Life on Wheels (18 page)

Reducing or quitting smoking

Switching sides with your leg and/or bedside drainage bags; this changes where the catheter contacts the bladder, rather than having it always contact the same spot

Using catheters that are less irritating; for example, hydrophilic catheters are softer than other catheters and are lubricated

Taking antioxidant vitamins such as E, C, and B6, which are thought to reduce the effects of carcinogens on cells

Having regular cystoscopic exams, as frequently as every two years if you are a longtime user of an indwelling catheter

When we do not walk, circulation through the legs is reduced. Contractions of the leg muscles are part of the circulatory system—an important mechanism for how blood is pumped through the body. For people with paralysis in the legs, blood may pool in the lower extremities.

The danger is that blood could begin to clot in a vein, coagulating into a more solid state, known as deep vein thrombosis (DVT). DVT limits circulation further, at the least. At worst, the clot could dislodge and travel through the body into the lungs or brain, causing a stroke or death. This is called a pulmonary embolism. A 1979 study found that 35% of people with DVT who were untreated died of an embolism.
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A clot in the thigh is the greatest concern, since this location gives a more direct route to the lungs.

DVTs are a greater concern at the acute stage of an SCI, when someone is inactive for an extended period of time during extended bedrest. DVTs have been observed as soon as 72 hours after injury. Researchers suspect that 80% of DVTs occur within two weeks of injury. Studies of people at this stage have found incidence rates from 15% to 47%. Studies have also found slightly higher rates of DVTs for those with complete SCIs compared to incomplete injuries.
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During periods of extended inactivity and bedrest, pneumatic compression stockings or wrapping with elastic bandages is often recommended. The drug heparin is sometimes used to reduce blood viscosity, improving flow. Electrical stimulation of calf muscles has also been explored.

Heterotopic ossification is a condition in which bone develops outside of the normal system, potentially clogging joints and limiting or freezing movement. It occurs in acute SCI, brain injury, and other neurologic traumas and takes a year or more to develop, making it difficult to diagnose early. Remaining active and keeping up regular range-of-motion exercises play an important preventive role.

Heterotopic ossification only occurs below the level of injury, commonly at the hips. It can lead to scoliosis problems as the nonneutral position of the pelvis puts curvature pressure on the spine. The condition can ultimately require surgical intervention. Some doctors use anti-inflammatory drugs to manage heterotopic ossification. Although studies have reported from 16% to 53% of occurrence of heterotopic ossification in people with SCIs, adequate acute management substantially reduces the need for surgery to free joints or correct scoliosis due to heterotopic ossification.

Without the regular loading of weight from walking, bones begin to lose calcium. This leads to osteoporosis, in which bones become more brittle and prone to fracture. The hips are a common site of fracture, as are the legs, spine, and arms.

Osteoporosis commonly occurs with aging, particularly in postmenopausal women. Risk is increased with diabetes, vitamin D deficiencies, or diets low in calcium. Smoking and alcohol abuse exacerbate the condition, as do lack of activity and lack of sunlight. If you are able to stand or walk, it is a good idea to do it as much as you can—with safety being your first priority—to help your bones remain strong. People with traumatic disabilities such as traumatic brain injury, SCI, or amputation tend to spend an extended initial period in bed, which invites osteoporosis to begin.

If you have osteoporosis or are at high risk for developing brittle bones, avoid stresses to your bones. To help prevent breaks, remove your feet from heel loops or restraining straps first when you make transfers to and from your wheels, making sure nothing will prevent your foot and ankle from rotating, and straighten your legs before rolling over in bed to minimize excessive strain to your bones. Just having a toe caught under a footrest when you transfer can be enough to break an ankle.

If you don’t have sensation in your lower body, you might incur a fracture and not know it—for example, a hairline fracture that produces only moderate symptoms. Pay attention to changes in spasticity or occurrences of dysreflexia. These could indicate a fracture that might not otherwise be apparent. If you hear a snap or other unusual sound, don’t ignore it. A bruise from internal bleeding is another potential sign, which you could mistakenly assume is from an impact you didn’t feel during the day.

Spasticity has a mixed impact on osteoporosis. When muscles spasm, they place a load on bones that help maintain their density. But severe spasms can break osteoporitic bones. For people who never stand, managing extreme spasticity is all the more important.

There are also wheelchairs capable of elevating you into a standing position, thus bearing weight on your legs. Such a chair would provide you with more frequent opportunity to stand, so it could contribute more to prevention of osteoporosis.

Standing frames address both osteoporosis and circulation. The act of walking helps pump blood through the body. Legs that are inactive have less efficient circulation, since their muscles are not helping the process. Always sitting also limits circulation to the legs because of the angles that veins and arteries must pass at the hips and knees. Standing lets gravity help circulation, as blood passes straight down the body without having to turn corners. Circulation is also a matter of hydraulics—the assistance of gravity to bring blood down to your legs also helps it flow upward in the closed pressure system of the body.

The risks of softer leg bones and poorer circulation can be addressed with standing frames, which comprise a growing segment of the medical supply industry. There are three types of standing frames:

Fixed. The frame remains in one place and does not have a seated position.

Movable. The frame includes wheels within reach, linked by a chain or belt to smaller wheels at the bottom so you can move within a room. Some frames are motorized and move by means of a joystick control, like a power wheelchair.

Integrated. Another kind of product is a wheelchair with the capacity to transform into a standing frame. Such a frame is intended for people at work, such as a mechanic who would need to stand beneath an elevated car, or for situations in which an extended reach is needed, such as at a supermarket. There are both manual and power models.

Other benefits of standing frames pointed to by manufacturers are reduction of spasms and muscle shortening, less chance of pressure sores, and improved urinary and bowel function, since the colon and intestines are constrained in the sitting position (although some physicians do not subscribe to this view). If you have shortened muscles from sitting for many years, a standing frame can be a means of getting your body straightened out again. A product that is able to be set at intermediate angles can allow you to therapeutically stretch in the frame and gradually lengthen your tissues out to a normal posture.