia?
Why does autonomic dysreflexia happen?
How is autonomic dysreflexia treated?
How can autonomic dysreflexia be prevented?
Low blood pressure: symptoms and assessment
What is orthostatic hypotension?
Who is at risk of experiencing orthostatic hypotension after SCI?
Why does orthostatic hypotension happen?
How is orthostatic hypotension diagnosed?
Low blood pressure: management and abdominal binders
What are abdominal binders?
What types of abdominal binders are there?
Why are abdominal binders used?
Are abdominal binders safe to use?
How do you put on abdominal binders?
What medications are used to treat orthostatic hypotension?
What other treatment options are there?
Mental Health
Recognizing depression
What is depression?
What are the signs and symptoms of depression?
How does depression affect people with SCI?
Assessment and getting support
How is depression diagnosed?
Psychological and lifestyle approaches
What causes depression?
How is depression after SCI treated?
Medications and other treatments
Nutrition
Dietary fibre and bowel health
What is dietary fibre?
Why is fibre important in spinal cord injury?
How much fibre do we get?
How much fibre should you get?
How do you safely increase dietary fibre intake?
How do you choose the right foods?
Understanding the gut microbiome
What is the microbiome?
What happens when the gut microbiome is out of balance?
What changes occur in the gut microbiome after SCI?
What changes occur to the bladder microbiome after SCI?
What affects the gut microbiome?
Food, supplements and microbiome treatments
What treatments have a positive effect on the gut microbiome in people with SCI?
Pain
Pain types, causes and assessment
Why is it important to know about pain after SCI?
What types of pain are there?
How does pain happen?
How is pain measured?
Pain management options
How is pain after SCI treated?
What medications are used for pain after SCI?
What physical treatments are used for pain after SCI?
What psychological and mind-body therapies are used for pain after SCI?
How is surgery used for pain after SCI?
Shoulder pain and injury prevention
Is shoulder pain common?
Shoulder anatomy
What are the different classifications of pain?
What are the risk factors for developing shoulder pain?
Shoulder assessment and treatment
What is involved in a shoulder assessment?
How can shoulder injuries be prevented and treated?
Sleep
Understanding sleep-disordered breathing
What is sleep disordered breathing?
Why is sleep disordered breathing common after SCI?
Symptoms, risks and diagnosis
What are the symptoms of sleep apnea?
Sleep and breathing treatment options
What treatment is available for sleep disordered breathing
COVID-19
SCI-specific information — historical guidance
Are you at a higher risk for COVID-19 because of your SCI?
What are the precautions you can take to prevent exposure?
How can you keep your equipment clean?
What can you do to ensure you are interacting safely?
When should you seek medical attention, and what do your healthcare providers need to know?
Caregiver information — historical guidance
Hygiene and equipment
What if you get sick?
Resources for caregivers
Mental health and social connection — historical guidance
Looking after your psychological and mental health
Coping with worry during global uncertainty
What is social isolation, and what are its potential effects?
When should I seek help?
What can I do to maintain good health during the pandemic?
Movement & Equipment
Movement and Exercise
Benefits and types of physical activity
What are the benefits of exercise after SCI?
What are ways I can exercise after SCI?
What are the exercise guidelines?
How can I adapt exercises?
What should I be cautious of when exercising?
Exercise guidelines and getting started
How were the exercise guidelines developed?
What are the exercise guidelines for adults with SCI?
What are cardiometabolic health, cardiorespiratory fitness, and muscle strength?
The exercise guideline details
Adapted sports and equipment
Why be physically active after SCI?
What are adapted sports?
What types of cycling and pushing sports are there?
What adapted court sports are available?
What adapted winter sports are available?
What water sports are available?
Supported standing: benefits, equipment and safety
Why is standing used as a therapy?
What types of equipment are used for standing?
How is standing done?
Is supported standing safe?
Does supported standing work?
Walking and Mobility
Walking rehabilitation and treadmill training
What is body weight supported treadmill training?
How is body weight supported treadmill training done?
Are there restrictions or precautions for body weight supported treadmill training?
Are there other limitations to using this treatment?
Does body weight supported treadmill training improve walking after incomplete SCI?
Can body weight supported treadmill training cause stepping after complete SCI?
Robotic exoskeletons: use and suitability
What are robotic exoskeletons?
What is the history behind robotic exoskeletons?
What types of exoskeletons are available?
What are exoskeletons used for?
Are there restrictions or precautions for using robotic skeletons?
How does walking with an exoskeleton change over time?
What influences walking speed and skill acquisition when using an exoskeleton?
Benefits, limitations and safety of walking devices
What are the risks and side effects of body weight supported treadmill training?
What are the risks and considerations for using an exoskeleton?
Can I get exercise benefits from walking in an exoskeleton
What evidence is there for using an exoskeleton in the community?
Wheelchairs and Equipment
Assessment, selection and wheelchair provision
What are wheeled mobility devices?
What types of wheeled mobility devices are there?
How is a wheeled mobility device selected?
Why is device selection and set-up important?
What is the wheelchair provision process?
Manual wheelchairs
Who can use a manual wheelchair?
What are the components of a manual wheelchair?
What are adjustments I can make to the set-up of my wheelchair?
What are health concerns related to manual wheelchair use?
Powered mobility
What are power wheelchairs?
What types of power wheelchairs are there?
What parts of a power wheelchair should I know about?
What impacts battery life?
What other powered mobility devices are there?
Power assist and propulsion devices
What are wheelchair propulsion assist devices?
What are the benefits of using a propulsion assist device?
What are the risks associated with using a propulsion assist device?
What should I consider when contemplating a propulsion assist device?
What are the options for non-powered propulsion assist devices?
What are the options for powered propulsion assist devices?
Seating and positioning
What is a wheelchair seating assessment?
Why is proper seating important?
Why are cushions important?
How can a cushion help redistribute pressure?
What kinds of cushions are there?
What aspects of a backrests can be modified?
Why are footrests important?
Why are arm rests important?
What accessories are used for seating?
Wheelchair maintenance
Why is wheelchair maintenance important?
What equipment do I need to maintain my wheelchair
What maintenance and checks should be done for a manual wheelchair?
What maintenance should be done for a power wheelchair?
What are common issues that arise with manual wheelchair use?
What are some simple repairs I can do?
Daily Life
Community Living
Housing and accessibility
Why is housing important?
What factors influence where I will live after the hospital?
How do I make my house accessible?
What renovations can I make to my home to make it accessible?
What are low-cost methods of making my home more accessible?
Driving and vehicle adaptations
Why is driving after SCI beneficial?
How do I know if I can drive?
What does a driving assessment look like?
How will I learn to drive?
What kind of vehicle can I drive?
What kinds of adaptations are available for my vehicle?
What are some considerations when using and buying an adapted vehicle?
Travel planning and accessibility
What should I consider when selecting a trip destination?
What are considerations for finding accommodations?
What are considerations for transportation?
What should I pack for my trip?
Air travel: Before the flight
Air travel: At the airport
Air travel: Boarding the plane
Air travel: During the flight
Air travel: Arriving at your destination
The role of mobile apps
Quality of life and community experiences
What is quality of life?
Does spinal cord injury impact quality of life?
What can increase quality of life for people with SCI?
What can decrease quality of life for people with SCI?
Does accessibility impact quality of life?
Reproductive Health
Pregnancy planning and care
Can I get pregnant after SCI?
What should I know before pregnancy?
What are the potential risks during pregnancy?
Should I get an epidural?
Do I need a caesarean section?
What should I expect after my pregnancy?
Labour, delivery and recovery
What should I expect during childbirth?
Do I have to give birth at a large hospital?
Breastfeeding and support
Why is breastfeeding recommended?
Can I breastfeed?
What are the challenges during breastfeeding?
Will the level of my spinal cord injury affect my ability to breastfeed?
How will I be able to get my baby to latch effectively?
What specific positions and aids can I use to help me with breastfeeding?
What should I do if I cannot produce enough milk?
What breast health issues should I be aware of?
Can I stay on my SCI medications and breastfeed at the same time?
Am I at risk for autonomic dysreflexia (AD) during breastfeeding?
Will I have difficulty bonding with my baby if I have breastfeeding problems?
Am I more at risk for postpartum depression after delivery of my child?
Where can I find additional support and information?
Contributors
Acknowledgements
Parenting experiences
Sexual Health
Sexual changes and relationships
What is “sexual health”?
What is “sex”?
How do the sex organs work?
What changes after SCI?
What other considerations affect sexual health?
What other techniques may be used to improve sexual health?
Sexual function and assessment
What is a sexual health assessment like?
Treatment options for men
What medical treatments are available for men?
Treatment options for women
What medical treatments are available for women?
Treatments & Recovery
Medications
Baclofen: uses, delivery and evidence
What is baclofen?
How is baclofen used?
Are there restrictions or precautions for using baclofen?
Baclofen: risks and treatment decisions
What are the risks and side effects of using baclofen?
Botulinum toxin: uses, treatment and evidence
What is botulinum toxin?
How is botulinum toxin treatment done?
How does botulinum toxin work?
Are there restrictions or precautions for using botulinum toxin?
Is botulinum toxin effective?
Botulinum toxin: risks and treatment decisions
What are the risks and side effects of botulinum toxin?
Alternative Medicine
Acupuncture: use, evidence and safety
What is acupuncture?
How is acupuncture done?
How does acupuncture work?
Are there restrictions or precautions for using acupuncture
What are the risks and side effects of using acupuncture?
Is acupuncture effective for treating the symptoms of SCI?
Cannabis: forms, uses and evidence
What is cannabis?
What are cannabinoids?
What is the difference between medical and recreational cannabinoids?
What are the ways cannabinoids can be used?
What is the suggested dosing of cannabis?
What are cannabinoids used for after spinal cord injury?
Cannabis: risks, interactions and access
What are the risks and side effects of cannabis?
Neuromodulation
Functional electrical stimulation: uses and equipment
What is “functional electrical stimulation” (FES)?
How is FES done?
Are there restrictions or precautions for FES?
Does FES improve strength and fitness after SCI?
Functional electrical stimulation: evidence and safety
How does FES work?
What are the risks and side effects of FES?
Does FES help with other complications of SCI?
Epidural stimulation: procedure, evidence and safety
What is epidural stimulation?
How does epidural stimulation work?
How are epidural stimulation electrodes implanted?
Are there restrictions or precautions for using epidural stimulation?
What are the risks and side effects of epidural stimulation?
Epidural stimulation and bladder and bowel function
Epidural stimulation and body composition
Epidural stimulation and pain
Epidural stimulation and respiratory function
Epidural stimulation and sexual function
Epidural stimulation and spasticity
Epidural stimulation and temperature regulation
Epidural stimulation and cardiovascular function
Epidural stimulation and hand function
Epidural stimulation and movement: trunk control
Epidural stimulation and movement: voluntary movements
Epidural stimulation and movement: walking and standing
Costs and availability of epidural stimulation
TENS: use, evidence and safety
What is “transcutaneous electrical nerve stimulation” (TENS)?
How is TENS used?
How does TENS work?
Are there restrictions or precautions for using TENS?
What are the risks and side effects of using TENS?
Is TENS effective for treating pain and spasticity after SCI?
Surgery
Nerve transfer: eligibility and planning
What is nerve transfer surgery?
Why are nerve transfers done?
Who is suitable for a nerve transfer?
What is the process for a nerve transfer?
How do nerve transfers compare to tendon transfers?
What are the limitations of nerve transfers?
Are nerve transfers effective?
Lived experiences of nerve transfer
Nerve transfer: procedure and rehabilitation
Nerve transfer: results, risks and experiences
What are the risks of nerve transfers?
Repair and Recovery
Neuroprotection: approaches, evidence and risks
What is neuroprotection?
What causes secondary injury?
What types of neuroprotection are there?
Why is it so difficult to find effective neuroprotective treatments?
Stem cells: approaches, evidence and risks
What are stem cells?
What are stem cells used for?
How can stem cells be used for SCI?
What stem cell research has been done in human SCI populations?
Accessing experimental treatments and making decisions
What are the risks and considerations of using stem cells?
Should I participate in a stem cell clinical trial?
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Pain and aging
How does aging affect pain after SCI?
Aging can add musculoskeletal and other health-related sources of pain.
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