The Aging Effects in Spinal Cord Injury Rehabilitation

Abstract

The prevalence of spinal injuries among older adults has been increasing more and more. The spinal cord injury (SCI) affects conduction of sensory, motor, autonomic nervous system generating a clinical picture of paraplegia or quadriplegia both accompanied by many organ dysfunctions. SCI can be traumatic or non-traumatic and complete or incomplete, depending on the absence or presence of the sacral sparing, respectively. Traumatic SCI is less frequent in older patients and non-traumatic SCI usually involves an underlying pathology. The patients’ clinical course depends not only on age at the onset of the injury but also is related to cumulative illness associated and in particular to completeness versus incompleteness of the injury. AIS D does better than B or A. In terms of age onset of the spinal injury, the more the age of onset is earlier, the longer the SCI subject will maintain his residual or acquired functional capacities. Older people may have premorbid medical conditions associated that determine poorer end results of the rehabilitation process if CIRS is >21. Respiratory complications are the most common cause of death. Cognitive impairment following SCI is high; education and income largely positively impact on the risk of depression. Moreover, SCI patients have a higher incidence of cardiovascular diseases, bowel disturbances, diabetes, skin and soft tissue complications, and neuropathic and musculoskeletal pain. Pain may occur with abnormal posture and gait and overuse and is more common and severe in older individuals. Osteoporosis, which is observed in the paralyzed part soon after SCI, reaches plateau level in the body 6–9 months after the onset of the spinal injury: the majority of pathological fractures occur in the knee. Most spinal cord injury subjects become obese and functionally limited as time goes by. Physical capacity and functioning after SCI may follow three phases: (1) the acute functional restoration, (2) the maintenance phase, and (3) the functional decline. Proper medical treatment, multidisciplinary interventions of the healthcare professionals, and social and family support largely impact on SCI outcomes as well as patient’s characteristics and willingness to cope and overcome the constraints of his condition.