Spinal Cord Injury
A spinal cord injury is an injury of any part of the spinal cord. When it happens, the brain cannot communicate with any part of the body located below the level of the lesion. The higher the injury on the spine, the bigger the number of parts of the body that are dysfunctional, or in other words, the bigger the part of the body that is completely or partially dysfunctional. A person with such an injury can have problems with sensory integration and motor skills. Such an injury can have a negative impact on mobility and sensory integration in lower extremities, as in the case of paraplegia, and in serious cases of tetraplegia, patients will not be able to breath on their own.
This injury can affect mobility, sensory integration and, quite often, can cause a partial or complete loss of the bladder control, pain and spasticity, problems with sexual function or a complete loss of sexual function, fertility problems. The scope of side-effect depends on the level of the lesion. The biggest problem with spinal cord injuries is the loss of communication between the brain and parts of the body below the level of the injury.
In addition, injuries are divided into complete and incomplete, depending on the degree of presence of sensation / feeling and movement below the level of injury. A complete injury means that there are no voluntary movements (spasms do not count - they are involuntary) or feelings below the level of injury.
The presence of some feelings or voluntary movements below the level of injury constitutes a partial injury.
Spinal cord injury is caused by traumatic events, such as traffic accidents, falls, but also some diseases, such as cancer, arthritis, multiple sclerosis that lead to inflammation of the spinal cord.
Spinal Cord Injury Classification
Since the spinal cord is surrounded by protective rings of bone called vertebrae and the vertebrae and spinal nerves are organized into segments, spinal cord injuries are classified according to this division and according to the severity of the lesion.
The spine is divided into four segments as follows:
- the cervical segment of the spine is a segment thanks to which our necks are erected
- the thoracic segment of the spine is a part of the spine from the neck to approximately the waist
- the lumbar segment of the spine is the segment in the lumbar area
- the sacral segment of the spine is the segment in the sacral area.
Cervical spine injuries
- Injuries of C1-C4 vertebrae – These injuries are usually the most severe of the spinal cord injury levels. There is paralysis in arms, hands, trunk and legs. The patient may not be able to breathe on his or her own or control bladder movements. Ability to speak is sometimes impaired or reduced. A patient with such an injury requires assistance in daily activities. When all four limbs are affected, this is called tetraplegia or quadriplegia.
- Injuries of C5-C8 vertebrae – These are injuries where corresponding nerves control arms and hands to a certain degree. A person may be able to breathe on his/her own and there are no speech impairments. A person can move around on his/her own with the use of wheelchairs.
- Injuries of C5 vertebrae – A person can raise his or her arms and bend elbows. He or she is likely to have some or total paralysis of wrists, hands, trunk and legs. Breathing when such an injury is present can be weakened. A person with such a spinal cord injury will need assistance in most daily activities, but once in a wheelchair, he or she can move from one place to another independently. There is a partial or complete loss of the bladder control.
- Injuries of C7 vertebrae – Nerves control elbow extension and some finger extension. Most of the people with such injuries can manage most activities of daily living on their own. There is little or no voluntary control of the bowel or bladder movements, but they may be able to manage on their own with special equipment. They can move around independently in the wheelchairs.
Thoracic spinal cord injuries
- Injuries of T1 – T5 vertebrae – Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles. Arm and hand function is usually normal. Injuries usually affect the lower body and legs (also known as paraplegia). Persons with these injuries most likely use a manual wheelchair and they can learn to drive a modified car. They can stand with medical aids.
- Injuries of T6 – T12 vertebrae – Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury. Persons with such injuries have normal upper-body movement. They have a relatively good control of bladder movements in the seated position and otherwise a little or no voluntary control of the bladder. Persons with these injuries most likely use a manual wheelchair and they can learn to drive a modified car. Some can stand in a standing frame, while others may walk with braces.
Lumbar spinal cord injuries
- Injuries of L1 – L5 vertebrae – These injuries generally result in some loss of function in the hips and legs. Persons with such injuries have little or no voluntary control of the bladder. Depending on strength in the legs, people with such injuries may need a wheelchair and may also walk with braces.
Sacral spinal cord injuries
- Injuries of S1 – S5 vertebrae – These injuries generally result in some loss of function in the hips and legs. Patients suffering from these injuries have little or no voluntary control of the bladder. Most likely they can walk.
Anal sphincter corresponds with the S4-S5 area and represents the end of the spinal cord. It is crucial for establishing a diagnosis of an injury type. It is accepted that voluntary anal contractions, regardless of other damages, is a sign of an incomplete spinal cord injury.
Psychological aspects of spinal cord injuries
When people receive a diagnosis and a new medical condition, like a spinal cord injury, they can experience stages in the readjustment process. This process naturally starts with shock and denial, followed by grief and in the end – the most important – acceptance.
The psychological adjustment is of an utmost importance. It is also important to emphasize that we should respect the fact that we are all individuals and that each process of adjustment is individual. Hence, we should not push ourselves, we should not skip stages and we should take time to experience each stage completely and not move to the next stage if we are not ready. Our loved ones are usually by our side in the process and they could serve us as a tremendous motivation to reach the final stage – acceptance.
Also, some of us have a tendency to get stuck in denial pretending that ‘nothing has changed’ and that is not what we want. For the emotional balance to be accomplished, it is crucial to becoming aware of the fact that certain, if not most of the old rules do not apply anymore and that we have the rest of our lives to define new (according to many people suffering from spinal cord injuries better than before) rules and viewpoints. This is how progress is made. This is how we start planning our future and try to live the best possible lives for us and how we respond to challenges in our lives.
We all have bad days and even if we manage to successfully master all stages up to the acceptance, we can still have bad days. This is why it is recommended that along with an open communication with our family and friends, we should meet other people with similar medical issues, we should look for inspiring testimonials of people with spinal cord injuries and find courage and comfort in their stories in order to bring purpose and happiness in our lives.
Frequently asked questions
The goal is to start the rehabilitation and recovery programme as soon as possible so it would be best to diagnose a spinal injury within 72 hours after it has been inflicted. A system of tests defines the level of the injury on the spine. These tests are focused on motor function and the level of feeling that a patient can feel in various areas of the body.
The ASIA / ISCoS Exam Chart is ranked by class in the range A - E, with class A indicating complete absence of motor and sensory functions below (below) the injury level, while class E means that more than 50% of the muscles below the level Injury functions normally and therefore enables the person to move, feel and physiological functions of the body.
Generally, paraplegia is an impairment in motor or sensory function of the lower extremities while tetraplegia is paralysis caused by illness or injury that results in a partial or total loss of use of all four limbs and torso.
“Complete” spinal cord injuries refer to any injury that results in the complete loss of function below the point of injury when a voluntary control of movements and sensory integration is not possible. “Incomplete” spinal-cord injuries, on the other hand, refer to a spinal cord injury in which some feeling or movement is still evident below the point of injury. Since such a sensory and motor function varies from person to person, various symptoms are also possible. This is why there are various rehabilitation and recovery programs.
After a period of time, when some swelling of the injured spinal-cord has subsided, it is possible for some functions to be recovered, especially if a spinal-cord injury is incomplete – usually within 18 months from the injury. A permanent full recovery does not happen often. However, thanks to rehabilitation programmes and scientific findings, a lot can be done at least to decrease the negative impact of an injury.
It is important to bear in mind that regardless of the same diagnosis, prognosis, the recovery process and results of rehabilitation programmes differ from person to person.
Until the middle of the 20th century, the majority of people with a spinal-cord injury would die from complications related to urinary and respiratory infections and pressure wounds several weeks after the traumatic event.
Today, thanks to antibiotics, medical aids and all new scientific findings and modern patient-care, many of them have a normal life expectancy if they receive an appropriate treatment within 24 hours of the initial injury.
So far, a cure for this type of injury has not been found. Scientific studies focused on treating spinal-cord injuries are concentrated on initiating growth of new nerves (since the existing ones below the level of the injury are damaged or destroyed). The studies are also focused on planting new cells that would act as a bridge between the damaged and healthy body parts in order to recover lost sensory and motor functions.
A level of independence, as well as a need for medical aids and assistance, depend on the level of a spinal-cord injury, as well as on the person. Personal hygiene, assistance at home, transport/mobility, special medical care, sports and parenting are aspects of living that person with a spinal-cord injury and his her family members should take into consideration in order to provide the best possible help and care.
Medical doctors and medical staff will be there for you to help you as much as possible, but it is advisable to join specialized associations and other support groups that provide assistance during the adjustment period.