What is a Spinal Cord Injury?
A spinal cord injury (SCI) is damage to the spinal cord that results in a loss of function, such as movement and feeling. The common causes are injury and accidents, or from such diseases like polio, spina bifida, Friedreich’s ataxia, and so on. The spinal cord does not have to be severed for a loss of function to occur. In fact, in most people with spinal cord injury, the cord is intact, but the damage to it results in loss of function. Spinal cord injury is very different from back injuries, such as ruptured disks, spinal stenosis or pinched nerves.
The spinal cord is a collection of nerves that travels from the bottom of the brain down your back. There are 31 pairs of nerves that leave the spinal cord and go to your arms, legs, chest and abdomen. These nerves allow your brain to give commands to your muscles and cause movements of your arms and legs. The nerves that control your arms exit from the upper portion of the spinal cord, while the nerves to your legs exit from the lower portion of the spinal cord. The nerves also control the function of your organs including your heart, lungs, bowels, and bladder.
For example, signals from the spinal cord control how fast your heart beats and your rate of breathing. Injury to the spinal cord nerves can result in paralysis, affecting some or all of the aforementioned body functions. The result is a spinal cord injury. There are approximately 12,000 new cases of spinal cord injury every year in the U.S.
What are the symptoms of a Spinal Cord Injury?
The symptoms of spinal cord injury depend on where the spinal cord is injured and if the injury is complete or incomplete. In incomplete injuries, patients have some remaining functions of their bodies below the level of injury, while incomplete injuries have no function below the level of injury. Injuries to the spinal cord can cause weakness or complete loss of muscle function and loss of sensation in the body below the level of injury, loss of control of the bowels and bladder, and loss of normal sexual function. Spinal cord injuries in the upper neck can cause difficulty breathing and may require the use of a breathing machine or ventilator.
How is a Spinal Cord Injury Diagnosed?
The physical examination includes x-rays of the neck or back, a computed tomography (CT) scan and a magnetic resonance imaging (MRI) scan, which is another more advanced imaging study that can identify a spinal cord injury. The MRI is better at evaluating the soft tissues, including the ligaments, intervertebral discs, nerves and spinal cord. The MRI scan also can show evidence of injury within the spinal cord. Most spinal cord injuries have immediate symptoms, including loss of physical sensation and voluntary movement.
Levels of Spinal Cord injury
SCI can be divided into two main types of injury. A complete injury means that there is no function below the level of the injury—neither sensation nor movement—and both sides of the body is equally affected. Complete injuries can happen at any level of the spinal cord. An incomplete injury means that there is some function below the level of the injury—movement in one limb more than the other, feeling in parts of the body, or more function on one side of the body than the other. Incomplete injuries can happen at any level of the spinal cord.
| C2-C3 | Usually fatal as a result of an inability to breathe | Totally dependent on all care |
| C4 | Quadriplegia and breathing difficulty | Dependent for all care; usually needs a ventilator |
| C5 | Quadriplegia with some shoulder and elbow function | May be able to feed self-using assistive devices; usually can breathe without a ventilator, but may need other types of respiratory support |
| C6 | Quadriplegia with shoulder, elbow, and some wrist function | May be able to propel a wheelchair inside on smooth surfaces; may be able to help feed, groom, and dress self; dependent on others for transfers |
| C7 | Quadriplegia with shoulder, elbow, wrist, and some hand function | May be able to propel a wheelchair outside, transfer self, and drive a car with special adaptions; may be able to help with bowel and bladder programs |
| C8 | Quadriplegia with normal arm function; hand weakness | May be able to propel a wheelchair outside, transfer self, and drive a car with special adaptions; may be able to help with bowel and bladder programs |
| T1-T6 | Paraplegia with loss of function below mid-chest; full control of arms | Independent with self-care and in a wheelchair; able to be employed full time |
| T6-T12 | Paraplegia with loss of function below the waist; good control of torso | Good sitting balance; the greater ability for the operation of a wheelchair and athletic activities |
| L1-L5 | Paraplegia with varying degrees of muscle involvement in the legs | May be able to walk short distances with braces and assistive devices |
Initially, efforts are made to stabilize the patient and reduce swelling around the injury. In the long term, rehabilitation, therapies, and medications can help maximize function within the limitations of the injury.
The prognosis for Spinal Cord Injury
When a spinal cord injury 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 go down, and people may regain some functioning. With many injuries, especially incomplete ones, the individual may recover some function as late as 18 months after the injury. In very rare cases, people with spinal cord injury will regain some functioning years after the injury. However, only a small fraction of individuals sustaining a spinal cord injury recover all function. Long-term data collected by the Shepherd Center and the Spinal Cord Injury Model Systems (SCIMS) show an increase in life expectancy for people who have lived 25 years or more with spinal cord injury. The survival rate at 25 or more years after the injury is 60%; this number has been climbing steadily over the years. In addition, many leading indicators show that the quality of that extended life expectancy is good.
Mobility for Those with Spinal Cord Injury
Many with severe spinal cord injuries require the use of a specialized power wheelchair. Quantum Rehab, the global leader in individualized power chairs, puts an emphasis on mobility technologies specific to the needs of those with spinal cord injuries. Quantum Power Chairs incorporate power-adjustable seating for user repositioning and comfort; speciality drive controls, including those requiring minimal hand strength; and, a highly-adaptable design to meet an individual’s current and future needs. Quantum Power Chairs feature the latest advanced technologies to increase the independence of those living with spinal cord injuries. iLevel seat elevation technology allows a user to operate the power chair at a seated or standing height. Bluetooth is also integrated into Quantum’s Q-Logic 3 electronics, so those with spinal cord injuries can operate much of their environment with the power chair drive control itself. Quantum Power Chairs are designed to provide optimal medical comfort and maximum independence for those with spinal cord injuries. Mobility and Assistive Technology Needs Depending on the level of the injury, some individuals may only require the use of a walker or braces to accomplish independent mobility.
A large percentage of those with an SCI relies on the use of power mobility to live independently or achieve independent mobility in their environment. Some individuals will require the assistance of a ventilator to aid with breathing. If a power mobility device is required, it is suggested the client be evaluated during rehabilitation in order to promote increased independence and improved confidence in his/her mobility and to achieve as high a level of independence as possible with the power mobility device. The client should be fitted with a power base that can meet various seating, positioning and electronics needs. Clients with a high level of injury will require a power positioning system to provide them with the ability to perform independent pressure relief, changes in positioning and gravity-assisted positioning. Power seating options for this group of individuals are power tilt, power recline, and power tilt and recline. Additional options are a power-adjustable seat lift, power-articulating leg rests and a power-articulating foot platform.
A customized seating system is an important part of helping a client compensate for weakness or lack of muscle control and providing proper support and pressure distribution for the prevention of pressure ulcer development. There are also many custom accessories that can be added to the seating system in order to maximize the individual’s independence with Mobility Related Activities of Daily Living (MRADLs). Optional LED fender lights on the Q6 Edge 2.0 help clients see and be seen. Often, a client’s needs and abilities will change over time due to gravity’s effect on the body (years or months). A modular seating system should be considered to accommodate these changes. Also, for this reason, periodic evaluation of the client should be performed to prevent orthopaedic deformity from occurring.
Solution
Clients with SCI who have significant mobility needs due to the level of injury will benefit from a power base that has the ability to accept full seating and positioning options like power tilt, recline, and power tilt and recline. This offers a client with decreased ability to shift weight with independent pressure relief and allows the individual to maintain healthy skin integrity at the tissue surfaces making contact with the seat cushion.