The spinal cord is a network of nerves running from the brain to the muscles. It also contains nerves that run from sensory receptors, which send messages about what the body senses to the brain. A spinal cord injury (SCI) is an injury that damages the spinal cord and results in a disruption in the normal flow of information up and down the spine. The brain is not able to talk to muscles whose nerves stem from below the level of injury. If the brain cannot talk to muscles, it cannot control them. These muscles are paralyzed.
When both legs are paralyzed, the injury is referred to as paraplegia. If both legs and arms are affected, the injury is called tetraplegia or quadriplegia. Not all injuries are complete. Some weak signals from the brain may get through the damaged part of the spine to muscles, allowing limited movement.
Damage is not limited to the circuits from the brain to the muscles. It also includes pathways carrying sensation from the arms and legs to the brain. This means that sensation below the injury in the spinal cord will be reduced or even lost.
Today more than ever, those with SCI can have a meaningful quality of life. However, their life expectancy may only be 85 per cent of what it once was. The leading cause of death is respiratory disease, with heart disease coming a close second.
Respiratory disease involves difficulty with breathing. The brain drives muscles that power breathing with signals sent through the spinal cord. As a result, many people with SCI are prone to respiratory ailments.
While five to 10 percent of people have symptomatic heart disease, the rate in those with SCI is five times higher. Brain signal changes, poor diet and physical inactivity all contribute to heart disease. Little can be done about structural problems related to brain signals. However, we can work to change the other two factors.
Our modern diet is high in both salt and calories. A high salt diet is linked to high blood pressure. Excess calories make us overweight. All of the reasons that anyone would eat poorly apply to those with a spinal cord injury. However, other issues must also be considered. Being unable to get around easily limits access to healthier food choices. Shopping and food preparation can be difficult. Since people with SCI tend to have less money, it is harder to afford healthy food.
The problem requires more than one solution. Issues with transportation and finances must be addressed, along with basic education about proper nutrition. Canada’s Food Guide to Healthy Eating is a good starting point.
About half of people who have spinal cord injuries lead active lifestyles. That is to say, they participate in regular physical activity. The benefits of regular exercise are well known. Muscle strength increases and cardiovascular endurance improves. Carrying out everyday tasks and activities becomes easier. Self-esteem, mood, social relationships and quality of life in general all improve. With or without a SCI, everyone can benefit from physical activity. In particular, the risk of heart disease lowers.
Many people have trouble finding time and energy for physical activity, including those with SCI. However, this group faces unique challenges. Lack of facilities, fear of injury, equipment costs, pain, accessibility, and transportation are all factors. Guidance from doctors about how to exercise is also necessary.
Becoming active is also more complicated. It is simply not possible to buy a new pair of running shoes and start walking. It is difficult to exercise enough in a standard wheelchair to benefit the heart. Special equipment, such as a stationary arm bike or a dedicated arm bicycle, is usually needed. As with other specialized exercise equipment, both are expensive. Access to gym facilities that are properly equipped for wheelchair athletes is the exception, not the rule. As well, transportation is always an issue. While public transportation is usually wheelchair-accessible, getting to and from bus stops can be difficult, particularly in winter.
Pain is common after spinal cord injury. Nerve pain can be severe and very difficult to treat. It is hard to be active when in pain. Chronic injuries related to the original spinal cord injury can also affect movement and the ability to exercise.
Finally, the fear of injury is real. The exercises will be different from those done before the injury. Those with SCI are also much more dependent upon their arms for any kind of activity. It is an understandable fear.
Wheelchair athletes have particular medical concerns. Pressure ulcers on the buttocks develop because activities are done while seated. Proper seating surfaces and positioning can solve this problem. A life-threatening elevation of blood pressure is another condition unique to those with SCI. The brain has less control over mechanisms regulating blood pressure. Learning about the problem and how to recognize symptoms can help.
Many organizations and societies support and organize wheelchair sports. National level organizations include:
Canadian Wheelchair Sports Association
which focuses on wheelchair sports.
Canadian Paraplegic Association
which is involved in all aspects of support and advocacy for those with spinal cord injuries.
In Alberta, these two organizations provide a wealth of information and opportunities for those with spinal cord injury to become more active.
Wheelchair Sports Alberta
Canadian Paraplegic Association
The benefits of regular exercise for people who have a spinal cord injury are well known. However, there is no simple one-size-fits-all recipe. Each person will have different goals, abilities, and situations. All play a role in how to achieve a healthy, sustainable, active lifestyle. Those with SCI should ideally work with a team to become active. Such teams should include rehabilitation medicine specialists, trainers, physiotherapists, occupational therapists, and athletic therapists who understand the unique challenges.
Learning about activity should start during initial in-hospital rehabilitation. During this time, the multi-disciplinary rehabilitation team can teach about appropriate activities. Various athletic activities can be demonstrated as part of rehabilitation. While in hospital, it helps to interact with other wheelchair users at varying stages of rehabilitation and activity participation. These people are perhaps the best source of information about how to approach an active lifestyle. Forming a social network is an important part of the benefits of an active lifestyle.
Of course, the selected activity must be appropriate. It is not just a matter of liking the form of exercise. The location of a spinal cord injury dictates what muscles are weak or paralyzed, affecting possible activities. Since most spinal cord injuries are related to trauma, secondary injuries may also come into play. Discuss appropriate activities with the multidisciplinary team. Most people with spinal cord injury can do far more than might be thought. Rehabilitation is all about becoming able to do as much as possible.
When we think about wheelchair users and activity, the wheelchair sports of the Paralympics often come to mind. However, this is just the tip of the iceberg. For every Olympic cyclist, there are countless recreational cyclists. For every Paralympian cyclist, there are countless wheelchair users who cycle for fitness and pleasure. Ideally, all regularly participate in activity for cardiovascular fitness and strength.
Community physical medicine and rehabilitation specialists can provide information and guidance about getting and staying active. Most people with a spinal cord injury are already seeing this kind of specialist. Provincial and national associations (see sidebar) can give further support. As always, anyone considering a new exercise program should consult a doctor first.