A Holistic Approach to Spinal Cord Injury

Spinal cord injury (SCI) is damage to the signal pathway within the spine that results in disrupted signals from the brain to the rest of the body. Injury can occur through direct trauma to the spinal cord, blood vessel malformation, infections, tumors, or immune disorders. Injuries to the spinal cord may result in temporary or permanent changes in feeling, movement, strength, and control of bodily functions. The way the body is impacted is based on where the injury occurs. If the injury is high in the spinal cord, it may impact all limbs (quadriplegia) or if it occurs lower, it may only impact the lower body (paraplegia). Injury to the spinal cord may be complete, meaning there is no nerve communication below the injury site (muscle control, feeling and function below the injury is lost) or incomplete meaning some signals and function persist below the injury site.

Symptoms of spinal cord injury:

• Numbness, tingling, loss of sensation in limbs
• Loss of movement in limbs or muscle weakness in limbs
• Pain
• Changes in breathing, bladder, or bowel control.
• Difficulty or inability to walk

Experts agree that multidisciplinary care is the gold standard of medical and rehabilitative care for individuals with spinal cord injury. We propose a new conceptual model for spinal cord injury (SCI) services that integrates issues and perspectives from multiple arenas including medical, habilitative, and social domains. The Children's Hospital New Orleans model incorporates the latest World Health Organization (WHO) framework for conceptualizing function and disability, but also the dimensions of activity and participation.

Building relationships with patients and families

Evaluation and treatment for patients with spinal cord injury and secondary conditions is achieved through a working partnership between interdisciplinary team members, the patient and family, and the patient’s primary care provider. Additionally, treatment plans are shared with the school and community care providers to optimize re-integration.

Secondary conditions we treat include:

• Muscle weakness

• Bladder or bowel problems

• Orthopedic issues

• Pressure wounds

• Changes in muscle tone

• Autonomic dysreflexia

• Pain

Collaboration with Physical Medicine and Rehabilitation

Pediatric physiatrists (physical medicine and rehabilitation providers) specialize in the rehabilitation care and medical management of children with spinal cord injuries. We understand how physical disabilities affect growth and development and incorporate this knowledge to work with patients and their families to develop and direct individualized treatment programs. The program’s main goals are to restore or improve function and maximize quality of life to facilitate school and community re-integration.

Collaboration with Gastroenterology

Children with spinal cord injury frequently have constipation caused by a neurogenic bowel, or a loss of normal bowel function. This can result from several issues including the colon’s failure to push stool out, a lack of sensation in the rectum and anus, and difficulty holding the stool in the anus. Constipation can affect everyday life and activities like school but can also lead to urinary tract infections. In our clinic, we have a gastroenterologist to help with the treatment of constipation. We discuss treatment options that work best for the child and the family. Some of these options include stool softeners and oral stimulants but frequently, rectal therapy with suppositories or enemas are required. Our goal is to treat constipation to ensure bowel continence, thus improving the child’s quality of life. Learn more about bowel management here.

Collaboration with Urology

The Urology Department at Children’s Hospital New Orleans is a large part of the multidisciplinary spinal cord clinic Urologic care of children with spinal cord injury and related disorders is an area of interest for our group. The complex neural pathways that govern normal bladder function are affected to various degrees in children with spinal cord injury and the amount of bladder dysfunction will vary. The primary goal in caring for these patients is to ensure that bladder dysfunction does not cause damage to the kidneys.

An annual kidney ultrasound is recommended to help detect any potentially negative changes in kidney health. Detailed assessment of bladder function is performed through specialized testing called urodynamics which is important to perform at regular intervals throughout childhood. Managing the bladder may require the use of intermittent bladder catheterization and/or bladder relaxing medications.

As a child ages, social continence becomes of great importance and additional medical therapies and surgical procedures may be needed to achieve this goal. We use both conventional and emerging technologies such as robotic surgery to meet the needs of this special group of patients. Urologic health in individuals with spinal cord injury and related conditions is a lifetime commitment between patients, their families, and their physicians and we look forward to serving your needs.

Equipment/ Wheelchair Needs

Physical Therapy is consulted for seating and mobility when needed.

Refer a patient

The Spinal Cord Clinic is held at the main campus at Children’s Hospital monthly and requires an internal referral after the patient is evaluated by a pediatric neurologist, neurosurgeon, orthopedic surgeon or physical medicine and rehabilitation provider.