Spinal Cord Injury

What is an acute spinal cord injury?

Illustration of the spinal cord
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The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body.

Acute spinal cord injury (SCI) is due to a traumatic injury that can either result in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. About 250,000 to 400,000 individuals in the US have a spinal cord injury. About 60 percent of these cases are 30 years old or younger.

The annual incidence of spinal cord injury in the U.S. is 40 cases per million, or 12,000 new cases each year. The number of people in the U.S. in 2008 living with a spinal cord injury is approximately 259,000, with a range of 229,000 to 306,000.

SCI results in a decreased or absence of movement, sensation, and body organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.

Anatomy of the spine:

The spine consists of 33 vertebrae, including the following:

  • 7 cervical (neck)
  • 12 thoracic (upper back)
  • 5 lumbar (lower back)
  • 5 sacral* (sacrum - located within the pelvis)
  • 4 coccygeal* (coccyx - located within the pelvis)

* By adulthood, the 5 sacral vertebrae fuse to form one bone, and the 4 coccygeal vertebrae fuse to form one bone.)

These vertebrae function to stabilize the spine and protect the spinal cord. In general, the higher in the spinal column the injury occurs, the more dysfunction a person will have.

Injury to the vertebrae does not always mean the spinal cord has been damaged. Likewise, damage to the spinal cord itself can occur without fractures or dislocations of the vertebrae.

What are the types of SCI?

SCI can be divided into two main types of injury:

  • complete injury
    Complete injury means that there is no function below the level of the injury - either sensation and movement - and both sides of the body are equally affected. Complete injuries can occur at any level of the spinal cord.
  • incomplete injury
    Incomplete injury means that there is some ability for the spinal cord to send messages to and from the brain. There is also some function below the level of the injury - movement in one limb more than the other, feeling in parts of the body, or more function on one side of the body than the other. Incomplete injuries can occur at any level of the spinal cord.

What causes an acute spinal cord injury?

There are many causes of SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:

  • birth injuries, which usually affect the spinal cord in the neck area
  • falls
  • motor vehicle accidents (where the person is either riding as a passenger in the car or is struck as a pedestrian)
  • sports injuries
  • diving accidents
  • trampoline accidents

Penetrating injuries that pierce the cord, such as gunshots and stab wounds may also cause damage.

What are the symptoms of an acute spinal cord injury?

Illustration of acute spinal cord injuries that would result either in quadriplegia or paraplegia
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Symptoms vary depending on the severity and location of the SCI. At first, the patient may experience spinal shock, which causes loss of feeling, muscle movement, and reflexes below the level of injury. Spinal shock usually lasts from several hours to several weeks. As the period of shock subsides, other symptoms appear, depending on the location of the injury.

Generally, the higher up the level of the injury to the spinal cord, the more severe the symptoms. For example, an injury at C2 or C3 (the second and third vertebrae in the spinal column), affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs.

SCI is classified according to the person's type of loss of motor and sensory function. The following are the main types of classifications:

  • quadriplegia (quad means four) - involves loss of movement and sensation in all four limbs (arms and legs). It usually occurs as a result of injury at T1 or above. Quadriplegia also affects the chest muscles and injuries at C4 or above require a mechanical breathing machine (ventilator).
  • paraplegia (para means two like parts) - involves loss of movement and sensation in the lower half of the body (right and left legs). It usually occurs as a result of injuries at T1 or below.
  • triplegia (tri means three) - involves the loss of movement and sensation in one arm and both legs and usually results from incomplete SCI.

The following are the most common symptoms of acute spinal cord injuries. However, each individual may experience symptoms differently. Symptoms may include:

  • muscle weakness or paralysis in the trunk, arms or legs
  • loss of feeling in the trunk, arms, or legs
  • muscle spasticity
  • breathing problems
  • problems with heart rate and blood pressure
  • digestive problems
  • loss of bowel and bladder function
  • sexual dysfunction

The symptoms of SCI may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Rehabilitation potential with SCI:

The following chart is a comparison of the specific level of SCI and the resulting rehabilitation potential. This chart is a guide, with general information only; impairments and rehabilitation potential can vary depending on the type and severity of SCI. Always consult your physician for more specific information based on your individual medical condition and injury.

Level of injury

Possible impairment

Rehabilitation potential

C2 - C3

Usually fatal as a result of inability to breathe

Totally dependent for all care

C4

Quadriplegia and breathing difficulty

Dependent for all cares; usually needs a ventilator

C-5

Quadriplegia with some shoulder and elbow function

May be able to feed self using assistive devices; usually can breathe without a ventilator, but may need other types of respiratory support

C6

Quadriplegia with shoulder, elbow, and some wrist function

May be able to propel a wheelchair inside on smooth surfaces; may be able to help feed, groom, and dress self; dependent on others for transfers

C7

Quadriplegia with shoulder, elbow, wrist, and some hand function

May be able to propel a wheelchair outside, transfer self, and drive a car with special adaptions; may be able to help with bowel and bladder programs

C8

Quadriplegia with normal arm function; hand weakness

May be able to propel a wheelchair outside, transfer self, and drive a car with special adaptions; may be able to help with bowel and bladder programs

T1 - T6

Paraplegia with loss of function below mid-chest; full control of arms

Independent with self care and in wheelchair; able to be employed full time

T6 - T12

Paraplegia with loss of function below the waist; good control of torso

Good sitting balance; greater ability for operation of a wheelchair and athletic activities

L1 - L5

Paraplegia with varying degrees of muscle involvement in the legs

May be able to walk short distances with braces and assistive devices

Spinal cord injury rehabilitation:

Rehabilitation of the patient with a SCI begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun.

The success of rehabilitation depends on many variables, including the following:

  • level and severity of the SCI
  • type and degree of resulting impairments and disabilities
  • overall health of the patient
  • family support

It is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence.

The goal of SCI rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.

Areas covered in spinal cord injury rehabilitation programs may include:

Patient need:

Example:

Self-care skills, including activities of daily living (ADLs)

Feeding, grooming, bathing, dressing, toileting, and sexual functioning

Physical care

Support of heart and lung function, nutritional needs, and skin care

Mobility skills

Walking, transfers, and self-propelling a wheelchair

Respiratory care

Ventilator care, if needed; breathing treatments and exercises to promote lung function

Communication skills

Speech, writing, and alternative methods of communication

Socialization skills

Interacting with others at home and within the community

Vocational training

Work-related skills

Pain and muscle spasticity (increased muscle tone) management

Medications and alternative methods of managing pain and spasticity

Psychological counseling

Identifying problems and solutions for thinking, behavioral, and emotional issues

Family support

Assistance with adapting to lifestyle changes, financial concerns, and discharge planning

Education

Patient and family education and training about SCI, home care needs, and adaptive techniques

The spinal cord injury rehabilitation team:

The spinal cord injury rehabilitation team revolves around the patient and family and helps set short-and long-term treatment goals for recovery. Many skilled professionals are part of the spinal cord injury rehabilitation team, including any/all of the following:

  • neurologist/neurosurgeon
  • orthopaedist/orthopaedic surgeon
  • physiatrist
  • internists
  • rehabilitation nurse
  • social worker
  • physical therapist
  • occupational therapist
  • speech/language pathologist
  • psychologist/psychiatrist
  • recreation therapist
  • dietitian
  • vocational counselor
  • orthotist
  • case manager
  • respiratory therapist
  • chaplain

Types of spinal cord injury rehabilitation programs:

There are a variety of spinal cord injury treatment programs, including the following:

  • acute rehabilitation programs
  • subacute rehabilitation programs
  • long-term rehabilitation programs
  • transitional living programs
  • day-treatment programs
  • vocational rehabilitation programs

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