Dr. Trevor Dyson-Hudson on Spinal Cord Injury
In this episode of Trevor Dyson-Hudson, MD. He is the director of the Center for Spinal Cord Injury Research and the Center for Outcomes and Assessment Research at Kessler Foundation. He spoke with Rob Gerth, the foundation's communications director.'s podcast, we are talking with
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Below is an excerpt from the conversation.
Rob Gerth: How does having a spinal cord injury affect your perspective?
Trevor Dyson-Hudson: Everybody's completely different. But having the injury definitely gives me an experience. I mean, aside from the paralysis that I experienced at the time of my injury, I immediately felt neuropathic pain. And that was almost, in some ways, more disconcerting to me than the paralysis because the paralysis was, "Oh, okay. That's because of my spinal cord injury. But what is this burning pain, and why won't it go away?" all of the strange feelings I had.
RG: What are some complications with spinal cord injury?
TDH: So spinal cord injury can affect bowel function, bladder function. You can have neuropathic pain. It affects the ability to control one's blood pressure, so people can have very low blood pressure. They can often have extremes in high blood pressure in response to pain, a condition called autonomic dysreflexia, where the body is feeling the pain so is having a fight-or-flight response, but the brain can't counteract that. The brain may know better, but it can't tell the body to stop because the spinal cord injury prevents signals from the brain to get down to the level of where the signals are coming in from the pain. So there's overuse injuries. There're so many different medical complications. And for some individuals, these complications affect their lives more than the paralysis itself because paralysis affects their mobility, and if you give that person a wheelchair that fits them, they can become very independent. But if they're having problems with bowel or bladder function, if they're having bowel accidents or bladder accidents or urinary tract infections, these are things that keep them at home, that can send them back to the hospital.
And that's what interested me, was the secondary medical complications because you have this spinal cord injury, and with rehabilitation the thing with spinal cord injury is the injury happens, and then you move on with what you have. And you try to regain as much function and become as independent as you can along the way, and you learn so much and you improve so much in many different ways, whether it just be in learning how to do things or some type of recovery. But you can still end up back in the hospital or back at home because of a bladder accident or because you have infections or pressure injuries. For me early on, pressure injuries, what people commonly call pressure sores, pressure ulcers-- they're changing the language all the time. They're now called pressure injuries.
RG: Could you explain what is the spinal cord injury model systems?
TDH: It's a model system of spinal cord injury care. And the idea is that they provide a continuum of care from time of injury to long-term follow-up. So it's a team approach to caring for an individual with spinal cord injury. And the idea evolved. It seems kind of obvious now, but back in the early days, somebody would have a spinal cord injury. They would get treated surgically. They may then sit on the surgical floor for weeks, months, whatever, and not necessarily getting rehabilitation. They get pressure injuries. They have all kinds of medical complications. They finally get transferred to rehabilitation, and they have all these problems. And they've lost a lot of muscle and all these other things. And then people might be discharged in the community, and there's no organized follow-up.
And so the concept of a model system is if we can coordinate with EMS, emergency medical services, who pick up people with spinal cord injury, make sure they get delivered to a Level 1 trauma center because the Level 1 trauma center will have around-the-clock neurosurgery or orthopedic surgery on hand so that we can either stabilize or operate on these people as soon as possible. There are trained professionals who are familiar with these cases, who know how to handle them. These individuals get stabilized as soon as possible so that they can start rehabilitating as soon as possible and then transfer to a specialized center that knows rehabilitation for people with spinal cord injury, the equipment needs, with the goal of getting them back out in the community, functioning, integrated into the community. And then that rehabilitation center can function as a resource for those individuals because for right now, there is no cure for spinal cord injury. So there is this need for a continuum of care and long-term follow-up. People will have whatever associated problems they have and will need to come back for new wheelchairs or just medical follow-up. And people within the field of rehabilitation may know spinal cord injury better than other professionals would, so.