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Spinal Cord Injuries General Information
Spinal cord injuries (SCI) refer to any physical
damage to the spine. To understand SCI, it is important to first understand what
the spine is. The backbones (also known as vertebrae) have a tunnel in the
middle of each bone where the spinal cord runs down. This cord (the spine) is a
pathway for your brain to connect to the rest of the body and control movement,
sensation and other functions. To be able to visualize this, please watch Spinal Cord Injury
Complete or Incomplete - Everything You Need To Know- Dr. Nabil Ebraheim.
Any damage to the spine causes the path to be
disrupted and consequentially, loss of sensation and movement anywhere below
the damage. This is why spinal cord injuries are mainly classified by how high
up in the body the cord is damaged. However, not all damage result in complete loss of function below the injury.
Depending on the how heavily the cord was damaged, there is a spectrum of how
much function a person has. A complete loss of function below the level of
injury is referred to as complete spinal
cord injury. With a partial spinal
cord injury, a person may lose control of their body below the damage but
still feel sensation or vice versa, they may just have weaker sensation and
strength, and some individuals have only one side of the body impaired.
Terminology
Many times, when we hear about a spinal cord injury,
they are referred to with foreign abbreviations used such as “C4” or T1”. These
letters and numbers refer to how high along the spine, the damage occurred
(remember that any part of the body below the damage is affected).
C = cervical (neck level)
T = thoracic (chest level)
L = lumbar (lower back level)
S = sacral (buttocks level)
C = cervical (neck level)
T = thoracic (chest level)
L = lumbar (lower back level)
S = sacral (buttocks level)
*Each level is further divided into numbers from the
highest sublevel being 1. For a more thorough and specific breakdown, please
watch Levels of Function in Spinal Cord Injury.
Prevalence
As of 2012, approximately 86 000 Canadians were
living with a spinal cord and there is an estimated 4 300 cases of injury per
year. Individuals with SCI’s have a lower life expectancy of 15-30 years than
the average Canadian and require approximately 30 times more hours of home care
services. There is also a huge financial burden for these individuals as it can
cost $1.6 to $3 million for care over their lifetime.
What
to Do if Someone may have damaged
their Spinal Cord
The most important period that determines the
chances and extent of recovery from a SCI is immediately after a person has
sustained injury to the spinal cord. Common causes of spinal cord injuries are motor
vehicle accidents, falls, violence, and sport incidents. However, any injury
that could possibly hurt the neck, or back should be treated as if there is a
SCI and the first aspect to address is immobilizing the head, neck, and back.
This is important because movement of the vertebrae after injury can cause more
damage leading to a significantly lower chance of recovery. That is why
paramedics will completely immobilize someone that may have a SCI even before
bringing them to the hospital. Always
call 911 if someone is suspected to have a head or SCI.
*Note that the procedure if someone is suspected to
have a head injury is more extensive and is not covered in this post on SCIs
From First
Aid & CPR Manual by Canadian Red Cross and
Warning Signs that someone may have a Spinal Cord Injury
SCI’s may not be immediately noticeable after an
accident. That is why it is important to see a physician after an accident even
if there does not seem to be any signs of SCI.
Physicians will typically perform an imaging test
such as an MRI (magnetic resonance imaging) to see if there is damage to the
backbones or spine. An MRI works by using a magnetic field, radio waves, and
computer technologies to obtain an image of the internal body.
There are also certain points to look out for within
the week after an accident. Since the spinal cord relays information for both
movement and sensation, loss of these two aspects are assessed for SCI’s.
Signs of movement, or motor function, impairment
include weak grips, inability to pull or push with regular strength, not able
to get up from a chair, and any other muscle weakness symptoms.
Sensory function loss will result in a person not being
able to feel or notice something that comes in contact with their skin below
the level of damage. A preliminary test would be to use a pen to stroke a
person along their leg then squeezing their fingers and shoulders and ask if
they are able to feel these tests performed on them.
Remember that the loss of motor function and
sensation will be below the level their cord is damaged. For example, someone
that has damaged their cord in the lower back will have normal grip strength.
From:
http://www.youtube.com/watch?v=g3Kl5VKdEwI,
Prevention
Many cases of SCI’s are preventable. As explained in
the “What To Do if someone may have
Damaged their Spinal Cord”, the most common causes of SCI’s are motor
vehicle accidents, falls, violence, and sport incidents. The chances of
sustaining a SCI or, equally as disastrous, causing someone to have a SCI can
be greatly reduced by taking precaution.
Motor
Vehicle Accidents
Taking a defensive driving course and assuring you follow
all traffic laws (wearing a seatbelt, not driving under the influence, staying
within speed limits, etc.) is perhaps one of the best preventative measures to
spinal cord injuries. Appropriate safety seats for babies and young children
and correct positioning of the seats is extremely important for their safety.
Falls
Erect gates that block infants from accessing stairs
will prevent accidents. Setting up railings and proper lighting where there is
a chance someone could fall (such as beside bathtubs or dark hallways) are also
helpful. Lastly, keeping your environment clean decreases the chances of
slipping on objects.
Sports
Incidents
Assure that everyone is wearing suitable protective
equipment during physical activity to prevent SCI’s.
Shaken Baby Syndrome
A baby or child may cry for a long period of time
and induce so much frustration in some people that they shake the baby. At this
stage in their life, the child is still fragile and violent shaking can cause a
SCI, fractures, other disabilities, and even death. NEVER shake a baby. Calm
yourself down by taking deep breaths and contact a crisis line or other sources
of help to deal with this issue.
From:
First Aid & CPR Manual by Canadian Red Cross
How can a Spinal Cord Injury Affect Someone’s Life?
As there is such a large range in SCI severity, the
effect it has on people’s lives vary considerably as well. Individuals that
have an injury in the higher neck region may require a ventilator to breathe
and not be able to move their arms. This severe case limits many aspects of
that person’s life. They become dependent on a caretaker for everyday tasks.
Some other consequences of cervical SCIs are incontinence, muscle loss, and
difficulty regulating blood pressure and heart rate.
Injuries at all levels require extensive
rehabilitation with professionals and on one’s own time. This can take up a
large portion of one’s daily life. Rehabilitation is not limited to physical
aspects. Mental care is also required after facing such a life-changing
event.
Pressure ulcers (also called pressure sores or bed
sores) can arise in individuals with SCI’s. A pressure sore is damage to the
skin and below the skin, and can reach as far down as the bone. It is caused by
pressure and friction on a part of the body for an extended period of time.
This can be caused by the weight of person on a particular part of the body
because they do not shift their position. The average person changes their
posture quite often without noticing it. However, a person with a SCI cannot
move their body below the level of damage and are highly susceptible to
developing bed sores. Bed sores can lead to other complications including
infections, deep tissue damage, and even death. Please refer to the “Options
for Individuals with Spinal Cord Injuries (Smart-e-Pants)” below for technology
that can greatly reduce the chances of developing pressure ulcers.
Severe SCIs affect the entire family. Whether family
members are the ones caring the individual after their SCI or a caretaker is
hired, families must adjust to this change. Contacting a social worker or a support network will help guide the family through
this transition. Some organizations to contact in Alberta include Alberta
Supports (1-877-644-9992) and Catholic
Social Services. Facing a SCI may feel overwhelming and
it is important to keep in mind, there is help available!
From: http://www.aihealthsolutions.ca/media-tracker/system/scanned_articles/1307/original/AMSVans.com_Feb17_2012_Smart-e-Pants__Bedsore_Prevention_for_Bedridden_Wheelchair_Users_VMush.pdf and http://ajot.aotapress.net/content/46/4/305.full.pdf
Options for Individuals with Spinal Cord Injuries
Surgery
After a SCI, there may be pieces of bone that are in
contact with the spinal cord or the cord may be inflamed causing compression by
the backbones. The patient may require surgery to remove these pieces or
relieve pressure on the cord. There have been studies, such the Surgical
Treatment of Acute Spinal Cord Injury Study (STASCIS), that reveal surgery
within the first day of a SCI can greatly increase the recovery process as
opposed to waiting longer. However, depending on how the cord was damaged and
condition of the individual, surgery may not always be appropriate. An example
would be a car accident where the patient is too weak to undergo a surgery as
it may put their life at risk.
Medication
Medication may be prescribed by a physician to
reduce inflammation around the spinal cord. The primary purpose of this is to
prevent compression on the spinal cord leading to more damage. Medication to
reduce pain may also be prescribed. It is important to ask and follow the
physician’s instructions regarding medication since improper use can manifest
various side effects.
Therapy
An individual with a SCI may work with more than one
type of therapist depending on the extent of their injury. For an individual
that is hospitalized, initial therapy sessions mostly begin inside the hospital
facility. The individual may then follow up by visiting the hospital for
therapy sessions, visiting a therapy clinic, or having a therapist come to their
home.
Physical
Therapy
Most people with SCIs will undergo physical therapy
(also known as physiotherapy). A physiotherapist will provide exercises and
support that helps an individual regain their mobility and function. They will
also work to teach basic manoeuvres of a wheel chairs and other equipment
necessary for moving. Beginning therapy early is beneficial since it allows
strength to be regained before there is significant muscle loss. Waiting longer
than necessary to begin may make the recovery process more difficult and even
prevent recovering to the extent that should be possible.
Occupational
Therapy
Occupational therapists (OT) focus on helping the
individual regain their ability to perform activities of daily living. Fine
motor skills may be lost with a SCI and occupational therapists are trained to
assist these individuals increase their ability to live independently. This
will include training the muscles to perform the fine motor functions and providing
advice for purchasing helpful equipment. OTs also help an individual find new
ways to adapt and enjoy their lives. Relevant leisure and sports activities are
often introduced by OT's.
Research
and Technology
Extensive research is being conducting on new
methods to help people with SCI’s regain function. The University of Alberta
conducts research on Intraspinal
Microstimulation (ISMS); a technique that uses implanted
electrodes to stimulate the spinal cord below the level of damage. The research
focuses on using this technique to recreate the walking motion in people with
SCI.
New technology is being created as we learn more
about SCI’s. One of these innovative inventions is Rewalk,
an electrically powered mechanical attachment that assists paraplegic
individuals with walking. It physically moves the legs with a remote the person
can control with their hand.
Functional
Electrical Stimulation
Functional Electrical Stimulus (FES) is a technique
that uses electrodes to provide a low current to stimulate nerves connected to
muscles. This causes the muscles to activate and move which allow people with
weakened or paralyzed muscles to perform exercises. For people with incomplete
SCI’s, it helps them regain muscle function. For individuals with complete SCI’s,
exercising the muscles that are no longer able to move has been known to reduce
the occurrence of chronic diseases associated with inactivity. The Steadward
Centre, located at the University of Alberta, is one
program that offers FES. Some physiotherapy clinics may also offer FES.
From: http://www.steadwardcentre.ualberta.ca/en/Programs/FunctionalElectricalStimulatio.aspx and http://wwrc.virginia.gov/FunctionalNeuromuscularStimulation.htm
To combat pressure ulcers, a University of Alberta
research group invented Smart-e-Pants:
an underwear that provides small scale electrical stimuli every 6-10 minutes.
These tiny shocks are enough to cause the muscles in someone to twitch. It
allows a person who cannot move anymore to mimic normal fidgeting (posture
change) which able-bodied people regularly engage in.
Wheelchairs
Wheelchairs
can be very expensive and there are many different types that accommodate one’s
specific needs. Whether an
individual has a complete, incomplete, or temporary SCI and requires a
wheelchair, Alberta
Aids to Daily Living is a good resource that helps with the
financial aspect of purchasing a wheelchair. They also have a list of the wheelchair
vendors across Alberta that provide medical equipment to
eligible individuals and may also be available to answer questions about
choosing a suitable wheelchair.
From: http://www.disabled-world.com/assistivedevices/mobility/wheelchairs/choosing-wheelchair.php
and http://www.health.alberta.ca/services/AADL-vendors.html
Spinal Cord Injuries in the Classroom
The classroom can become a frightening place for a
child that has a SCI if consideration for the student is neglected. Parents,
teachers, the principal, others involved in the school system, and the children
themselves must work together to create a positive environment for the child.
If a child is attending a new school, or has
recently had a complete SCI, parents must be organized and act as early as
possible in contacting the principal of the school. For a child attending a new
school, parents should contact the school well before the school year begins.
Together, they can plan and prepare everything ahead of time so the student
will have immediate access to the required services when the school year
begins. Such services include: accessible ramps, safety plans in case of fires
or other emergencies, accessible washrooms, and transportation. It is important to remember that referrals
and evaluations to receive government support takes time as well.
Teachers should be informed of any special concerns
they should be aware of. Some students with SCIs may have difficulty
controlling their bladder and require their desk to be close to the door so
they can access the washroom quickly and easily. Damage to T6 and above may
need special medical attention where it is imperative that teachers are able to
notice signs that the child may be in danger.
Teachers and other staff must also work together to
modify or find new activities that are inclusive. Inclusion does not mean
students with SCI’s should be given separate tasks and activities; neither does
it mean activities should exclusively revolve around them. Rather, they should
be able to participate and play with other students in activities everyone can
enjoy. Of course, not all activities can be shaped in this way and it is up to
the teachers, staff, students, and the child to come up with what they can do
in these situations.
Knowledge is an important determinant of whether a
student will have a positive experience in the classroom. Knowing that they are
not alone is important for their psychosocial development. Luckily, there are
many books, both fiction and non-fiction, that reveal the experiences of
children which have had SCI’s. By searching in your local library, one can find
an abundance of resources. Even simply searching the word “wheelchair” in the
online public library search box returns many results for books that are geared
towards children.
Another part of knowledge is educating the entire
school. SCI’s will most likely be foreign to many students and can lead to
misunderstandings about someone with a SCI. Inviting a guest speaker that has sustained a SCI to tell their
story to the school is a good way to expose children to why safety is important
and what it is like to live with a SCI. This allows students to empathize and
ultimately create an environment of understanding.
College and university students that have SCI’s
should be aware that there are usually services available provided by their
student’s union. These services provide the resources required to give students
with disabilities an equal chance to succeed in their academic pursuit. Such
resources include copies of other students’ notes, information on scholarships
that are for students with disabilities and more.
Communication is key in helping a child with a SCI.
Since the ultimate goal is to help the child, it is important that they are
able to have input on what they want for themselves. A child cannot make all of
their own decisions of course but sometimes we become so focused on what we
think can help a child, we actually forget to ask the child if that is what
they want for themselves. Asking them to voice their opinion is the first step
in empowering the individuals and providing them with the freedom they deserve.
From: http://ajot.aotapress.net/content/46/4/305.full.pdf
, http://www.christopherreeve.org,
and http://www.christopherreeve.org/atf/cf/%7B173bca02-3665-49ab-9378-be009c58a5d3%7D/CHILDREN'S%20AND%20TEEN%20BOOKS.VIDEOS%20ON%20DISABILITY%203-11.PDF
Resources
Brain and Spinal Cord
National Institute of Neurological Disorders and
Stroke
Christopher and Dana Reeve Foundation
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