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.
Levels of Injury
- HIGH CERVICAL NERVES (Neck)
- LOW CERVICAL NERVES (Neck)
- THORACIC NERVES(Upper Back)
- LUMBAR NERVES(Lower Back)
- SACRAL NERVES
What Causes a Spinal Cord Injury?
Traumatic spinal cord injury may result from a sudden, traumatic blow to your spinethat fractures, dislocates, crushes, or compresses one or more of your vertebrae e.g.car accident. It also may result from a gunshot or knife wound that penetrates andcuts your spinal cord.
Spinal cord injuries may occur when there is no history of an accident. Osteoarthritis,inflammation, infection, disk degeneration of the spine or a tumour may cause spinalcord compression and injury.
Factors that affect the injury severity
Your ability to control your limbs after spinal cord injury depends on two factors:-
i. The area of the injury along your spinal cord
ii. The severity of injury to the spinal cord.
Complete vs Incomplete SCI
Complete SCI
Total loss of sensory and motor (movement) function below the level injury.
Incomplete SCI
Spinal cord’s ability to convey messages to or from the brain is NOT completely lost.
Some sensation, even if it’s faint and/or movement is possible below the level of injury.
How will my Spinal Cord Injury Affect me?
Spinal cord injuries affect each person differently, both physically and psychologically,depending on many factors. Previous activity, profession, education, family support,independence and age at the time of the Spinal cord injury all play a huge role in how you will adapt. No two spinal cord injuries are the same and no two patient journeys are the same. This is your life and your journey and although it may be similar to others, it will always be unique to you.
Mobility is often affected post spinal cord injury and the extent to which it is affected is directly related to the site and extent of the injury. It is important to understand the nature of your injury as this will affect the prognosis (How healthy and active we expect you to be in the future). Any other injuries or conditions such as a traumatic brain injury or limb fractures in addition to any mental health concerns will affect how you recover
and the time it takes.
Lack of Sensation and Pain can be very limiting post Spinal Cord Injury. Pain may be due to the injury itself or due to the body’s nervous system struggling to process the effects of the injury. The good news is that pain is treatable in many ways. Pain level is not an indicator of damage to the body. Pain is the body’s response to a sensory stimulus and sometimes the body confuses an everyday touch (a piece of clothing against the skin) with a painful one (a burn). The body overreacts to this pain and sends itself into a spiral. Movement, activity, meditation, relaxation, heat and cold and therapeutic electrical stimulation can all help to control and in some cases eliminate pain. Medication is available for more severe pain. Remember, you do not need to be in pain. Speak to your Rehab team whenever you are in pain so we can help.
Respiratory complications may affect some people with cervical and high thoracic lesions tend to have marked limited chest expansion, decreased ability to cough because of weakness or paralysis of the diaphragm, intercostal and latissimus dorsi muscles. This may result to respiratory tract infections. Overall endurance level can be reduced as the body cannot take in sufficient breath and therefore oxygen. Endurance can be improved by assisted breathing and by vigorous Respiratory Therapy. Respiratory therapists can advise and teach the best way to clear the lungs of secretions. Secretions are produced normally by the lungs and help to keep them moist. It is usual to cough up any excess secretions. Post spinal cord injury, some individuals have a weak cough or are unable to cough. A buildup of secretions can harbor infection which can then lead to pneumonia, a life threatening condition of the lungs.
Being proactive and managing secretions is the best way to reduce the risk of pneumonia. Manually assisted coughs and deep breathing exercises are essential to maintain optimal lung function. If you smoked before your injury, you may fell now is a good time to stop. Not only will this help your lung function but also positively affect your circulation, endurance and bone health. We can help you to stop smoking. Speak to your Rehabilitation team to discuss support.
Swallowing problems can put you at risk of infection and affect your enjoyment of food. The therapist may recommend an altered diet for safety. This will depend on assessment and will be to minimize risk of choking or chest infections. They may establish a treatment programme to strengthen your swallow, if safe to do so. Some patients, especially those who require assistance to breath post spinal cord injury, may require assistance in speech production. Our speech and language therapists are highly trained in the use of speaking valves and augmentive communication devices to assist in regaining or improving communication skills.
Sensory loss increases the risk of skin breakdown. Sensory loss means you cannot feel the pressure and shearing of prolonged sitting or lying in same position or the presence of pain or heat against the body. Pressure causes the loss of blood supply to the area involved, which can damage the skin and underlying tissues. Areas most likely to develop skin breakdown are bony prominences over the sacrum, ischium, trochanters, back of the head, elbows and heels; however, other bony prominence such as iliac crest, scapula, knees, toes and rib cage are also at risk.
If you see any redness/blister especially on the above listed areas, inform your nurse/Dr or therapist.
Prevention
- Position change in bed every 2 hours
- Use specialized mattresses and wheelchair cushions
- Pressure relief (weight shift) every 20-15 minutes when sitting on a wheelchair
