At this stage in your recovery, awareness of physical changes and limitations is a primary concern. You may not be able to walk to the bathroom, tie your shoes, or eat your food without assistance from another person. Like Jim, you may not be able to walk at all. If your cervical spine is damaged, your arms and hands may be weak or paralyzed. You may not be able to turn over in bed, feed yourself, or hug your child.
For many people with spinal cord injury, being unable to walk is the most frustrating part of their disability. Persons with paraplegia can sometimes learn to walk with crutches and metal braces, but this is not for everyone. “Brace-walking” may require weeks and weeks of intensive physical therapy, because it is quite different from “normal” walking. It requires a whole gamut of new physical skills, and it can be slow and extremely strenuous. Even with sophisticated braces, lightweight crutches, and extensive physical therapy, some individuals with paraplegia find that walking with crutches and braces is simply too difficult, too strenuous, and too slow for use in the real world.
Individuals with injury at a very high level of the spinal cord may need to use a mechanical ventilator (respirator), because the muscles that control breathing are partially paralyzed. Some need special help to cough or clear fluids from the throat and chest. Some people have difficulty communicating because the ventilator and tracheostomy tube interfere with speech, and paralysis of the arms prevents them from writing. Weeks of speech therapy and specialized tubing and air valves may be needed to learn to talk again.
Depending on the type of spinal cord damage, you may have mild or profound changes in sensation. If you are quadriplegic, you may be unable to regulate your body temperature, perhaps experiencing fluctuations from hot to cold (even developing a fever in hot weather) and having to rely more on air conditioners, heaters, blankets, and so forth. You may experience bowel or bladder incontinence, inability to empty your bowel or bladder spontaneously, or a combination of these, requiring bladder catheterization or a bowel program to maintain healthy elimination. And your sexual function and sensation may be affected. Men may have changes in their ability to have an erection, experience sexual pleasure, or ejaculate. Women’s menstrual cycles may be temporarily interrupted, although menses and fertility generally return after some months, and they may have changes in genital sensation and the ability to lubricate or have an orgasm.
Rehabilitation is the period in which you confront and come to understand the full range of your limitations, disabilities, and complications. This is one of the most physically difficult tasks a person can undertake. It is also emotionally disruptive, intellectually demanding, and a challenge to your personality, social skills, and spiritual beliefs. One of the keys to success is being able to cope with a variety of emotional responses while simultaneously focusing your energy on physical recovery.