What is Spinal Cord Injury?
Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. Frequent causes of damage are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida, Friedreich's Ataxia, etc.).
The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.
A person can "break their back or neck" yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized.
What are the spinal cord and the vertebra?
The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and Parasympathetic Nervous Systems.
The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience. The vertebra are named according to their location. The eight vertebra in the neck are called the Cervical Vertebra. The top vertebra is called C-1, the next is C-2, etc. Cervical SCIs usually cause loss of function in the arms and legs, resulting in quadriplegia.
The twelve vertebra in the chest are called the Thoracic Vertebra. The first thoracic vertebra, T-1, is the vertebra where the top rib attaches. Injuries in the thoracic region usually affect the chest and the legs and result in paraplegia.
The vertebra in the lower back - between the thoracic vertebra, where the ribs attach, and the pelvis (hip bone) - are the Lumbar Vertebra. The sacral vertebra run from the pelvis to the end of the spinal column. Injuries to the five Lumbar vertebra (L-1 thru L-5) and similarly to the five Sacral Vertebra (S-1 thru S-5) generally result in some loss of functioning in the hips and legs.
What are the effects of SCI?
The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected.
An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.
The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses. Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers.
Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.
Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder. Sexual functioning is frequently affected: men with SCI may have their fertility affected, while women's fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers.
Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.
How many people have SCI? Who are they?
According to a study initiated by the Christopher & Dana Reeve Foundation, there are nearly 1 in 50 people living with paralysis -- approximately 6 million people. That's the same number of people as the combined populations of Los Angeles, Philadelphia, and Washington, D.C. And that number is nearly 33% higher than previous estimates showed. It means that we all know someone -- a brother, sister, friend, neighbor, or colleague -- living with paralysis.
Is there a cure for SCI?
Currently, there is no cure for SCI. There are many researchers attacking this problem, and there have been many advances in the lab. Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs, such as methylprednisolone, reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug Sygen® appears to reduce loss of function, although the mechanism is not completely understood.
Do people with SCI ever get better?
When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to decrease and people may regain some functioning. With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning.
Does everyone who sustains SCI use a wheelchair?
No. Wheelchairs are a tool for mobility. High C-level injuries usually require that the individual use a power wheelchair. Low C-level injuries and below usually allow the person to use a manual chair. Advantages of manual chairs are that they cost less, weigh less, disassemble into smaller pieces and are more agile. However, for the person who needs a power chair, the independence afforded by them is worth the limitations. Some people are able to use braces and crutches for ambulation. These methods of mobility do not mean that the person will never use a wheelchair.
Many people who use braces still find wheelchairs more useful for longer distances. However, the therapeutic and activity levels allowed by standing or walking briefly may make braces a reasonable alternative for some people.
Of course, people who use wheelchairs aren't always in them. They drive, swim, fly planes, ski, and do many activities out of their chair. If you spend time with people who use wheelchairs, you may see them sitting in the grass pulling weeds, sitting on your couch, or playing on the floor with children or pets. And of course, people who use wheelchairs don't sleep in them, they sleep in a bed. No one is "wheelchair bound."
Do people with SCI die sooner?
Yes. Before World War II, most people who sustained SCI died within weeks of their injury due to urinary dysfunction, respiratory infection or bedsores. With the advent of modern antibiotics, modern materials such as plastics and latex, and better procedures for dealing with the everyday issues of living with SCI, many people approach the lifespan of non-disabled individuals.
Interestingly, other than level of injury, the type of rehabilitation facility used is the greatest indicator of long-term survival. This illustrates the importance of and the difference made by going to a facility that specializes in SCI.
People who use vents are at some increased danger of dying from pneumonia or respiratory infection, but modern technology is improving in that area as well. Pressure sores are another common cause of hospitalization, and if not treated, death.
Do people with SCI have jobs?
People with SCI have the same desires as other people. That includes a desire to work and be productive. The Americans with Disabilities Act (ADA) protects the rights of people with disabilities, including those with SCI to fully participate in society. Of course, people with disabilities may need some changes to make their workplace more accessible, but surveys indicate that the cost of making accommodations to the workplace in 70% of cases is $500 or less.
The state and federal government provides programs such as Vocational Rehabilitation, which assists persons with disabilities, including persons with SCI, to return to or stay at work after an injury.
Can people with SCI have sex and have children?
SCI frequently affects sexual functioning. However, there are many therapeutic and assistive options that allow people with SCI to have an active and satisfying sex life. Fertility is also frequently affected in men with SCI, due to decreased sperm count, motility and ejaculation issues. Methods similar to those used for non-disabled men with fertility problems have allowed many men with SCI to become parents. It is important for men with SCI to consult with a physician (usually a urologist) who is experienced in SCI, for sexual function and fertility issues.
The fertility of women with SCI may be affected in the first months after injury, when trauma may cause menstruation to stop temporarily. Most women retain the ability to have normal pregnancies and deliveries after SCI. However, it is important that women with SCI consult with an OB-GYN physician who is experienced in SCI, for sexual function, birth control, pregnancy and delivery issues.
What do I say when I meet a person with SCI?
A person with a SCI is just that: a person first. People with SCI have the same capacity for hopes, dreams, interests and desires as all human beings. Although individuals with SCI may accomplish them differently, their goals to work, play, love and participate in life are no different than any one else's, and no less achievable.
The most important thing to remember is: Life does not end with spinal cord injury, it just changes.