Managing Spinal Cord Injuries with Tracie Lemus

In this episode, Tracie Lemus, RN, CCM, MSCC, National Catastrophic Nurse Consultant at Midwest Employers Casualty, highlights critical care strategies and rehabilitation insights for better recovery outcomes for spinal cord injuries. Tracie provides invaluable knowledge on injury types, common complications, and the importance of comprehensive treatment. 

Topics covered include:

• Understanding spinal cord injury demographics and causes 
• The importance of immediate care and specialized centers 
• Complications and their management 
• The role of rehabilitation in recovery 
• Transitioning home and ongoing support needs 
• Impact of vocational rehabilitation on independence 

Chapters

• 0:02 Understanding Spinal Cord Injuries
• 7:28 Reintegrating Through Vocational Rehabilitation

Transcript

Sara Hance: 0:02

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast from Midwest Employers Casualty. I'm Sara Hance and in these Expert Insights episodes you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Today, Tracie Lemus, national Catastrophic Medical Consultant, will discuss spinal cord injuries. Now let's hear from Tracie.

Tracie Lemus: 0:31

Throughout my career, I've worked with spinal cord injuries from immediately after they happened to multiple years out into the future. I've learned that there can be so many components to a person who has had a spinal cord injury and I hope that today I can give you some things to take away and use in your daily work. So the average age of injury is 43. Most of them are men upwards of about 78%. Car crashes are the leading cause of spinal cord injuries, followed by falls. The location of the spinal cord injury dictates what part of the body is affected, for instance, cervical controls, the neck, diaphragm, shoulders, wrists and fingers. There is a loss of muscle strength and function in all four of the limbs. Bowel and bladder is affected. Breathing can be affected and at a higher cervical injury, a person will require a ventilator to breathe for them. This level is also the most life-threatening of them all Thoracic or the middle back controls, controls, hand, trunk and chest, and abdominals. There can be significant loss of sensation and or weakness in the legs, as well as a loss of feeling in the genitals or the rectal region. These individuals will need a wheelchair, but they may also be able to stand with some assistance, like a walker or even a person be able to stand with some assistance like a walker, or even a person. Lumbar or low back controls the hips, the quadriceps, the hamstrings, the knees and feet. This level is usually not life-threatening. They could have a loss of bowel and bladder control. They may need a wheelchair, but actually may also be able to walk with devices like braces. People with this level of injury can gain back some of the independence in their life Sacral controls, erection, bowel and bladder. So a takeaway is that the higher the level of injury, the more severe the deficits will be. All levels, though, will most likely impact bowel and bladder in some way.

Tracie Lemus: 2:18

But another important aspect of a spinal cord injury is whether it is complete or incomplete. Complete injury is when there is complete or incomplete. Complete injury is when there is no nerve communication below the injury site, which means there's no muscle control, no feeling or function, and it is permanent. You may hear it referred to as being severed. With an incomplete injury, there can still be some feeling, function and muscle control below the level of the injury. The spinal cord is not fully severed. These are the injuries where you see people gaining back sensation or some function, being able to walk again.

Tracie Lemus: 2:52

Initially after the spinal cord injury they will spend some time in an acute care hospital. Surgery is done to the spine to perform and relieve the cord compression. They usually require intensive care treatment. Here at Midwest we encourage transfer, if at all possible, to a center of excellence, which is hospitals that have specialized programs with high expertise in spinal cord injuries. The disciplines work very closely together to give the person the best functional outcome. Usually the physicians and staff are experts in the care of spinal cord injury and they have all the most comprehensive treatment available.

Tracie Lemus: 3:26

There are many complications that can happen with a spinal cord injury and for time reasons, I'm just only going to touch on a few of the more serious ones. Pneumonia is a more common complication with a higher injury more to the cervical area, and that's due to their breathing status as well as possible impaired coughing. This actually has the greatest impact, though, on life expectancy of all the levels. Autonomic dysreflexia is an abnormal overreaction of the involuntary nervous system and it's usually due to stimulation. Their blood pressure can increase, slowed pulse, headache, chest tightness, sweating, nasal stuffiness Most common in the T6 levels and above, which is a higher thoracic, into the cervical levels, and they're most common in complete injuries.

Tracie Lemus: 4:08

It can be caused by something simple like a full bladder or tight clothing. This can be life-threatening, and if a patient is prone to this, there's education done on prevention and what to do if it occurs. Pressure ulcers can occur due to limited movement. This can lead to infection and can take long periods to heal. Urinary tract infections are common at all levels of injury. There's pain, yes, there's pain. A person can still have pain even though they have a spinal cord injury. It could be neuropathic or musculoskeletal in nature, due to nerve damage, pressure or just overuse of other body parts. There can also be spasms of the extremities that can be severe enough to be uncomfortable for the patient. As these complications occur, they are treated, but education on prevention is really the key. The various health care providers focus intently on this teaching with both the injured person as well as their family and or caregivers. This is why a center of excellence is preferred. They are keen to these more special type of complications and they gear their education and treatment to the more specific issues.

Tracie Lemus: 5:07

A spinal cord injury individual will actually transfer from an acute inpatient care if not at that center of excellence, to an inpatient rehab If at a center of excellence. They'll remain from acute inpatient through their rehab, so extensive time could be spent in an inpatient. Rehab could be up to several months depending on the level and the extent of the spinal cord injury. So let's talk about rehab. Rehab is the key to success with spinal cord injuries. There are multiple people on the rehab team, from medical doctors to physical occupational therapists, speech-language pathologists, psychologists or counselors, nutritionists, social workers and nurse case managers. This is the multidisciplinary approach to treating a spinal cord injury. In rehab they will need extensive PT for strengthening muscles and occupational therapy to redevelop their fine motor skills and perform normal basic activities in their daily living, like personal hygiene, eating, getting in and out of bed. They'll get counseling to help them deal with what has happened and develop coping skills as they are integrated back into the community. There are recreational activities they can do again to help integrate them back into the community, along with learning and managing their nutritional needs to promote recovery.

Tracie Lemus: 6:22

The next phase is their transition to home. They'll usually require continued outpatient PT OT. They may require some attendant care in their home, depending on their level of injury and caregiver support that they have. They may need to follow up with multiple medical specialties. Physical medicine and rehab is the ideal specialty that is preferable with a spinal cord injury. They also might require some urologist follow-up and even any type of other follow-up that they needed while they were inpatient. They could, and most likely will, need durable medical equipment in their home, from simple needs such as a commode, shower chair and or transfer boards to more complex things like lifts that can be mechanical or manual. They may need oxygen, special beds, etc.

Tracie Lemus: 7:05

Most common need for a spinal cord injury is a wheelchair, and this could be a whole nother talk on its own. So basically, the takeaway is there are multiple types of chairs, from manual to power chairs. From manual to power. An evaluation really should be done by a qualified person who knows wheelchairs to get this person into a chair that is the most beneficial to their body, habitus and their type of injury. Vocational rehab may need to be explored once they go home. You know, working leads to a healthier, more social and longer life, and just because there is a spinal cord injury, it does not always need to prevent a person from being able to return to gainful employment If you leave here with nothing else. Know that with comprehensive treatment that includes an interdisciplinary approach to rehab. A person who has had a spinal cord injury can reintegrate back into the community, become more functional again and live a productive life.

Sara Hance: 8:05

Thank you for tuning in to MEC Connect Expert Insights. I'm Sara Hance from Midwest Employers Casualty. We hope you found Tracie's talk on spinal cord injuries valuable. Stay tuned for more from MEC Connect and more Expert Insights episodes. Thank you for listening.