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What is Spinal Cord Injury?

Spinal Cord Injury or SCI refers to damage caused to the spinal cord that results in partial or complete loss of function in parts of the body controlled by the spinal cord.

 

Spinal cord injury represents a major life event and a significant life change for individuals and their family.

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Causes of Spinal Cord Injury

The spinal cord consists of millions of nerves that permit communication between the brain and different parts of the body. The nerves of the spinal cord travel through the vertebrae of the spinal column. Outgoing communication from the brain to the limbs serves to ‘instruct’ limbs to move in a particular fashion or direction. Incoming communication from the limbs to the brain will carry information about ‘sensation’ allowing the brain to know if a part of the body has been touched, or if a part of the body is hot, or cold, or feeling pain. Information carried through the nerves of the spinal cord is also important for proper functioning of the bowel, bladder and the sexual organs. Damage to the spinal cord can result in restriction of movement, sensation, bowel and bladder function, and sexual functioning. Various forms of trauma can result in damage to the spinal cord. The most common causes of spinal cord injury include motor vehicle crashes, falls, sporting or recreational accidents.

Types of Spinal Cord Injury

Spinal cord injuries are distinguished primarily in terms of the limbs and bodily functions that have been affected or preserved. The control of bodily movement originates in the brain, and nerve signals send information down the spinal cord to neck, trunk and limbs. When damage occurs to the spinal cord, the function of limbs below the site of the injury will be affected, but the function of limbs above the site of injury will be preserved.

A spinal cord injury might be classified as complete or incomplete. Complete spinal cord injury is one where damage is such that there are no nerve signals below the point of injury. With complete spinal cord injuries there is no sensation and no voluntary movement in the limbs that were served by spinal nerves below the site of injury. Incomplete spinal cord injury refers to a type of spinal cord injury where some degree of movement control or sensation will still be preserved below the site of injury.

Severity of Spinal Cord Injury

Spinal cord injuries are graded along a continuum of severity primarily as a function of the ‘level’ of the spinal column at which the injury was sustained. In general, the ‘higher’ the level of the injury, the more severe the physical symptoms.

There are 7 cervical vertebrae (neck region), 12 thoracic vertebrae (trunk region), 5 lumbar vertebrae (lower back region), and 5 sacral vertebrae (pelvic region). Quadriplegia, also known as tetraplegia (partial or total loss of control of the arms and legs) occurs when injury has been sustained to the upper section (cervical region) of the spinal column. Paraplegia (partial or total loss of control of the legs) occurs when injury has been sustained to the lower sections (thoracic, lumbar, or sacral regions) of the spinal column.

The Symptoms of Spinal Cord Injury

The symptoms of SCI will vary as a function of the ‘level’ of the injury, and the treating healthcare professionals and medical team will be able to assess the specific symptoms associated with the specific injury. Very high injuries (cervical region) can result in a loss of many bodily functions including the ability to breathe. In cases where an injury has been sustained to the cervical region of the spine, breathing aids such as mechanical ventilators or diaphragmatic pacemakers might be needed. Injuries to the cervical region of the spine might leave shoulder and bicep control preserved, but the function of the hand might be lost or compromised.

Injuries of the thoracic region of the spine can result in paraplegia. Typically, control of the hands will be preserved, but the individual might lack abdominal muscle control and have poor trunk control.

When injury has been sustained to the lumbar or sacral region of the spine, control of the trunk and abdominal muscles is usually preserved but function of the hips and legs might be reduced or lost.

In addition to partial or complete loss of sensation or movement, spinal cord injury produces other changes as well. Additional problems can include bowel and bladder dysfunction, problems with sexual functioning and problems with fertility. Other problems associated with spinal cord injury might include low blood pressure or the inability to regulate blood pressure, the inability to sweat below the level of injury, and chronic pain.

Duration of Symptoms

While most tissues of the human body possess the capacity to repair themselves, the nerves of the spinal cord are very limited in their ability to repair themselves. When damage has been sustained to a spinal nerve, the damage is most often irreparable. There are new advances in medical science that provide a new outlook for people with spinal cord injury, though these may be several years away from clinical treatment.

In the weeks or months following a spinal cord injury, some degree of improvement can be observed. However, the observed improvement is typically not due to healing or regeneration, but rather to reduced swelling. Following a spinal cord injury, some nerve cells will die while others will become inflamed. Inflammation compromises the proper functioning of the spinal nerves. As inflammation decreases in the weeks or months following a spinal cord injury, some recovery of function may be observed.

Additional challenges can arise for the individual over time further complicating the management of spinal cord injury. As a result of prolonged immobility, an individual with SCI might develop pressure ulcers.Vigilant attention by the health care team along with extra cushioning or assisted turning or movement is often required to prevent or treat pressure ulcers.

Nerve damage or excessive muscle strain associated with transfers or wheelchair use can lead to persistent and debilitating symptoms of pain.

Spasticity can also occur, and refers to uncontrollable tensing or contracting of muscles below the level of the injury. This is variable in severity. Lack of limb use can also result in the shortening of muscles, tendons or ligaments referred to as ‘contractures’.  Lack of limb movement can lead to loss of bone density, in turn increasing the risk of fractures.

Disability associated with SCI

The symptoms of SCI can interfere with an individual’s ability to engage in many activities of daily living. SCI can restrict an individual’s ability to participate in family, social and recreational activities, and can contribute to work disability, highlighting the importance of ongoing family and healthcare support. An individual with severe symptoms of SCI might require some degree of assistance to manage his or her activities of daily living.

The Treatment of Spinal Cord Injury

The treatment needs of the individual with a spinal cord injury (SCI) will change along the path of recovery.

Immediately following injury, emergency life saving measures might need to be provided. As symptoms are stabilized, the individual might require rehabilitation services in order to maximize the probability that he or she might be able to participate as fully as possible in important activities of his or her life.

Immediately following injury, emergency life saving measures might need to be provided. As symptoms are stabilized, the individual might require rehabilitation services in order to maximize the probability that he or she might be able to participate as fully as possible in important activities of his or her life.

As symptoms are stabilized, the individual might require rehabilitation services in order to maximize the probability that he or she might be able to participate as fully as possible in important activities of his or her life.

Some rehabilitation interventions might focus on assisting the individual in completing basic activities of daily living; other rehabilitation interventions might focus on upgrading the individual’s employment-related skills to allow the individual to resume occupational activities. The individual might require modifications to his or her environment to ensure that necessary supports are in place to ensure safety and the highest level of independence possible.

Post-Injury Care

One of the first steps in the treatment of a spinal cord injury is immobilisation of the spine. Following a severe injury, the spine is considered to be ‘unstable’ and susceptible to further damage. As much as 25% of the damage caused to the spinal cord might be the result of post-injury movement or transport to a hospital. In efforts to prevent further damage to the spinal cord, emergency response personnel might apply a rigid cervical collar to the neck, and immobilize the body by strapping it to a backboard. The injured person will also be covered to keep warm given that SCI can interfere with the body’s ability to regulate its temperature.

Emergency Care

Accidents that are severe enough to result in a SCI will often also cause additional injuries. The treatment of additional injuries in the accident that caused the SCI might require emergency care. Surgery might be required to remove bone fragments or other penetrating objects from the spinal column. Surgery might also be required to replace or realign displaced vertebrae.

Inflammation can cause further damage to the spinal cord by reducing the blood supply to spinal and surrounding tissues. Anti-inflammation medication might be used to reduce pressure in order to prevent further damage that could be caused by inadequate blood supply. Medication might also be required to manage the dyisregulation of cardiac function that can occur with SCI.

Pain medication might also be considered to manage the symptoms of pain that can be associated with SCI. The type of pain medication that is prescribed will vary according to the type of pain that is experienced. For example, medication used to treat pain caused by nerve damage will be different from pain medication used to treat musculoskeletal pain.

Rehabilitation and life after Spinal Cord Injury

The treatment of SCI is not just about managing the symptoms or health complications of the spinal injury. The treatment of SCI also aims at helping the injured individual experience full participation in important life activities.

For many individuals with SCI, rehabilitation and assistive resources might be required on an ongoing basis. A major focus of rehabilitation efforts will be maximising mobility. Individuals with incomplete spinal injuries might be able to resume walking with orthoseis (supports for joints) or a cane. Others might require the use of a manual or motorised wheelchair.

The rehabilitation and resource needs of the individual who has sustained a SCI will change through the lifespan. Immediately following injury, the rehabilitation focus might be on developing basic life skills. At a later point in rehabilitation, the focus might change to independent living, and perhaps even career development. The goal of most rehabilitation efforts will be to maximise full participation and best quality of life despite the limitations that were brought about by the SCI.  There are important community based services (including sporting clubs such as tennis and sailing) that assist people with spinal cord injury to reach their potential. The treating healthcare professionals and medical team will be able to link the person and their family to these services.  Advances in assistive technology, home modifications and care packages mean that the individual has greater access to helpful resources than ever before.

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