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SPINAL CORD INJURY: BODY IMAGE AND SENSATION
Body image refers to the psychological experience of the body. This includes feelings and attitudes about one’s body, its parts, and its functions, as well as awareness of bodily boundaries (what’s inside and outside the body), where the body is located in space, and the relationship of the body to the environment. Body image is a part of overall self-image, and this may be disrupted or altered by the effects of spinal cord injury on sensation.
In complete spinal cord injuries, sensory as well as motor function is lost below the level of the injury. In incomplete injuries, partial loss of sensation is common. So accompanying the changes in how the body looks are dramatic changes in how the body feels. These changes run the gamut from complete loss of all bodily sensation below the level of the injury, to diminished sensation for touch, temperature, pain, or position, to distorted or “phantom” sensations of pain, tingling, or position (that is, having the sensation that part of your body is in a position other than the position it’s actually in).
If you have diminished or distorted sensation, you have to rely on visual cues and memory to maintain a cohesive body image. Visual feedback can be essential for incorporating changes in the way your body functions. You may need to look at your leg to know whether it is properly placed on the bed or chair. Similarly, if you have a visibly altered gait or use a wheelchair, others will respond to you on the basis of these visual cues. Perhaps in part to counter these cues (still generally perceived as negative), people with spinal cord injuries often pay more attention to their personal appearance and to looking as attractive as possible than they did before the injury. This creates visual and sensory feedback that helps restore an accurate body image, and it focuses positive attention on oneself, further improving self-esteem and promoting social encounters.
Loss of tactile (touch) and kinesthetic (movement) sensation has obvious practical implications, too. Without normal pain and pressure sensations, you are more vulnerable to accidental injuries such as burns and to pressure sores (decubitus ulcers) on your skin. Instead of relying on pain sensation to tell you when your body is threatened, you need to anticipate your body’s needs. For example, doing pressure releases on a schedule will prevent pressure sores, and testing (or asking someone else to test) the temperature of water, cookware, and so forth will protect you from burns on body parts that can’t feel heat or pain. You may need to examine your skin for signs of accidental bruising, cuts, infection, and so on. Similarly, if you cannot feel pressure ? your bladder or bowel, you must schedule regular catheterization and a bowel program to avoid bladder infections or bowel impaction.
Diminished or absent pelvic and genital sensation, in addition to its effects on sexual function, can play havoc with body image and sense of self. While it is only one part of total sexuality, genital sensation is, for most adults, an important part of feeling feminine or masculine. Until you have had the opportunity to explore other aspects of sexuality or sexual experience and to discover other erogenous zones, the loss of genital sensation may be disorienting. Your sense of self as a sexual being may seem to be irreparably damaged.
The extent of permanent changes in mobility, appearance, and sensation after spinal cord injury varies widely, depending on the level of injury and degree of recovery. These changes inevitably have some effect on self-perception, body image, and self-image, but their effect on overall psychological adjustment is not necessarily devastating. The extent of the impact often depends more on attitudes, social context, and the psychological meaning of particular changes than on the extent of the actual alterations in mobility and sensation.
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