Module 1 - Spinal Cord Injury and Seating
An overview of spinal cord injuries
It is estimated that the prevalent population of people in Australia with a spinal cord injury (SCI) is approximately 9,000-10,000 people. SCI is caused by both trauma and by disease processes (non-traumatic SCI) such as spinal cord infection and infarction. Typically people who acquire a traumatic SCI are young and male, whilst non-traumatic SCIs occur more often in later life and with a more even gender split.
Persisting SCI impacts on every aspect of a person's life: health status, physiological, active community participation, psychological, social, reproductive, economic, employment, educational and recreation.
An SCI will affect people in variable ways, depending on the level of the spinal cord lesion and the completeness of the injury. Generally all people with SCI have some degree of motor or sensory loss and a disrupted autonomic nervous system. This has a profound effect on a person's health, function and physiology. The most important factors predicting functional outcome are the neurological level and degree of completeness of spinal cord lesion. However, a range of other medical and non-medical factors can influence outcome, including age, body shape and weight, associated injuries, pre-existing disease, spasticity and contractures, living arrangements and family support, level of education and financial resources. As the neurological level becomes lower, functional independence should increase. Functional goals are based on sequential organisation of spinal segments and capacity of spared muscle groups to perform specific activities of daily living, qualified by other factors such as those listed above.
When working with clients to establish wheeled mobility goals, it is essential to understand the individual impact of a person's SCI and other health issues associated with co-morbid conditions and with ageing. Pre-morbid lifestyle and interests, personality characteristics and coping style, degree of social support and economic circumstances will all be important factors influencing adjustment and eventual outcome. Within the learning modules is information about establishing and assessing a client's health status.
For people who require wheeled mobility, the effective prescription and use of a wheelchair enables and empowers them to participate in life and interact in their community. Many clients with a spinal cord injury will spend most of their waking hours in their wheelchair; each client is unique and has highly individual and, over time, changing needs. It is no longer acceptable, if it every was, to prescribe a wheelchair and seating system without careful consideration of the client's goals and postural, pressure, functional, safety and environmental needs.
A correctly prescribed wheelchair and seating system will optimise function, address the impact of environmental factors, correct and prevent postural and pressure issues and meet a client's community participation needs. The short and long term consequences of an incorrectly prescribed system can be profound, as are the safety issues associated with wheelchair use. It is equally important to consider how a client perceives their wheelchair, and the psychological issues of self- and societal perception of wheelchair use when working with the client in setting goals.
Further information about SCI is available in the resources section of this site. It is strongly recommended that health professionals gain a good understanding of the risk factors for developing a pressure ulcer, the impact this condition has on clients, how to reduce risks and implement treatment options.