NEUROSURGERY ARTICLES

THE QUALITY OF LIFE FOLLOWING SPINAL CORD INJURY

Kim Anderson, Ph.D.

Becoming paralyzed as a result of a spinal cord injury (SCI) encompasses much more than just not being able to walk. Other biological problems can include loss of bladder and bowel function, loss of the ability to feel, reduced heart and blood vessel control, diminished wound healing ability, reduced breathing capacity, increased pain, and altered sexual function. The extent to which these problems occur depends on where and how severely the spinal cord is damaged. In addition to coping with these physical effects, there are also a number of social and psychological issues that must be dealt with to varying degrees after SCI. These include environmental and architectural accessibility, the ability to obtain an education and/or employment, financial limitations, presence or absence of family/friend support, access to government services and medical services, social discrimination, and depression. Thus, living with SCI can be a very complex, stressful situation.

Basic science researchers are trained to objectively investigate the biological problems that result from SCI. People actually living with SCI know the most about which biological problems have the most significant impact on their quality of life. Scientists have been pressured on many fronts to develop an all encompassing "cure" for paralysis. A "magic bullet". The complexity of such an "all or nothing" approach is rather daunting, however. A more realistic approach, if we are interested in improving the quality of life of a large proportion of the paralyzed population in a more expedient time frame, may be to develop treatments that lead to partial functional recovery. It is important to stress that the ultimate goal is, and should be, to "cure" paralysis; emphasizing treatments leading to partial functional recovery does not take away from that goal, but rather may offer a more practical and efficient path towards achieving it.

Thus, a survey was performed, by a research faculty member of the UCI neurosurgery department, in order to identify which functions were most important to the SCI population, with the goal of using that information to guide research towards clinically important areas. A total of 681 people living with SCI participated in the study. Regaining arm and hand function was most important to people living with quadriplegia (paralysis due to a neck injury), while regaining sexual function was the highest priority for people living with paraplegia (paralysis due to a back injury). Improving bladder and bowel function was of shared importance to both injury groups.

Do people's priorities change if they have been living with paralysis for a long time? An additional analysis revealed only slight differences between individuals who had been injured less than 3 years compared to those injured for more than 3 years. Regaining trunk stability was more important early after injury while eliminating pain became more important the longer that a person lives with an injury. Additionally, the majority of participants indicated that they felt that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise.

This research has provided scientists with good evidence of what issues should be included in their future studies. Since the publication of these results, there have been many more studies evaluating arm function, bladder control, sexual function, and pain reduction. Restoring any amount of biologic function will lead to an equivalent increase in independence, and this will have a profoundly positive effect on the adverse psychological, social, and economic factors associated with the SCI population.

Targeting Recovery: Priorities of the Spinal Cord Injured Population. Kim D. Anderson. 2004. Journal of Neurotrauma 21(10):1371-1383.

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