Spinal Cord Injury

                   In the human body there are two basic fundamentals, one is the Brain and the other is the Body. The brain works as a commanding agent for the movements of the body and it also judges and evaluates all the decisions and transmits signals in the form of electrical shocks to all of the muscles located at the different places of the body, it also regulates the movements and functions of the some of the most important parts of the body such as Heart and lungs etc. As far as the body is concerned it consists of bones, muscles and organs which are regulated by the brain through electrical shocks. In the body section of the human being the most important part is the back bone which in technical or medical term is called as Spine. The human spine consists of two parts, one is the Spinal Column and other is the Spinal Cord. The Spinal Column is the boney part of the spine. It consists of Spinal Disks or Spinal Buttons and the Spinal Muscles. Spinal Disks are the rounded bones encircling our Spinal Cord, it makes sure that the spinal cord is well protected from the outer impacts. The Spinal Muscles, as the name suggests are to move the spine accordingly. And the Spinal Cord which is also our main topic is a nerve type structure which starts from the brain and goes all the way down to the end of the spine. It goes from the centre of the spine and is connected to all the cells and organs of the body through small veins. The basic function of the spinal cord is to transmit the signal generated by the brain to the respective cell or organ and also to transmit back the responsive signal generated by that organ or cell to the brain. It is protected by the spinal button type bones and the small vein connecting it with the body parts go through the spinal disks. These veins are so small that even the microscope can’t pick all of them. I guess this brief introduction would have cleared the basic purpose of the spine and spinal cord in your mind.
Spinal Disability
                   In the terms of disability, the spinal disability can occur due to many reasons. Some people get it from the pre birth time, in their mother’s womb their spinal cord or their spinal disk or button is not fully developed or it is over developed or not developed properly and they carry the spinal disability from the birth to the end of their life. The other reason can be because of any accident or any mishaps that occur to them damaging their spinal cord, this kind of disability can happen at any stage of the life and it can make a person complete or partial disable. One of the other reasons behind this kind of disability is the sitting or walking style of the person, it sound ridicules that some one’s sitting style can make him disable but it is a fact that those people who sit in a position that a hump is created in their back gradually starts to damage their back bone and ultimately damaging their spinal cord in the process. Some polio affected persons can also have this disability as well, the polio can attack near or on the spine thus damaging the spinal cord.
The symptoms 
                   The symptoms of the spinal cord injury are fatal. The spine is a complex organ, its symptoms vary from person to person. The disability is more or less regarding the level of the disability. Now the question is what these levels are? the levels are the disks of the spine, the spine consists of approximately 30 disks or buttons in the human spine, as I mentioned earlier the small veins interconnecting brain with the different organs of the body through the spine go through these disks which are the spaces between two spinal buttons, the point from which disk or the button the spinal cord is damaged is named to be the level of disability. Now what are the names that these levels are mentioned with? The upper most seven buttons are considered as Cavalry Nerves and thus are named from the first letter as C1 to C8, they basically control or transmit the signals to the neck and shoulders, so it is quit obvious that if the spine is damaged from these buttons the body will be paralyzed from the neck or shoulders down ward. One thing I will like to mention here is that the point of spinal cord damage is the level of injury and thus all the organs or functions that come below that point will also lose their power of being controlled by the brain, because the spinal cord is the path of interconnection between brain and the organs of the body and if the path is damaged although the path before and after the place of injury is working fully but their communication will be abundant. The next 12 buttons or disks of the spinal column are called as Thoracic Nerves, they control the signals and transmit them from the arms to the belly muscles and are named from T1 to T12. The next eight buttons come in the area of Lumber Nerves, and are named as L1 to L5. They control the movements of the lower tummy and the legs muscles. The next four buttons are called as Sacral Nerves and control the urination, stool and the sexual organs of the body in collaboration with the brain and are named as S1 to S5. another thing that a spinal cord disabled person faces is the jerking of the disabled muscles, that is the muscles below his disability level, when they are tired or the blood circulation in them is interrupted due to any reason they start to jerk back and forth, it also happens if the legs are not properly placed on the ground, why this happen? The answer is that the muscles of the spinal cord disabled persons are not dead, they just have lost the connection from the brain and the brain is not regulating their movements, thus when ever they are not relaxed for a long time or sometimes generate the signals to be transmitted to the brain but as the connection is no more there these signals become the reason of the jerking behavior. I mentioned here that if the muscles are not relaxed for a long time then they start to jerk, yes it is a way for the spinal cord disabled persons to know that now they should shift their side or change the posture of sitting, but it is not a trustful thing, not every time the muscles are uneasy they will jerk, sometimes they just do not give any response what so ever, for example those spinal cord disabled persons who are operated by the doctors often do not have the responsive muscles. It can be checked if you try to touch the sole of feet of the spinal cord disabled person, if it start to stiffen it means that his muscles have not given up the responsive behavior and the jerking in these type of spinal cord disabled persons is more then the other ones. This jerking of these spinal cord disabled persons can be a plus point but it is also a negative point because it can affect them when they are shifting from one place to another, if the legs start to jerk at this time they can easily lose balance and fall. Sometimes the jerking is so much that they can be thrown down by his legs. Now the question is, how can a spinal cord disabled person stop these jerking muscles? The answer is that there is no possible way of stopping them from jerking, but you can stop it from getting quit often by the physiotherapy, if a spinal cord disabled person is having a problem of jerking muscles the best way is to massage his legs all the way from thighs to ankles every day for ten to twenty minutes, it will help the person to relax his muscles. Now some of the physicians who do not have knowledge and when a spinal cord disabled person consult them give him a wrong suggestion of to get operated and get your muscles cut off, this is a real shameful suggestion and ridicules as well because a spinal cord disabled person do not have the sensation and feeling and by cutting the muscles they are cutting the only source of balance in there disabled body, these muscles help you in shifting and they also help you in relaxing your body, so cutting them is a not a good suggestion. I recommend them to try to exercise and relax their muscles and do not consult the doctors who are not specialist for the spinal cord disability.  Some spinal cord disabled persons think that they will recover and start to move normally, I have a suggestion for them until they are disabled till then they should not sit in the house, they should try to avail each and every second of this time to achieve the success of life. 
Level from C1 to C7          
The complete paralyzed body will not function regarding the level of the disability, the higher the level of the disability the disability will be more severe in nature and will affect the more parts and organs. In the C1 to C8 level disability the neck and shoulders are affected in the first place but all the organs and levels of spine below this level will also be disconnected from the brain and will not work according to the will and order of the brain, for example, a person with this level of disability will also lose the control over his chest and belly muscles, he will not be able to control his urination or stool as well. The people with this level of disability do not have control over their hands and arms as well and thus are fully dependent and need someone to help them in their most basic chores of life like eating, bathing, cloth changing etc. 
Level from T1 to T12
                   In the disability between these levels of spine cause the disability by paralyzing the body from arms to tummy area. The persons with this level of disability are mostly independent they can work most of their daily life chores by themselves but with a little help from some one. In this level of disability if the level is high like fromT1 to T5, then they have generally shifting problems from one place to another and they usually have balancing problems and can not sit with out back or side support. Another problem is that they get certain stiffness in their legs and all the uncontrolled muscles which it even worst for them to balance.
Level from L1 to L5
                   In the disability between these levels of the spinal cord the person loses the control over his lower body like the legs. These kind of persons are mostly independent and do not have much of the problem regarding the shifting or balancing problems. 
Level from S1 to S5
                   In the disability between these levels of spinal cord the person is visibly alright. You can not know from looking at him that he is a disable person. The symptoms of this kind of disability are that the person loses control over his urination and stool and as well as his reproductive system. 
                    Except for the S1 to S5 level disability the persons with spinal cord disability can not walk completely or properly on their feet and all the mobility is by the wheel chair. I will like to mention here that the people with high level of disability such as Cavalry and Thoracic Nerves (from T1 to T3) can not use a manual wheel chair and need an electric wheel chair for their mobility. In most of the Cavalry Nerves disable persons they can not even move an electric wheel chair and are fully dependent.
Types of Spinal Cord Disability 
                   The spinal cord disability can be divided in two types, Complete Spinal Cord Disability and Incomplete Spinal Cord Disability. In the Complete spinal disability all the sensation of the body is gone and the person with this type of spinal cord disability can not control any of his organs below the level of disability. This kind of disability happens when the spinal cord of the persons is completely cut or the damage to the spinal cord is so severe that the spinal cord nerves are completely blocked, thus no signal can reach to or from the brain to the organs or muscles. In the other type of spinal cord disability the spinal cord is not completely damaged or blocked but can transmit some of the signals to and from the brain. In such cases the disabled person can have some sensation in his body or even can some time move his legs up to an extent. The second type of the disable persons have quit a chance of recovery and can recover almost all the way or even up to some extent but in the first type of disability the chances of recovery are almost zero percent. In the second type the disabled persons can have some control over certain parts of their body but the first type disabled persons can not control any of their disabled parts.
Spasticity in the Spinal Cord Injured persons
                   A spinal patient will always have this condition even if he is walking, the condition is that his paralyzed part of the body will erect and will fold involuntarily. This will irritate the patient in most cases and can be controlled up to an extent with the help of exercises, but they can never be stopped. Some doctors cut the muscles from the joint to avoid it but it is not a good treatment of the problem as the patient is loosing the part of his body which may recover.
Life Style of Spinal Cord Disable Person 
                    The lifestyle of the spinal cord disabled persons is some what different from the other disabled or non-disabled persons. The spinal disabled persons have to live a very strict life. They have to manage their life to a time table according to their disability. They can not relax with this time table. The time table is made according to their disability in a way that they have to make their timings for every routine chore of their life. They have to manage their life with the fact that they do not have any sensation or feeling in their body below the level of their disability. The spinal disabled persons have to set timing for their stool passing and urination. They have to manage their food with their lifestyle so that their liver do not create problems, it is very important for them because they do not know when the stool will pass because as the non-disable person they do not feel the pressure on their bowls when they need to pass stool. The urination time has also to be set accordingly, because in some cases the urine does not come out at all and have to be manually forced out. I will describe the stool and urination procedures in detail in the next portion but for now I wanted to tell you some thing about the time table. Another problem that the spinal disabled persons have to face is the “Bed Sore”, I will describe it in detail in the next section, and they have to manage their shifting timings to avoid the bed sore which can cause death. Then they also have to exercise accordingly as well to avoid tiredness and stiffness n their body. 
Passing the Stool 
                   Passing the stool for the spinal cord disabled person is a fatigue that they have to go through daily. Passing the stool is more important for the survival of human being then even eating food, because you can bear hunger for a day or two but can not bear the irritation that the bowls put on you if they need to be emptied. The process of passing the stool is so different for the spinal cord disable then the non-disable or even the disabled persons of any other disability. The spinal cord disabled person has to pull all the fesses manually, the manually means as the spinal cord disabled persons do not have control over muscles so they can not push the fesses the natural way so they have to do that by a process called P.R. They use a glove and then with some lubricant they have to pull all the fesses out. Another thing I would like to mention here is that as they do not know when they need to go to toilet, they also do not know whether they have emptied their bowls fully or not, for that reason they have to evaluate whether they have pulled out enough amount of fesses as much as they have taken the food or not. It sounds ridicules but it is the biggest drawback that a spinal cord disabled person have to face daily, because of that his toileting time is so much more then the other peoples. Another problem with the spinal cord disabled persons is that almost all of them can not use the Indian toilets, the persons with disability level from T6 to L8 can use a comport, all the other spinal disabled persons higher then T6 can not use the comport as well because they do not have the balance of sitting without any support, for these level disabled persons comport chair is the only choice, the reason for that is these level disabled persons have to use one hand for stool purpose and thus have only one hand to balance and can not keep themselves intact, and certainly the stiffness problem is also another difficulty they have to cope with.
Urination System 
                   As the stool passing for the spinal cord disabled persons is different from all other persons, it is the same with the urination. The spinal cord disabled persons, as they do not know when they should urinate, they have to manage it according to a time table. They have to adjust their urination time according to their body. The process of urination is different from all other persons, because they can not push their urine out so they use different ways of urinating. One process is to insert a catheter for 14 days, this process is very risky because if they use this process they have to drink extra water, because the catheter keeps on pulling urine out and their should always be water in the urethra for the catheter, else it will start to pull blood from the catheter which is as alarming as it sounds. Another way is to use a Nelaton catheter, that is not a permanent catheter, it is inserted after every four to six hours to empty the bladder, one thing to check is that when ever it is inserted it has to sterilized and free from germs else they will expose their inner body to the germs and will cause themselves an infection which is deadly, and secondly it should be properly lubricated before insertion so that their should be no scratches or rashes. With Nelaton catheter, as it is hourly their can be some overflow of urine because if the bladder gets overloaded during this period sometimes the urine starts to come out so they have to use an External catheter, it is a condom with a nozzle at the end which is connected with the urine bag, so that if the urine starts to over flow it is stored in the urine bag and can be emptied any time later. A draw back of both of these processes is that there is a constant threat of infection which is deadly and causes very high fever and can even cause death if not taken care of. In some cases due to the infection they have to use a third way, in this way a tube is inserted directly in to the bladder through the belly. In some of the cases of spinal cord disabled persons they can manage their timing s perfectly that they can urinate at the perfect time when it is needed, but this kind of perfection in timing can only be adjusted in lower levels disability from belly. 
The spinal cord disabled persons have to take the calculated amount of food and water because of the above mentioned reasons.
Bed Sore 
                   In the spinal cord disabled persons most of the deaths are due to the bed sore. Most people do not know what this is, why it happens and how can it be avoided. For all these questioned to be answered the information about these should be complete. A bed sore as the name suggests is an injury which is caused by the bed, now the question is how can the bed injure a person, for the answer you have to dig down deep, the spinal disabled persons do not have sensation of anything that whether they have any pain or anything teasing them in the disabled area of their body. Consider them sitting on a wheel chair, as they do not know when their body will be tired of sitting in the posture they are sitting they will never change it and the result will be a bed sore. When a person is sitting somewhere his buttocks or the point of impact with the ground or any thing he is sitting on will be bearing the weight and the blood circulation in this part of the skin will be abandoned and because the circulation of the blood has stooped so obviously the cells of the skin that are directly in the focus of the pressure and tension will not get oxygen because no new blood is coming from the heart to them, thus a spinal cord disabled person do not feel the pain on the impacted part of the body he do not move and thus the cells become dead and after that if they are not given the proper attention they start to increase their diameter and starts to go deep in the bone and ultimately starts to drip with the infected and poisoned water and causes the infection to the person and as the signal processes of the brain is not their so the healing process is also slow and it takes a long time to heal properly, its treatment is to put if possible no weight on the infected part of the body but if you do not have the information and do not take care of the skin it can take you to death. As I have mentioned that the bed sore is deadly it is not obvious that it will only happen on your buttocks and all other parts of your body are safe, it is not the case any part of the body bearing the pressure will face the possibility of bed sore. One thing that a spinal cord disabled person should cope with is that they can not change the side at night during sleeping specially the higher level disability persons so their sides of the hips and even ankles can be affected so they should change their side after maximum every two hours and when sitting on the wheel chair or any where should try to lift their hips up for a minute or so after every ten to twenty minutes to release the pressure. Another thing they must do is that they should check their back side for the bed sore by the mirror daily and also should massage all the pressure points of their body to avoid any possible blockage in the blood circulation system. Another thing I will like to mention here is that the spinal cord disabled persons should always wear shoes, not to mention they should not be tight, to avoid any scratch on their feet due to dragging them on the ground.
Mobility and Job 
                   The mobility of most of the spinal cord disabled persons is not a big problem, the spinal cord disabled persons with their disability below the T4 level can move either on their feet or on the wheel chair. They have enough power in their hands to move manual wheel chair freely. The spinal cord disabled persons with a disability from C4 to T3 can move freely if provided with an electric wheel chair. Above that all the levels can not use either electric or manual wheel chair and are fully dependent. Most people think that a spinal cord disabled person can not drive a car, which is a complete misconception, they can drive a car if its control is all on the hands. As far as the job is concerned the spinal cord disabled person can do all the office work but field job is some what difficult to accommodate with by him. The spinal cord disabled person can work best on the jobs in which only hand works are required. 
Society and the Spinal Cord Disabled persons 
                   When some one become a spinal cord disabled person he has to face the fact that he is no more a non-disable person and from the first day of his disability he has to manage his life. But it easy saying then doing it, because when a person becomes disabled due to any mishap he has to counter the shock of the fact that he is now a disable person and his life will never be the same and he will have to cope with certain challenges in life. He will have to make a time table regarding his disability and then will have to stick to that time table all his life and he can not relax the terms of the time table not today nor tomorrow or for the rest of his life. For making a time table good enough for your whole life, you must have all the required information about your disability and every thing that you will have to cope with, but specially in Pakistan the awareness regarding the spinal cord related disability is not much and even the doctors who should be the best consultant in managing one’s life do not have enough information about it and all the spinal cord disabled persons have to learn the art of living with the disability the hard way. They have to go through all the mishaps to learn the disability the ways of coping it. They should be told how to manage their life, how much should be the intake of food and water and how it should go out. How to mange the timing of one’s urination, what will be the best way for him to urinate regarding his disability, and how can he protect himself from the infections of urination. How he should save himself from the bed sore and all the possible mishaps of the spinal cord disability. How he can solve his dependency problems and how can he increase his mobility, what he should be doing to solve his financial problems. These all are the hurdles that a spinal cord disabled person has to go through in the initial stages of his disability. And if he can get the right information at the right time he can manage his life far better and easily. It is the responsibility of the society and the people related with the spinal cord disabled person to help him and not to ignore him. Another problem especially in Pakistan is that there is no doctor or physician specialized in spinal cord disability consultancy, and the persons with spinal cord disability in Pakistan have to go to the physicians and doctors who know nothing about spinal cord disability or do not have enough information about how to treat a spinal cord disabled person, and thus a spinal cord disabled person in Pakistan has to suffer the consequences of the wrong treatment by the doctor, which sometimes cause an increase in the disability or infections or bed sore. Due to the lake of information to the doctors sometimes they operate a non-disable person with some other disease and due to the wrong or no information about the spinal cord disability, they unintentionally damage the spinal cord of the person and make him a spinal cord disabled person and no one take the responsibility of ruining the life of a person. One thing in the societies like Pakistan is common that when ever a person become disabled, it is considered that he is no more a useful person and now he has become worthless and will stay all his life dependent and will have to stay at home as he has committed a  crime. I believe every spinal cord disabled person can be useful part of the society and can play his part in the society as good as a non-disable person can do. So he should be provided with the chances to come forward and help himself for the improvement of his life.
          I am writing this article only to give information to the general public and especially to the spinal cord disabled persons who are in the initial stage of their disability and are trying to manage their lives accordingly.