The spinal marrow is a collection of billons of nerve tracks . It is a two centimetre wide, 50 centimetres long strand from which, at every one and a half centimetres, left and right, back and front, subdivisions branch out. Those subdivisions or nerve roots serve as ex-tensions of the spinal marrow. Together with the brain the spinal marrow forms the ‘central nervous system’. The spinal marrow can be seen as a communication channel.
It passes signals from the brain to the body, and from the body to the brain. The brain gives infor-mation to the muscles and organs so they can function properly. In that way all motion is guided. Organs and skin give sensory information to which the brain can react. A signal comes form the skin when it gets burned, a signal comes from the bladder when it is filled etc. The spinal marrow enables movement and sensibility.
Through illness or trauma the spinal column may be damaged, it can break or be crushed so that parts of the column end up in or against the spinal marrow. Lesion means ‘dam-aged’, spinal cord lesion is damaged spinal marrow. The body does not function the way it did before. Most people think of a wheelchair when they hear of spinal cord lesion and many people with this condition end up in a wheelchair. But it means much more than ‘not being able to walk anymore’. Other functions of the body are affected as well. The nature of the damage determines whether there is complete or partial loss of functions.
The spinal marrow is enclosed by 33 rings of bone called vertebrae which have a hole in the middle and are stacked on top of each other. Through this channel the spinal marrow runs. This whole we call the spinal column.
Is divided into the following zones:
neck
middle back
lower back
sacrum
tailbone
In the diagram on the left is shown which functions can fall out after damage to the spinal marrow; the higher up the damage is, the more loss of function there will occur.
Just after the spinal cord lesion has occurred there will be a ‘spinal shock phase’ as reaction of the body to major incidents. Functions can temporarily disappear en reappear later on. Sometimes functions can partly improve, other functions may never come back.
What people do with limited possibilities varies widely. People make use of their bodies in varying ways and they experience their situations in different ways.
Degree of the restriction.
When the spinal marrow does not pass any information anymore we speak of a complete spinal lesion. The body below the lesion is senseless and the muscles cannot be controlled anymore. If, after the first few days spontaneous recovery does not occur, we can assume that the fall out remains complete. Sometimes the spinal marrow functions partly. In case of such an –incomplete- spinal cord lesion some movement or sensitivity may be possible. Sense or feeling is usually less damaged. In case of a partial lesion there is more chance of recovery, although recovery will be slight. When the spinal mar-row is really damaged it does not recover. Scar tissue in the spinal marrow is not re-placed; it will continue to stop the flow of information.
Paralysis of arms, legs and rump.
When orders from the brain to move are not passed on to the muscles one is paralyzed. The muscles have lost their control and remain unused.
A spinal cord lesion almost always causes complete paralyses of the legs. The higher the lesion, the more the rump will be paralyzed and lack any feeling. This increases the diffi-culty of sitting properly and keeping one’s balance. Everyday actions for which the arms are necessary, such as dressing, washing and eating may be hard to perform. When a spinal cord lesion is so high up that the arm and hand functions are impaired, dependence on others increases. Even the most essential activities, such as moving the wheelchair and personal hygiene, can be difficult or even impossible.
In case of a high lesion the rib and stomach muscles that are necessary for deep breath-ing and coughing are paralyzed as well. Breathing only happens through the midriff. When coughing is impossible an accumulation of slime in the lungs will occur. This can cause infections. Often it is possible to learn to cough in another way, with or without the help of someone else. Only in case of a very high lesion, -the upper three vertebrae – the midriff is paralyzed and breathing is difficult or impossible. Then one is dependent on a life sup-port machine.
Other impairments to legs, arms and rump.
Depending on the height of the lesion there is a slack or a spastic paralysis. In case of the latter, the muscles below the lesion can involuntary tighten without the possibility of con-trol. This can be small movements, but a paralysed leg can also just jerk up of a sudden. This is called a spasm. A light form of spasm can be useful to keep the muscles in a good condition. Spasm can lead to bodily problems such as constipation, inflammation of the bladder, damage because of pressure or small wounds. Psychological pressure can also worsen spasms. Spasms can be avoided by removing the causing factors and maybe through therapy or spasm restraining medicines.
Muscles and joints.
Muscles and joints can become useless when there is not enough movement and they remain in one position. This causes shortening of the muscle tissue or withering of the joint capsule. The tissue shrinks so that the joint becomes contracted and forced into a certain position. Exercises done by a physiotherapist right after the trauma occurs are very important in order to prevent contractures. Self-exercise can – if possible – cause improvement. Only if exercising shows no result is treatment with splints or an operation necessary.
Feeling
The body beneath the lesion often has no sense of feeling. In the beginning this is a strange experience, as though this part of the body does not belong to you. Internal pain often is not felt either and with the loss of feeling we loose an important natural alarm sys-tem.
It seems strange, but people sometimes feel pain in their senseless legs or arms. This is similar to the phantom pain people can experience after an amputation. “Root pain “ can be felt as well, which is caused by damaged nerve roots. It appears to be difficult to sup-press this pain. Some people find relieve in sports like yoga. As time goes by this pain can lessen or disappear.
Bladder.
Just as the legs, the bladder has a slack paralysis in the first days after the spinal lesion has occurred. This slack paralysis usually does not improve after a low lesion. In case of higher lesion a “reflex bladder” may develop. This means that the bladder will be taut and can contract. A slack bladder can best be emptied by catherisation at set times. Usually people learn to do this themselves, so it is possible that during a match there may be loss of urine. Especially with a sport as judo where constantly pressure is applied to the body this is not unusual. Taking precautions like wearing protective clothing or emptying the bladder before training may solve the matter.
Bowel movement.
Incontinence of faeces or the care of it is often seen as the largest problem for people with a spinal cord lesion. Often the sphincter is paralysed or there is no sense of a full intes-tine. The chance of incontinence is high. Often it is possible to achieve a sort of control because the intestines are completely emptied at set times. Fibrous food such as whole meal bread, raw vegetables, fresh fruit and bran, and a fixed rhythm are important to achieve this. Usually some sort of medication is applied, like micro enema or suppository. If this will not suffice rinsing of the intestine may be a solution. Experience and precau-tions before or during the training can solve these problems as well.
Blood pressure.
Disorganization of the before mentioned autonomous nervous system can also influence blood pressure. In case of spinal cord lesion above the 6th vertebrae autonomous disor-ganizations may occur, and blood pressure may suddenly soar. It will not always happen but it is important to know of this phenomenon because it is very dangerous. It can be caused by an alarm signal in a “hollow” organ beneath the lesion such as a too full blad-der or intestine, or a pain signal from the womb. If the signal is not understood the blood vessels will narrow. The vessels above the lesion will in vain try and compensate by wid-ening themselves and the pressure goes up. An attack will show itself by sweating, hot flushes or a horrible hammering headache, dots in front of the eyes, the skin of the face may be red and warm, the nose may be blocked and there may be a feeling of fear. First the bladder needs to be emptied with the help of a catheter. If necessary the intestine should be emptied with a finger. Then it is necessary to put the person in a sitting position, elastic stockings and other pressing clothing should be removed. If all this does not help a doctor should be called and the pressure will have to be brought down with medication.
Skin
The skin is a constant focus of attention after a spinal cord lesion. The skin has become more vulnerable and the condition of the muscles beneath the skin has deteriorated. Be-cause of paralysis you sit and lie relatively a lot during judo which causes extra pressure on the skin. When a lot of pressure or friction is applied to one spot, blood vessels can become squeezed off or the skin becomes damaged. Usually this causes a burning or painful sensation which will cause you to move. After a spinal cord lesion this signals are not felt anymore. When the pressure is applied too long decubitus or sores will occur. Because of lack of blood in the skin tissue will die off. First the skin becomes red. If the skin remains red longer than half a hour after the pressure has been removed then there is the beginning of a sore. If the pressure remains the skin will turn darker. Skin and un-derlying tissue will break down. The longer the pressure continues, the deeper the sore will be. Sores will occur where bone is just beneath the skin. When playing judo sufficient attention should be paid to this fact. With the help of adjustments such as: wearing socks, knee pads or other materials that protect the skin sores can be prevented. Wounds and sores develop quicker than they heal and there is a chance of infection. The conse-quences can be serious and crèmes and ointments are of no avail. The founder of spinal cord lesion treatment, dr. Guttmann, says: “it does not matter what you put on decubitus as long as you do not put the patient on top of it”. Sores of course develop in places where a lot of pressure is applied. When decubitus develops on the backside it is neces-sary to remain in bed, preferably lying on the stomach because then there will be no pres-sure on the skin.
