People with quadriplegia are faced with a unique set of health care concerns and their health and well-being depends on having knowledge of and access to specific care techniques and practices. Proper bowel and bladder care, in addition to respiratory, skin and muscle care are fundamental to quadriplegics’ health and ability to stay in their homes. Here are some resources that we’ve found helpful.
Bladder & Bowel Care
Maintaining bowel and bladder health are among the most crucial and challenging issues faced by people with quadriplegia. There are many techniques used to achieve and maintain both bowel and bladder function. There are also many inherent difficulties. The following sites may be of help in addressing some of the issues and choices involved.
New Mobility.Bladder Matters: Ditching Drug Side Effects
Assisted Cough (Quad Cough)
By having someone assist you in coughing, your cough will be more forceful and productive and you will be able to both prevent and treat some respiratory complications by bringing up secretions normally present in the lung.
Indications for an assisted cough are:
• Weak or ineffective cough, and/or
• Excessive secretions
Reasons to avoid an assisted cough are:
• Internal problems, such as abdominal complications, where pushing on the abdomen could cause more complications
• Chest injury ( broken ribs)
• Flail chest, where the chest has excessive mobility, usually due to paralysis of the muscles which control it.
Following is the procedure for an assisted cough:
• Place the fist of one hand, immediately below the breastbone, and the heel of the other hand on top of the breastbone. The hands need to be over the diaphragm area.
• The hand position may vary from the illustration, but the hands must be below the ribs.
• Take a breath and cough as you exhale the air. Your assistant should push inward and upwards as you cough. NOTE: If you are on a ventilator, your assistant should push during inhalation. An ambu-bag may be substituted for the ventilator for a stronger cough.
• Repeat, as necessary, with rest periods, as needed, between efforts
Assisted coughing can be used while in bed or sitting up. Be sure the brakes of your wheelchair are locked before assisting cough. If lung congestion is present, assisted coughing is more effective when combined with postural drainage.
Pneumonia Preventative Steps
Persons with high level quadriplegia are about 150 times more likely to die from pneumonia than the general population. In addition to seeing a doctor and getting appropriate vaccinations and treatments, the following simple steps can help prevent pneumonia:
• Drink plenty of liquids
• Do breathing exercises, with assistance if needed
• Breathe through your nose, not your mouth
• Sit right if possible
• Lose weight, eat healthy foods
• Sleep on your side, not on your back
• Limit time in a supine position
• Change positions at night if possible
• Wear abdominal binder if diaphragm muscles are weak
Individualized Exercise-Based Therapy in the San Francisco Bay Area
Spinal Cord Injury Functional Integrated Therapy (SCI-FIT) offers a comprehensive, post-traditional, exercise based therapy program for individuals who are living with spinal cord injuries and other neurological conditions to help them achieve their maximum functional outcome. They have locations in Petaluma, Dublin, Sacramento and Fresno, find out more on their website: www.sci-fit.org
Videos on Yoga for People Affected by Quadriplegia
Christopher & Dana Reeve Foundation
Free Service for Speech Disabled
Speech to Speech is a free service to people with speech disabilities. It provides a third-party communication assistance for people with difficulty in being understood over the telephone. It is available for personal, business and medical communications by phone. www.speechtospeech.org