VCU Physical Medicine and Rehabilitation

What is SCI

What Does Having a Spinal Cord Injury Mean?

 

Recently you or a family member/acquaintance may have been diagnosed as having a spinal cord injury (SCI) and you probably have a number of questions regarding current issues or long-term outcomes. This handout has been prepared to help inform you of some general terms related to SCI and to provide information relating to the abilities of persons at various spinal cord injury levels.

 SPINAL CORD INJURY (SCI): General Terms:

 Spinal Cord:      The spinal cord is a part of the central nervous system that allows for control of movement (legs and arms), bladder, bowel, sexual response, and sensation (feeling) to touch and temperature. 

Spinal Cord injury (SCI): A spinal cord injury is an injury to the spinal cord that may result in paralysis of certain areas of the body, along with the corresponding loss of sensation.

Tetraplegia (or Quadriplegia):  Refers to paralysis (weakness) from the shoulders down, including the arms and legs.

Paraplegia:                    Refers to paralysis from approximately the waist down with loss of movement (weakness) in the legs.

 Level of Injury (LOI):        The LOI is designated as the lowest spinal cord area (level) that has normal function after an SCI.

“Complete” Injury:           Term used when there is no movement or feeling in the lowest-body areas (foot and rectal area).

“Incomplete” Injury:         Term used when movement or feeling is partially preserved below the injury level and including the lowest body areas (foot and rectal areas).

What are some important factors in the potential “recovery of function” after a spinal cord injury?

 1.       Complete vs. incomplete injury – incomplete injuries have a better potential (chance) for recovery; the more incomplete you are upon hospital admission, the better chance you have for further recovery.

2.       Rate of recovery – the sooner recovery is noted and the longer it continues to progress, the better the outcome you can expect.

3.       Medical/surgical care – early competent emergency, intensive care and rehabilitation medical management is important for addressing medical issues (see below).

4.       Rehabilitation – access to competent and comprehensive SCI rehabilitation is important for maximizing functional abilities no matter how much recovery occurs.

 What are typical early MEDICAL ISSUES? 

• Spinal (bony) stability– maintaining spine stability and alignment (surgery and/or braces may be necessary).
• Respiratory – maintaining adequate oxygenation and control of lung secretions.
• Bladder – maintaining bladder emptying (catheterization is usually necessary) to protect bladder & kidneys.
• Bowel – maintaining bowel emptying to prevent constipation or obstruction (Medication, timing and positioning are important).
• Spasticity – preventing / treating muscle spasms (if problematic).
• Pain – maintaining adequate pain (nerve or muscle/tissue) control.
• Prevention of secondary medical complications, such as:

Pressure sores (skin breakdown)
DVT’s (blood clots)
Pneumonia (Lung Infection)
Bladder overfilling, incontinence or kidney injury
Urinary tract or kidney infections
Bowel incontinence
Muscle contractures (tightening) 
 

What are the early REHABILITATION GOALS? 

• Medical – Address and manage issues listed above
• Physical Therapy - Maximize “mobility” function (bed, transfers, wheelchair, ambulation), muscle strengthening (if applicable), and joint range of motion to prevent muscle contractures.
• Occupational Therapy - Maximize “self care” activities (dressing, bathing, feeding).
• Psychology - Assist patient/families with emotional issues or pain associated with SCI.
• Medical/Nursing - Maximize independence with medical/nursing issues.
• Social Work - Assist with personal, social and economic issues. Planning for discharge.
• Therapeutic Recreation - Provide leisure counseling and discover recreational abilities.
• Speech-language therapy – provide assistance with speech and swallowing if necessary

 NOTE:

 The impact and/or severity of a SCI can be very different depending on the level and completeness of injury.  Information below details some of the functional expectations for individuals with a complete SCI at various levels.  The patient’s motivation, medical complications and social situation will also affect outcome.

 C-2 through C-4: These individuals have weakness of the upper and lower extremities, although there is some control of the neck muscles.  They may require ventilator assistance.

 C-5: The C-5 patient will have use of their biceps and can assist with feeding themselves, with the aid of assistive devices, and can perform simple activities of daily living such as feeding and  grooming.

 C-6: These patients have use of their wrists and may become independent in grooming and bathing and driving.

 C-7: In addition to the above activities, C-7 patients can straighten their arms.  Some patients are capable of total independence with mobility and self care abilities, and can live alone with some adaptations in their homes.

 T-1 through T-6: The T-1 patient has all cervical segments intact, thus upper extremities/hands have normal strength. Lower extremities are weak.  The patient should be capable of independent living in a wheelchair accessible environment.  A patient with a T-6 injury has much better breathing due to control of chest muscles.

 T-12: The T-12 patient has complete trunk control, with good abdominal muscles.  Sitting balance is good.  Ambulation may be possible with long leg braces, though very difficult and tiring. Wheelchair mobility is still preferred by most.

 L-2/3: Individuals at this level can work towards independent ambulation, though may still require some foot or knee braces, and may prefer wheelchair mobility.

 L-4: The L-4 patient has use of the hip flexors and quadriceps.  He can extend his knees and raise his feet.  There is still some paralysis in the back of the legs, but ambulation is likely with the assistance of short leg (ankle/foot) braces.