How is non-traumatic SCI treated?

Author: Dominik Zbogar, Kelsey Zhao | Reviewer: Peter New | Published: 17 September 2024 | Updated: ~

Most of the rehabilitation process will be similar between traumatic and NTSCI while treatment of the underlying conditions that cause NTSCI will vary. Rehabilitation common to both traumatic SCI and NTSCI includes:

• Education about the SCI and the related medical problems that need to be managed.
• Complication management and prevention: In people with all types of SCI, complications like urinary tract infection, pneumonia, pressure ulcers, spasticity and neuropathic pain are common and managed in rehabilitation. Prevention and education are essential to minimize complications.
• Physical and occupational therapy: Physical therapists work with patients to regain mobility, strength, and coordination. Occupational therapists focus on helping patients adapt to their new circumstances, relearn daily living skills, and regain independence. Both are critical essential to rehabilitation after SCI.
• Assistive devices: Mobility aids, adaptive equipment, assistive technologies, and other supports like cushions and mattresses can significantly improve the quality of life for people with SCIs. These devices help with mobility, communication, daily tasks, and prevent complications like pressure ulcers.
• Pain management: Chronic pain is a common issue in that can be managed with medications, nerve blocks, or other interventions to alleviate discomfort.
• Bladder and bowel training: Medical treatments can be used to treat bladder and bowel problems. Training also includes learning how to manage your bladder and bowel care after rehabilitation.
• Psychological support: Psychological support and counseling can help individuals and their families navigate the challenging emotional aspects of coping with SCI.
• Community reintegration: In preparation for leaving rehabilitation, the health team should provide support in finding local resources and services, managing finances, returning to regular life activities, and adapting the home for SCI.

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NTSCI presents unique rehabilitation challenges. Given that those with NTSCI tend to be older, there is an increased likelihood of chronic conditions such as arthritis, diabetes, cardiovascular disease, obesity, and other conditions. These comorbidities can negatively impact rehabilitation and recovery.

Predicting rehabilitation outcomes after injury is particularly difficult in those with a progressive NTSCI, where the condition underlying the SCI leads to a deterioration over time compared to those with a non-progressive cause of NTSCI. The cause of NTSCI is an important predictor of outcomes, length of stay, and survival.

Considering the older age of many people with NTSCI, the various possible chronic health conditions that they may have, and that many NTSCI are incomplete, it can be very hard to predict the recovery from NTSCI. Making comparisons with traumatic SCI is also very hard for the same reasons.

People with NTSCI have improved recovery outcomes when they are treated in a spinal-specific rehabilitation unit rather than in general rehabilitation. Clinicians agree that that a spinal rehabilitation unit that specializes in NTSCI is the ideal setting for treatment. However, there is a tendency for spinal rehabilitation units to give preference to traumatic SCI when admitting clients as NTSCI is considered less urgent and they may exclude older patients or those with metastatic cancer presumably referring them to gerontology and oncology units, respectively.

Depending on the cause of the NTSCI, some people will undergo treatments for the underlying condition at the same time as rehabilitation. This could include surgeries, radiation therapy and chemotherapy for tumours, immunosuppressant medications for auto-immune conditions, antibiotics for bacterial infections, etc. The rehabilitation unit needs to be aware of these treatments for safety and to optimally plan treatments and rehabilitation therapy. Some treatments for underlying conditions can be draining and negatively impact rehabilitation if therapy is scheduled soon after.

There is also a possibility for people with NTSCI to be admitted to rehabilitation without a diagnosis or with an incorrect diagnosis of the underlying condition. In these situations, rehabilitation clinicians and therapists may end up being involved in determining the correct diagnosis.