Spinal Cord Injury

The spinal cord is a bundle of nerve fibers that carries messages between brain and body. Acute spinal cord injury (SCI) results from a traumatic injury that can bruise or tear the spinal cord. SCI impacts movement, sensation, and body organ function below the level of the injury. The most common sites of injury are the cervical (neck) and thoracic (upper back) areas.

The spine consists of 33 vertebrae, which 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.

SCI can be divided into two main types of injury:

• Complete injury: There is no sensation or movement below the level of the injury, and both sides of the body are equally affected.
• Incomplete injury: There is some function below the level of the injury, such as movement in one or both limbs, preserved feeling in parts of the body, or more function on one side of the body than the other.

Symptoms of Spinal Cord Injury

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

The following are the main classifications of spinal cord injuries:

• Quadriplegia (Tetraplegia): Loss of movement and sensation in all four limbs (arms and legs)
• Paraplegia: Loss of movement and sensation in the lower half of the body (both legs)

Each person may experience a spinal cord injury differently, but common symptoms include the following:

• 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

Causes of 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
• Falls
• Motor vehicle accidents
• Sports injuries
• Diving accidents
• Trampoline accidents
• Violence (such as gunshots or stab wounds)

Treatments and Rehabilitation for SCI

While each patient is different, the location and severity of the SCI generally determine what level of function and rehabilitation may be possible:

• C2-C3 Level Injury: Causes tetraplegia and typically requires a ventilator for breathing. The patient may be totally dependent for all care.
• C4 Level Injury: Causes quadriplegia and breathing difficulty. The patient may be dependent for all care and may require a ventilator.
• C5 Level Injury: Causes quadriplegia with some shoulder and elbow function. Patients may be able to feed themselves using assistive devices. They can usually breathe without a ventilator but may need other types of respiratory support.
• C6 Level Injury: Causes quadriplegia with shoulder, elbow, and some wrist function. The patient may be able to propel a wheelchair on smooth surfaces and may be able to help feed, groom, and dress.
• C7 Level Injury: Causes quadriplegia with shoulder, elbow, wrist, and some hand function. The patient may be able to propel a wheelchair outside, transfer themself, and drive a car with special adaptions.
• C8 Level Injury: Causes quadriplegia with normal arm function and hand weakness. The patient may be able to propel a wheelchair outside, transfer themself, and drive a car with special adaptions.
• T1-T6 Level Injury: Causes paraplegia with full control of their arms but loss of function below the mid-chest. The patient may be able to care for themselves independently with use of a wheelchair.
• T6-T12 Level Injury: Causes paraplegia with good control of the torso but loss of function below the waist. The patient has good sitting balance and is better able to operate a wheelchair and participate in athletic activities.
• L1-L5 Level Injury: Causes paraplegia with varying degrees of muscle involvement in the legs. The patient may be able to walk short distances with braces and assistive devices.

SCI rehabilitation 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 severity of the SCI, the type of resulting disability, the patient’s overall health, and family support.

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

Areas covered in spinal cord injury rehabilitation programs may include:

• Self-care skills, such as feeding, grooming, bathing, and dressing
• Physical care, such as support of heart and lung function, nutrition, and skin care
• Mobility, such as walking, transfers, and self-propelling in a wheelchair
• Respiratory care, such as ventilator care, breathing treatments, and exercises to help lung function
• Communication skills, such as speech, writing, and alternative methods of communication
• Socialization skills
• Vocational training
• Pain and muscle spasticity management, including medication
• Psychological counseling
• Family support, such as assistance with lifestyle changes and financial concerns
• Education, such as training about home care and adaptive techniques

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

Why Choose Columbia for SCI Rehabilitation

Our expert team is highly skilled in partnering with patients and families to help individuals with spinal cord injuries achieve their best possible outcomes. Combining clinical expertise and personalized attention, our rehabilitation specialists focus on effectively treating spinal cord injury symptoms, such as difficulty with mobility or using the upper limbs, bowel or bladder issues, and muscle spasticity.