Running Head: LIFE AFTER A SPINAL CORD INJURY

The Quality of Life After a Spinal Cord Injury

Jennifer Brenner

Florida A&M University

School of Nursing

Hocevar and Gray (2008) states , “Spinal Cord Injury (SCI) is a devastating and life-altering event, either temporary or permanent that affects motor and sensory integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel, neurogenic bladder, and sexual dysfunction” (p. 160). The majority of spinal cord injuries occur in young individuals and there is no treatment option for restoring spinal cord function below the level of injury. Approximately 253,000 people in the United States are living with SCI, and an estimated 11,000 new injuries occur each year (Hocevar & Gray, 2008). However, the complications of SCI can be reduced by medical treatment and rehabilitation. The purpose of this paper is to review research articles addressing the impact of SCI on quality of life from alterations in physical, cognitive, and emotional function. Studies have been conducted and showed that chronic pain and neurogenic bowel functioning are some of the major sequelae of SCI and they have a considerable impact on quality of life

Living with a SCI is overwhelming due to the adjustments in lifestyle: the environmental barriers and activity limitations. The physical effects of SCI range from mild, as in incomplete lesions, to disabling, as in complete lesions at the cervical level which create total paralysis and sensory deficits (Murray et al., 2007). However, a person’s potential is only limited by their determination, but pain can prevent a person from reaching their ultimate level of functioning. Pain is a complicated problem to manage because of its many contributing pathophysiological and psychosocial factors, which decreases the person’s chances for an optimal quality of life (Widersstrom-Noga, Finnerup, & Siddall, 2009). Researched by Murray et al. (2007) supports that loss of mobility, sensation, sexual function, loss of control over bladder and bowel function, muscle spasms, and pressure sores are somatic consequences for those with SCI, but sensory loss does not preclude the onset of pain and muscle spasms. Chronic pain rates almost as highly as loss of function in terms of impact on quality of life.

According to Budh and Oseteraker (2006), “Pain is an important factor that negatively influences perceived life satisfaction”. One study showed that individuals with SCI and pain had a lower satisfaction with life in general than patients without pain. They also experienced a negative impact on common daily activities and quality of sleep, which affected the patient’s mood. Psychosocial factors such as depressed mood, anger, and negative cognition are associated with increased pain severity after SCI. Mood disorders are also consequences of the SCI itself. Another study examined that frequency of reported visceral pain at 5, 10, and 15 years after injury to determine whether the presence of visceral pain is related to quality of life, and to determine what extent visceral pain should be of concern to clinicians treating patients with SCI. Methods used: Visceral pain and quality of life in persons with SCI were compared from a combined Craig Hospital and National Model SCI systems database at 5 (N=33), 10 (N=132), and 15 (N=96) years after the injury. Results: The rates of visceral pain increased at each measurement (10% at year 5, 22% at year 10, and 32% at year 15); even though these numbers reflect cross-sectional data, they show a clear statistical change. At 10 years after injury, individuals who had reported visceral pain at any time reported a significantly lower quality of life than those never experiencing visceral pain (Kogos et al., 2005).

Research showed that colorectal dysfunction is a common problem affecting approximately 80% of patient that incontinence. Accordingly, fecal incontinence and constipation related symptoms often impair the quality of life and activities of daily living of SCI patients. Cross-sectional studies suggest that colorectal dysfunction after SCI worsens as time goes by. SCI decreases the anal sphincter tone and causes incomplete evacuation of stool, which increases the risk of fecal incontinence. Results revealed that the frequency of and severity of constipation-related symptoms increase with time, but there is a decrease in the frequency of fecal incontinence (Faaborg, Christensen, Finnerup, Laurberg, Krogh, 2008).

Majority of researchers found that while living with SCI your overall quality of life can be decreased due to pain and bowel dysfunction. Once pain and bowel function is managed overall quality of life can be restored and increased. Pain is known to affect quality of life, vocational status, leisure and recreational activities, quality of sleep and sexuality. Pain thus plays an important role in long term satisfaction with life and rehabilitation outcome. To improve life satisfaction it is important to decrease pain intensity and improve mood, therefore, chronic pain due to SCI should always be treated in a multidisciplinary setting where pharmacological, physical and psychological therapies are combined (Budh & Oseteraker, 2006).

As a nurse it is imperative to understand and acknowledge these research findings, and that we support the client in managing pain and bowel dysfunction. The nurse can educate the patient about treatments to reduce the severity of pain and aim to increase individual coping skills to improve quality of life by using treatment strategies that include cognitive-behavioral components directed toward enhancing coping skills. The nurse can also, encourage social support. Pain and bowel dysfunction play a major role in decreasing the quality of life in people with SCI; but nurses can play an even bigger role helping the client increase their quality of life. The nurse can also develop a therapeutic and supportive relationship with the client and family. The nurse can emphasize the client’s strengths and positively reinforce the client’s efforts to improve self-concept and self-care abilities. During nurse-patient interaction, the nurse can actively listen, encourage, and share the client’s successes (Smeltzer, Bare, Hinkle, & Cheever, 2008). There are many roles a nurse can take on providing care to a client living with SCI.

References

Budh, C.N. & Osteraker, A. (2007). Life Satisfaction in Indiviuals with a Spinal Cord Injury and Pain. Clinical Rehabilitation, 21, 89-96.

Faaborg, P.M., Christensen, P., Finnerup, N., Laurberg, S., & Krogh, K. (2008). The Pattern of Colorectal Dysfunction Changes with Time since Spinal Cord Injury, 46, 234-238.

Hocevar, B. & Gray, M. (2008). Intestinal Diversion (Colostomy or Ileostomy) in Patients with Severe Bowel Dysfunction Following Spinal Cord Injury. Journal Wound, Ostomy, Continence Nurses Society, 35(2), 159-166

Kogos, S.C., Richards, J.S., Banos, J.H., Ness, T.J., Charlifue, S.W., Whiteneck, G.G., & Lammertse, D.P. (2005). Visceral Pain and Life Quality in Persons with Spinal Cord Injury: A Brief Report, 28(4), 333-337.

Murray, R.F., Asghari, A., Egorov, D.D., Rutkowski, S.B., Siddall, P.J., Soden, R.J., & Ruff, R. (2007). Impact of Spinal Cord Injury on Self-Perceived Pre- and Post-Morbid Cognitive, Emotional, and Physical Functioning, 45, 429-436.

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2008). Textbook of Medical-Surgical Nurisng (11th Ed.) Philadelphia, PA: Lippincott Williams & Wilkins.

Widerstrom-Noga, E.G., Finnerup, N.B., & Siddall, P.J. (2009). Biophysical Perspective on a Mechanism-Based Approach to Assessment and Treatment of Pain Following Spinal Cord Injury. Journal of Rehabilitation Research & Development, 46(1), 1-12.