[Host] Not many people know about spinal cord injury, they just know that this disease can make people unable to walk. So where exactly is the spinal cord located in the body? What is its function?
The spinal cord is a part of the central nervous system and is located in the vertebral canal of the spine, which is long and cylindrical. The upper end is connected to the medulla oblongata in the skull, and the lower end is conical, which varies with individual development (e.g., the difference in height), and finally the lower edge of the first lumbar vertebra or the upper part of the second lumbar vertebra in adults (the third lumbar vertebra is flat in newborns). In clinical practice, lumbar puncture or lumbar anesthesia is most often performed between the 3rd-4th or 4th-5th lumbar vertebrae because the spinal cord is not damaged by puncture here.
The spinal cord is composed of many bundles of nerves and nerve cells. It can transmit sensory stimuli from the body (e.g. pain, temperature, touch) to the center (brain) and also transmit commands from the brain to motor muscle groups (limbs, trunk, etc.) to produce random movements, such as walking, running and jumping, squatting, picking up things, etc. In addition, the control of urination and defecation is also a function of the spinal cord.
Moderator】What causes spinal cord injury? What are the consequences of spinal cord injury?
There are two main causes of spinal cord injury, one is due to trauma and the other is due to congenital development or certain diseases.
The most common trauma is a fall from a height (e.g. Deng Pufang), others such as construction workers, air conditioning installers, high-rise cleaners, etc., followed by car accidents and heavy objects (one of the patients was injured by a six-ton sandbag), and natural disasters (Tangshan and Wenchuan earthquakes).
Non-traumatic spinal cord injuries include the following causes: developmental diseases: spinal vascular malformations, congenital scoliosis, spina bifida, spondylolisthesis, etc. Acquired diseases: infections, the most familiar polio, everyone takes sugar pills to prevent this disease, as well as spinal tuberculosis, septic infection of the spine, transverse myelitis, etc.; spinal cord tumors (Zhang Haidi), degenerative diseases of the spine, etc.
The consequences of spinal cord injury, especially the more serious spinal cord injuries, are very serious. Because of the different parts of the injury can cause “quadriplegia” (refers to the cervical spinal cord injury) that is, paraplegia and “paraplegia” (refers to the thoracic and lumbar spinal cord injury).
This is mainly due to loss or loss of sensation below the level of injury, inability to move the limbs, incontinence, etc. The person loses the ability to walk for the rest of his or her life, and cannot control urination or defecation, and needs to use diapers. People with complete spinal cord injury, in particular, cannot take care of themselves and need to be cared for, and many comorbidities can arise as a result. For example, pressure sores (commonly known as bedsores) caused by prolonged bed rest and local skin pressure, urinary tract infections caused by urinary incontinence, osteoporosis and even fractures caused by prolonged non-standing, deformity, contracture and fixation, muscle atrophy caused by prolonged bone and joint immobility, and spasms (commonly known as “cramps”) and pain caused by destruction of spinal nerves. The heterotopic ossification around the hip and knee joints, venous thrombosis of the lower extremities, etc. In addition, because there is no effective medical treatment for spinal cord injury, the above-mentioned serious consequences can cause great psychological trauma to the patient, resulting in psychological imbalance, pessimism, disappointment, anxiety, depression may arise, and serious suicidal behavior.
[Host] We have heard that many injured people, who were able to move their limbs, ended up not being able to do so once they were moved during resuscitation, what happened?
[Experts] Yes, it is a pity that people who did not have spinal cord injury have spinal cord injury due to improper resuscitation at the scene. And according to medical research, about 1/4 of the patients’ condition is aggravated by improper resuscitation at the scene, making the original spinal fracture without spinal cord injury produce spinal cord injury, or making the original very mild become serious spinal cord injury.
Moderator] Then how to deal with cervical, thoracic and lumbar trauma patients in first aid at the scene?
If everyone understands the mistakes that should be avoided in on-site first aid, it will definitely reduce the tragedy of spinal cord injury a lot. In the field of first aid, be sure to fix the head, especially not to lower or turn the head, the head and torso must be turned in one direction at the same time; in addition, it is best to carry in situ, can not easily change the position of the casualty, especially not to use one person to lift the axillary part, one person to lift the lower limbs of the method of transport, the casualty should be fixed on a hardwood stretcher to carry, and fix the casualty can not move, to avoid unnecessary examination at the scene, so said ; “Recovery begins when moving.” This is the truth.
Host] The consequences of spinal cord injury are so serious, can it still be cured?
Expert】For incomplete spinal cord injury, various functions can be restored through treatment and self-healing ability, but for complete spinal cord injury, functions below the injury site will be permanently lost, such as a wheelchair for life.
Moderator] Then why do we let patients with spinal cord injuries go to rehabilitation? What role can rehabilitation play in spinal cord injury?
[Expert] Rehabilitation is not only a treatment for the patient, but also the only way to improve function and ability. It is the application of modern medical technology to enable patients with spinal cord injury to restore motor and sensory functions as far as possible, and to guide patients with severe spinal cord injury to learn to use their residual limb functions to the maximum extent possible to compensate for the lost functions, to eliminate and alleviate the functional impairment of patients, and to help patients to recover their living and working abilities to the maximum extent possible within the scope of their body’s permission, to rejoin social life, to be self-reliant, and to become a A person who is disabled but not disabled, a person who has the ability to live independently. Regardless of the degree of spinal cord injury, after early surgery or medical treatment, rehabilitation should be carried out as early as possible.
Moderator] When is the best time to start spinal cord injury rehabilitation? How early is early?
Experts】Patients with spinal cord injury have two types of conditions after the injury: one requires surgery, and the other is conservative treatment (i.e., no surgery). As long as the condition is stable and there are no other combined injuries, rehabilitation should begin. Of course, the early activities are not allowed to be too wide, and should not affect the effect of surgery. The main activity should be to move all joints of the body to maintain normal joint mobility, 2 to 3 times a day, with each joint moving for less than 1 minute. In addition, with the doctor’s permission and under the nurse’s guidance, position change, that is, regular turning, to prevent pressure sores, usually once every 2 hours, and protruding bone parts (such as the scapula, heel, posterior back, sacrococcygeal, and both limbs) with soft cushions, there is now an anti-pressure sore air cushion that is alternately inflated, which can well prevent the occurrence of pressure sores. In addition, we should pay attention to the smooth discharge of urine and stool, temperature changes, comforting patients, improving their psychology, notifying doctors and nurses of any abnormal changes, paying attention to the nutrition of food and drinking water regularly. If early rehabilitation is done well, it will create a good foundation for comprehensive rehabilitation training in the future.
Moderator】What are the main methods of spinal cord injury rehabilitation at present?
【Expert】The main methods are
(1) Physiotherapy: mainly to improve the movement of all joints and strengthen the residual muscle strength, as well as balance and coordination movements and position exchange and transfer movements (for example: lying to sitting, turning, moving from bed to wheelchair, from wheelchair to toilet, etc.), and physical therapy: using hydrotherapy, light therapy, biofeedback and other targeted to promote recovery.
(2) Occupational therapy: mainly daily life movements (such as basic skills for clothing, food, housing, and transportation), occupational labor movements, and craft labor movements (such as knitting, etc.) to enable patients to adapt to their personal, family, social, and labor needs after discharge from the hospital. In addition, the operation department also provides patients with simple auxiliary tools to facilitate the successful completion of family life movements.
(3) Psychotherapy: A psychotherapy plan is developed for changes in different stages of the psyche (such as denial, anger, depression, opposition to various stages of independence seeking adaptation, etc.), which can be carried out individually and in various ways such as group, family, and behavioral.
(4) Rehabilitation engineering: Some necessary supports can be custom-made to practice standing and walking, and in addition, special tools such as walkers can be equipped to compensate for the lack of function by these tools.
(5) Clinical rehabilitation: Prevention of various comorbidities by means of nursing care and medication, as well as some therapeutic clinical treatment to reduce symptoms and promote functional recovery.
(6) Traditional Chinese medicine rehabilitation: Using traditional Chinese medicine, acupuncture, massage, electroacupuncture, and ionization of Chinese herbal medicine to promote recovery, in addition to the treatment of comorbidities, Chinese medicine can be widely used internally and externally.
(7) Nutritional therapy: Develop reasonable recipes and enhance nutrition to meet the needs of rehabilitation training.
【Moderator】As a patient’s family, what should you pay attention to during the patient’s rehabilitation training?
【Expert】After spinal cord injury, especially during hospitalization, we should pay attention to the following issues.
(1) should cooperate with the doctors and nurses, in accordance with the doctor’s orders to complete the treatment and training tasks, do not listen to the prescriptions, folk remedies, special prescriptions, etc., to prevent deception.
(2) Give the patient spiritual encouragement and comfort, not to complain about people, not to be impatient. Patients are often bewildered and overwhelmed because they are mentally unprepared due to sudden trauma, so help patients to recuperate at ease and mention less about the adverse prognosis.
(3) Patients should be provided with nutrients, patients with indwelling catheters should drink more water, and post-surgical patients should enhance nutrition and eat more fruits. (Eat reasonably and do not eat large amounts of fish and meat to prevent excessive weight gain)
(4) If there is no stool for more than a week, the doctor should be notified to give treatment. Patients with sweating, uncomfortable, flushed face and fast heartbeat should think that it is poor stool, and should be handled by the doctor and nurse in time, don’t be careless!
(5) Assist the patient to move all joints daily to protect the normal range of motion of the joints for future rehabilitation training and completion of daily life movements.
(6) If the skin color is abnormal, notify the nurse promptly and give massage with the nurse’s consent to promote blood circulation in the skin. Do not put pressure on areas where pressure sores have appeared, pad around them, and use anti-pressure sore air cushions in a timely manner.
(7) Drink water regularly, urinate regularly, and limit intake. Drink water once an hour, no more than 125 ml each time, and do not drink large amounts of water at a time. Some patients once the urinary tract is obstructed, it will make the bladder expand for a short time, which is damaging.
(8) To comfort the patient to recuperate at ease and encourage the patient’s confidence to overcome the disability. The support of family members is the guarantee and strong backing for the patient’s recovery.
【Moderator】How is the effect of spinal cord injury rehabilitation?
【Expert】The effect of spinal cord injury rehabilitation is called “rehabilitation goal” in medical science. This goal can vary depending on the degree of disability caused by different injury planes. The rehabilitation effect of quadriplegia caused by cervical injury is worse than the effect caused by thoracolumbar injury.
In general, patients with a cervical 4 injury are dependent on others for basic living assistance, but can rely on self-help devices for meals and can rely on head control of a long-backed power wheelchair.
Patients with cervical 5 injury can take care of their own movements on the table, but others still need assistance, and can use a long-back manual wheelchair.
Patients with neck 6 injury can perform most of their daily activities by themselves, can move horizontally, and can push the manual wheelchair.
Patients with cervical 7 injury can take care of their own daily activities, turn over and sit up, and support their bodies for transferring movements. They can use the manual wheelchair freely.
Patients with cervical 8 and thoracic 1 injuries can use long lower limb braces and double crutches to walk in a small range.
Patients with thoracic 1 and thoracic 2 injuries do not need assistance from others at all and are otherwise better off than thoracic 1. The situation is basically similar to that of thoracic 11.
Patients with thoracic 12 injuries had good trunk balance and could walk and go up and down stairs with long braces and double crutches.
Patients with lumbar 1 injuries are basically the same as thoracic 12, but the pelvis can be lifted.
Patients with lumbar 2 injuries can complete practical walking with a brace.
Patients with lumbar 4 and sacral 1 injuries can walk with a short lower extremity brace.
As for how long to train to achieve the above goals, if in a rehabilitation specialist hospital, it takes about 8 to 12 months for neck injuries and about 4 to 6 months for thoracolumbar segments. Of course, the above goals can also be achieved in the community or at home under the guidance of a physician, which also takes a relatively long time. In general, the training time is relatively short for young and physically fit patients and relatively longer for older and frail patients. In addition to physical training, it is also necessary to spend a certain amount of money to equip the support and wheelchair, otherwise it is difficult to achieve these goals.
Host] Can a neural stem cell transplantation that is now available allow spinal cord injury patients to stand up?
Expert】Neural stem cell transplantation is an international and domestic research direction, and it is hoped that this method can really make patients stand up. However, the entire world medical community is now in the exploration and experimentation stage, and there is not a single successful case, especially for patients with complete spinal cord injury. Therefore, many medical professionals put their hopes on Chinese medicine treatment. It is hoped that the combination of Chinese and Western medicine can improve the various functional conditions of patients as much as possible. Especially, acupuncture treatment.
[Host] Acupuncture is recognized in many countries as our national treasure, and I have heard of many miraculous effects in the treatment of diseases. What role can acupuncture play in the recovery of spinal cord injury?
Expert】Chinese medicine, especially acupuncture, has achieved fruitful results in the treatment and research of spinal cord injury, especially in improving urinary and fecal functions, sensory and motor functions, controlling symptoms, improving quality of life, and reducing the death rate, etc. The effectiveness is remarkable.
Host】What is the characteristic treatment of Chinese medicine in our rehabilitation center?
【Expert】 Acupuncture and moxibustion and Chinese medicine are used. Especially the moxibustion method in acupuncture is a method that we improve the traditional moxibustion method to treat the characteristics of spinal cord injury patients. The main types are as follows.
The moxibustion method is a combination of traditional moxibustion “Guan Yuan” method and “refining umbilical cord method” and improved. The first time it was seen in the Yellow Emperor’s Classic of Internal Medicine, the Jin dynasty, Ge Hong’s and the medical doctor Chen Yanzhi, was one of the pioneers who advocated moxibustion therapy, applying “with the year”. From the Tang Dynasty to the Ming and Qing Dynasties, it was included as an important content in the medical texts such as “Qianjin Yifang”, “Qianjin Essentials”, “Shengji Zuilu”, “Wai Tai Secrets” and “Zisheng Jing of Acupuncture and Moxibustion”, etc. It is rich in acupuncture points and involves a wide range of diseases, including first aid, miscellaneous internal diseases, surgical diseases, gynecology, male diseases, pediatric diseases and mental symptoms.
”The moxibustion method is a simple method of quantification that takes into account individual differences and provides an excellent solution for the quantification of moxibustion treatment.
The moxibustion method has the function of warming the dantian, strengthening the yuan yang, cultivating the yuan and strengthening the essence, and tonifying the marrow. It can be used by healthy people to strengthen the body, delay aging and prolong life.
②Ren vein moxibustion: self-invented moxibustion method. It is a method of applying moxibustion on the Ren vein. The moxibustion area is from the Hatsuo point to the Zhongji point, and the umbilicus is filled with the medicine invented by our department, which nourishes kidney yin and warms kidney yang, covered with ground ginger 125px wide and 62.5px high, covered with moxa strips, and ignited.
The Ren Vessel is the sea of the Yin Vessel, which can be adjusted to nourish the blood, promote digestion, nourish the Yin and replenish the deficiency, protect the female uterus and ovaries, delay menopause, and care for the function of the male prostate. This moxibustion method is widely used to treat a variety of diseases, especially effective for Yang, deficiency and cold evidence, can play: health care, anti-aging and prevention of decline; warming Yang to replenish deficiency, return Yang to fix off; tonifying the middle and benefiting Qi, rising Yang and lifting trapped, warming the menstruation and dispersing cold, moving Qi and relieving pain, benefiting Qi and invigorating blood, dispersing nodules and eliminating swelling, supporting the righteous and anti-cancer, pacifying the liver and lowering rebellion, leading Qi downward.
It is a special method of moxibustion for treating diseases by moxibustion on the back of the body. The whole moxa cone is slowly burned out, each time can moxibustion 1-3 strong.
The moxibustion combines the therapeutic effects of the meridians, drugs, ginger and moxibustion, with ginger being pungent and warm, and moxibustion being warm and permeable, both of which enhance the permeability of the skin and promote the absorption of the drug components. The moxibustion method includes the comprehensive advantages of meridians, acupuncture points, drugs, moxibustion method and other factors, which can be described as the method of yin and yang, and in the number of techniques, multi-pronged, straight to the disease to adjust the whole body, play the function of warming the yang and dispersing cold, tonifying the kidney and the Governor, strengthening the bones and penetrating the muscle, moving Qi and blood, breaking the stasis and dispersing the knots, and relieving paralysis and pain, to achieve the effect of tonifying the deficiency of the kidney and the Governor’s stagnation “the symptoms and the root cause of the treatment”.
④Moxibustion at the anointing point: from the ancient method. Everyone knows that the idiom “sickness into the heart” originates from an allusion in the Zuo Zhuan. Commonly used “sickness into the vitals”, “the disease of the vitals” to refer to serious illnesses difficult to treat. The anointing point on the back of the human body, in the fourth and fifth thoracic vertebrae next to open three inches (about four fingers), belongs to the foot sun bladder meridian, is the main treatment of various deficiency and chronic disease points. It is named after its unique therapeutic effect. “This is a line from an acupuncture song. In the “Thousand Gold Formula”, it is said that “the Anointing can treat deficiency and thinness, five labors and seven injuries and dream loss of semen, cough, phlegm and fire, forgetfulness, prenatal and postnatal, etc., all diseases are treated”. The point is very widely used in the treatment of deficiency labor. When the body is weak and thin, the most suitable point for moxibustion can play a preventive and therapeutic role in the treatment of “disease in the heart”. It can help to support Yang and strengthen Wei, Ji Yin and calm Ying, and harmonize Qi and blood throughout the body, thus restoring strength to the body.
Although there are many treatments, spinal cord injury is still a disease that causes severe disability. Especially if it is caused by trauma, it is all the more saddening when something happens to young and strong people, the old and young at home, the pillars of the family. Therefore, in life and work, we must pay attention to safety, do not drink and drive, comply with the rules of safety, etc.. Or that saying, there is health is everything!