Old age comes with all kinds of stiffness and pain. For a person with a spinal cord injury (SCI), the struggle with frailty may begin earlier and be more difficult to overcome, but a few lifestyle changes can help keep old age at bay
A sure sign of ageing is the loss of your ability to do things you once could. It may show up in the difficulties of dressing in the morning; brushing your teeth; transferring in and out of your wheelchair; or even just waking up in the morning.
Research has shown that SCI can intensify physical and physiological declines such as musculoskeletal, cardiovascular, gastrointestinal, pulmonary and integumentary (skin) systems. In other words, people with an SCI are likely to develop problems associated with old age at a younger age.
The leading causes of death for people with an SCI include respiratory disease and urinary tract infection. This differs from individuals without an SCI, who die primarily from heart disease, cancer and stroke.
What to do
It is only through taking care of our body that people stay active. A weekly routine can help maintain, and sometimes improve, mobility, independence and appreciation of life.
What you do will depend partly on the location and severity of the injury. An SCI is said to be complete when there is no sensory feeling, or ability to move below the point of injury. An incomplete SCI, on the other hand, leaves you with some ability to feel or move below the site of the injury.
Either way, there are many things you can do to postpone the onset of ageing, or overcome the negative effects associated with frailty.
No matter what your age, it is important to keep moving. Joint contracture, or joint stiffening, occurs when joints are not moved regularly enough to maintain their full range of movement (FROM). Two ways to improve flexibility is through passive range-of-motion exercises (PROM), and self-range-of-motion exercises (SROM).
The former is called passive because no physical effort is made: instead a caregiver helps you move your limbs and joints through their full range of motion. SROM exercises can be done by yourself to maintain and improve movement in your limbs.
Both are different from stretching as no force is applied to stretch the joints. Still, caution must be taken not to overextend joints when working alone or with an inexperienced partner.
Linda Hunter, a physiotherapist at Netcare Rehabilitation Hospital Spinal Unit, says: “SROM allows you to retain some flexibility in your muscles, nerves and joints. Without this, your posture in your wheelchair and your ability to perform functional activities will be negatively affected.”
Hunter suggests only five minutes a day, either in the morning, or at night before you go to sleep. A more intense exercise routine is advised for people with greater mobility. Rowing is a great exercise and requires your upper body to paddle, but your lower body needs to remain upright. Other options include weight lifting, basketball, or even bowls, where there is an equally beneficial social benefit to be had.
The quality of your bed and mattress, and a comfortable sleeping position that doesn’t leave you with aches and pains, are vital – without this, all else is lost.
Riona Rajkaran, a physiotherapist at the Netcare Rehabilitation Hospital Spinal Unit, says: “At night the best sleeping position is on the tummy. Not only is this the best position to prevent bedsores, it helps to relieve spasms.
“In other sleeping positions, the trick is to get the entire body into a comfortable, supported position that does not require muscle effort to hold. This includes careful positioning of the head and neck.
“As always, special care must be taken to ensure that potential pressure points are positioned adequately to prevent pressure sores. Also, make use of supports, such as pillows, to prevent yourself from rolling out of position while asleep.”
A good diet will ensure that you receive all the nutrients needed to keep a healthy body and mind. Charlene Grimsehl, dietitian at the Netcare Rehabilitation Hospital in Johannesburg, says: “With a lack of exercise, diet becomes the mainstay of weight management. It is very important to establish and maintain an ideal weight.”
If you are underweight, there may not be enough muscle to support your bones, causing them to fracture more easily. It also means you can get pressure sores more easily because the bones press directly against the skin.
On the other hand, being overweight makes moving around more difficult. There is also the risk of developing lifestyle diseases such as diabetes, cholesterol and hypertension. Here, too, the additional weight on pressure points can lead to pressure sores.
“Diet also plays a role in good skincare. Resilience against pressure sores and other skin afflictions can be enhanced with a good intake of protein and anti-oxidants,” says Grimsehl.
Everybody faces the challenge of getting old at some point. It is unfortunate that for most people with an SCI it will come sooner – but one can recognise the signs and do whatever it takes to challenge the order of things.