A spinal cord injury (SCI) is damage to the spinal cord that causes changes in its function, either temporary or permanent. These changes translate into loss of muscle function, sensation, or autonomic function in parts of the body served by the spinal cord below the level of the lesion.

Spinal cord injury occurs when there is any damage to the spinal cord that blocks communication between the brain and the body. After a spinal cord injury, a person’s sensory, motor and reflex messages are affected and may not be able to get past the damage in the spinal cord. In general, the higher on the spinal cord the injury occurs, the more dysfunction the person will experience. Injuries are referred to as complete or incomplete, based on whether any movement and sensation occurs at or below the level of injury.

The most important point is that each person’s recovery from spinal cord injury is different.

Causes:

• Traumatic injuries
• Motor vehicle accidents
• Football
• Falls
• Gymnastics
• Violence
• Diving into shallow water

Spinal cord injuries affect more men than women. The majority of people who sustain a spinal cord injury are young adults between the ages of 16 and 30 because of riskier behaviours.

Non-traumatic injuries/illnesses

• Cancer Osteoporosis
• Multiple sclerosis
• Inflammation of the spinal cord
• Arthritis

Effects:

The effects of spinal cord injury may include the following:

• Loss of movement
• Loss of sensation
• Loss of bowel and/or bladder control
• Exaggerated reflex actions or spasms
• Changes in sexual function, sexual sensitivity and fertility
• Pain or intense stinging sensation

Levels of Injury

Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur.

High-Cervical Nerves (C1 – C4)

• Most severe of the spinal cord injury levels
• Paralysis in arms, hands, trunk and legs
• Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.
• Ability to speak is sometimes impaired or reduced.
• When all four limbs are affected, this is called tetraplegia or quadriplegia.
• Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
• May be able to use powered wheelchairs with special controls to move around on their own
• Will not be able to drive a car on their own
• Requires 24-hour-a-day personal care

Low-Cervical Nerves (C5 – C8)

• Corresponding nerves control arms and hands.
• A person with this level of injury may be able to breathe on their own and speak normally.

C5 injury

• Person can raise his or her arms and bend elbows.
• Likely to have some or total paralysis of wrists, hands, trunk and legs
• Can speak and use diaphragm, but breathing will be weakened
• Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently

C6 injury

• Nerves affect wrist extension.
• Paralysis in hands, trunk and legs, typically
• Should be able to bend wrists back
• Can speak and use diaphragm, but breathing will be weakened
• Can move in and out of wheelchair and bed with assistive equipment
• May also be able to drive an adapted vehicle
• Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C7 injury

• Nerves control elbow extension and some finger extension.
• Most can straighten their arm and have normal movement of their shoulders.
• Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
• May also be able to drive an adapted vehicle
• Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C8 injury

• Nerves control some hand movement.
• Should be able to grasp and release objects
• Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
• May also be able to drive an adapted vehicle
• Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

Thoracic vertebrae are located in the mid-back.

Thoracic Nerves (T1 – T5)

• Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
• Arm and hand function is usually normal.
• Injuries usually affect the trunk and legs(also known as paraplegia).
• Most likely use a manual wheelchair
• Can learn to drive a modified car
• Can stand in a standing frame, while others may walk with braces

Thoracic Nerves (T6 – T12)

• Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.
• Usually results in paraplegia
• Normal upper-body movement
• Fair to good ability to control and balance trunk while in the seated position
• Should be able to cough productively (if abdominal muscles are intact)
• Little or no voluntary control of bowel or bladder but can manage on their own with special equipment
• Most likely use a manual wheelchair
• Can learn to drive a modified car
• Some can stand in a standing frame, while others may walk with braces.

Lumbar Nerves (L1 – L5)

• Injuries generally result in some loss of function in the hips and legs.
• Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
• Depending on strength in the legs, may need a wheelchair and may also walk with braces

Sacral Nerves (S1 – S5)

• Injuries generally result in so me loss of functionin the hips and legs.
• Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
• Most likely will be able to walk

How can Rehab Basics Help?

Rehab Basics physiotherapists will assess and plan a personalised rehabilitation program which will include the following depending on condition, age and severity:

• FES
• Exercise Equipments.
• Stretching activities to maintain muscle and tendon length and reduce or keep muscle spasms/spasticity to a minimum.
• Flexibility and strengthening exercises for the whole body.
• Breathing exercises to maximise lung function and prevent chest infection.
• Balance and posture exercises which can help to reduce pain associated with poor posture and balance impairment and ensure correct transfer techniques (in/out of wheelchair, bed, toilet/bath, car etc.)
• Functional activities to improve fundamental movement patterns such as rolling over and sitting up, and standing where appropriate.
• Walking re-education, if there is sufficient muscle activity and power in the legs.
• Advise on use of appropriate equipment such as wheel-chairs and pressure releasing cushions.

Treatment Sessions are offered in clinics across Northamptonshire and Milton Keynes or at Home Environment.

For further information about our service or to book an appointment with Rehab Basics please contact us