Nervous System Recovery

Posted by Nurse Linda in Daily Dose on September 21, 2022 # Health

Central Organ of Human Nervous System Brain Anatomy stock photoSeptember is Spinal Cord Injury Awareness month. As most individuals are reading these blogs, spinal cord injury or brain injury has probably already happened. Recovery of the nervous system follows some general principles in the brain, as in the spine. Understanding recovery after nervous system injury is another way to be aware of what happens in that process.

Early treatment of spinal cord injury helps with improved outcomes. Stabilization of the spine by use of a backboard in emergency transportation and early surgical decompression of the injury site prevents further injury to the spinal cord. Early treatment in brain injury by use of medications to reduce swelling and surgical intervention to relieve extra blood pressing on the brain leads to less damage to the delicate brain tissue.

The biggest misconception about the nervous system is that no healing can occur once it is affected by disease or injury. That is simply not true. The nervous system does have the capability of healing in a couple of ways.

One way the nervous system heals is by the restoration of cells. The nervous system has a series of cells that perform functions of feeding and oxygenating nervous system cells, cleaning debris or waste from the cells, and even creating new nerve cells to replace old or damaged cells. All cells in the body replenish themselves. Mostly, you can see this in skin cells because you can look at a small cut and see a scab, then a scar, form over time. These new cells are not as elastic as the original, but they do serve the purpose of closing skin. You cannot see nervous tissue heal because it is inside your body, but the cells are repairing, albeit at a much slower rate.

The slowness of repair of nerve cells is because of many reasons, one of the simplest is body structure. Skin is exposed to the outside world which makes quick repair a necessity. Nerves in the peripheral nervous system (PNS, all the nerves in the body outside of the brain and spinal cord) have a regeneration rate of one inch per month. Peripheral nerves have soft tissue protection.

The central nervous system (CNS) is the most extensively protected area of the body. The brain is in the rigid skull, the spinal cord is in the vertebrae, which can flex a bit, but mostly is rigid. If you think about the structure of the body, the CNS is the most protected. The next level of protection is the heart and lungs protected by the rib cage. The rest of the body is arranged with soft tissue closer to the underside of the skin and the boney structure inside the tissue to support the body. Because the CNS is so greatly protected by bones, there is not as big of a need for fast healing, as damage to the CNS is rare. However, as we know, it does happen.

Another way the nervous system attempts to heal itself is by rerouting nerves. This is called neuroplasticity, as the nervous system has a ‘plastic’ quality, meaning it can remold itself as needed. If an injury in the nervous system occurs, the nerves will attempt to learn to transmit messages to other nerves. This may happen faster in smaller injuries but may take much more time to learn new transmission pathways in larger injuries.

You may have seen this yourself years after a nervous system injury, where something did not function but now has a bit of movement or sensation. Often individuals may discover a movement in a toe or finger that appears years after injury. This is an example of a connection being made. Eventually, the individual may be able to control this movement, usually having to look at the body part and then just being able to move it on their mental command. If these movements can be harnessed into functional use, it would appear that additional functionality may be restored. Most individuals dismiss their new function as a quirk and do not pay close enough attention to it or discuss ways to enhance it with their healthcare professionals.

Electrical stimulation is a possibility to be used as a treatment for new nerve route pathways. Stimulation of the nerves of the body (or now directly through the skin over the spinal cord) sends messages through the spinal cord to the brain as opposed to from the brain to the body part. Still, the message pathway is found and can be later mimicked in either direction. Although this process is in early development, the potential is outstanding.

Once a spinal cord injury has occurred, the body goes into spinal shock. An injury or even progression of a disease can disrupt function above or below a spinal cord injury or around the area of a brain injury. This is due to the body’s natural protection response, where extra fluid and blood are sent to an area of injury to produce a cushion to avoid further injury. Once this fluid has resolved, individuals will see some improvement in their spinal cord injury in as little as six weeks to as long as six months. Those with brain injury may see some issues improve over a longer period of time.

A couple of odd things can occur that are actually recovery from spinal cord injury. This is the occurrence of pain and tone (spasticity). I call these odd because they are not comfortable for the individual. However, they are both evidence that messages are getting through below the spinal cord injury, just not effectively.

Pain as an indicator of recovery is typically neuropathic pain, which is specifically nerve pain. This can be extremely uncomfortable. Neuropathic pain can be relieved only by medication developed uniquely to treat nerve pain (gabapentin or pregabalin) or other more intense treatments. Sometimes movement can help relieve the pain. Finding the right treatment can be difficult, and nerve pain medication can take up to six weeks for effectiveness. However, nerve pain does indicate messages are being transmitted to that area below the level of injury, which is good, but a balance must be found for comfort.

Tone (spasticity) is another indication that messages are getting through to the area of the body below the level of spinal cord injury. Slight muscle twitches or more significant jerking spasms are misinterpreted or incomplete messages. These can be painful or physically challenging to control. Adding movement to fatigue the muscle may help as well as some medications.

Many individuals want to eliminate pain and tone. Quite frankly, who would not due to the pain or safety concerns that accompany these issues? But learning to harness the pain and tone can help turn these issues into functional returns. It is a complex process of balancing benefits and risks to your advantage. Your healthcare professional will be able to work with you to see how you would like to proceed and what treatment will be best in your individual situation.

Another issue can be tingling below the level of injury. This indicates the nerves for sensation are responding. Tingling can be annoying but also helpful, as it indicates that something is bothering your skin. If you can tolerate the tingling sensation, you may be able to use it to your advantage for sensation issues of pressure, temperature, or other concerns.

You may hear that there will be no further improvement two years after a nervous system injury. This is another falsehood. Recovery comes fastest in the first six months, mostly because the protective swelling reduces over that time and spinal shock resolves. The use of therapeutic techniques can enhance improvement by stimulating the body in its usual functions. The two-year time limit is because that is how long individuals were historically studied for improvements. People just gave up looking because neurological recovery is a slow process. However, we now know that recovery never ceases. More likely, people stop trying because they are told that nothing will happen. However, individuals that continue to move their bodies have additional recovery.

Here is a website with more detailed information about spinal cord injury recovery by phases.

The Brain Injury Association of America has some strategies on its website. It can be found here.

Pediatric Consideration:

Nervous system injury in children can be different, as they are still developing their nervous systems. Rehabilitation of already developed functions, as well as stimulation of the nervous system to develop new functions (habilitation), should be used. Nervous system plasticity can be harnessed for excellent outcomes. This article is an excellent summary with ideas that you can use.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.