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Understanding Spinal Cord Injury & Functional GoalsSpinal Cord Injury - InfoSheet #4 Level - Basic Date: Updated July, 2000 Any damage to the spinal cord is a very complex injury. People who are injured are often confused when trying to understand what it means to be a person with a spinal cord injury (SCI). Will I be able to move my hands? Will I walk again? What can I do? Each injury is different and can affect the body in many different ways. This is a brief summary of the changes that take place after a
spinal cord injury. It tells how the spinal cord works and what some of the
realistic expectations are for what a person should eventually be able to
do following a spinal cord injury. Included is a chart of functional goals
for specific levels of injury as well as additional information resources. The nerve fibers that make up the communication systems of the body can be compared to a telephone system. The telephone cable (spinal cord) sends messages between the main office (the brain) and individual offices (parts of the body) over the telephone lines (nerve fibers). The spinal cord is the pathway that messages use to travel between the brain and the other parts of the body. Because the spinal cord is such an important part of our nervous system, it is surrounded and protected by bones called vertebrae. The vertebrae, or backbones, are stacked on top of each other. This is called the vertebral column or the spinal column. The vertebral column is the number one support for the body. The spinal cord runs through the middle of the vertebrae [See Figure A]. The spinal cord is about 18 inches long. The cord extends from the base of the brain, down the middle of the back, to about the waist. The bundles of nerve fibers that make up the spinal cord itself are Upper Motor Neurons (UMNs). Spinal nerves that branch off the spinal cord up and down the neck and back are lower motor neurons (LMNs). These nerves exit between each vertebrae and go out to all parts of the body. At the end of the spinal cord, the lower spinal nerve fibers continue down through the spinal canal to the sacrum, or tailbone. [See Figure C] The spinal column is divided into four sections. The top portion
is the cervical area. It has eight cervical nerves and seven cervical vertebrae.
Moving down the back, the next section is the thoracic area. It includes
the chest area and has twelve thoracic vertebrae. The lower back section
is the lumbar area and has five lumbar vertebrae. The bottom section has
five sacral vertebrae and is the sacral area. The bones in the sacral section
are actually fused together into one bone.[See
Figure B] After a spinal cord injury, all the nerves above the level of injury keep working like they always have. From the point of injury and below, the spinal cord nerves cannot send messages between the brain and parts of the body like they did before the injury. The doctor examines the individual to understand what damage has been done to the spinal cord. An X-ray shows where the damage occurred to the vertebrae. The doctor does a "pin prick" test to see what feeling the person has all over his body (sensory level). The doctor also asks, "what parts of the body can you move?" and tests the strength of key muscle groups (motor level). These exams are important because they tell what nerves and muscles are working. Each spinal cord injury is different. A person's injury is described
by its level and type. Tetraplegia [formerly called quadriplegia] generally describes the condition of a person with a spinal cord injury that is at a level from C1 to T1. This individual can experience a loss of feeling and/or movement in their head, neck, shoulder, arms and/or upper chest. Paraplegia is the general term describing the condition of a person who has lost feeling and/or is not able to move the lower parts of his/her body. The body parts that may be affected are the chest, stomach, hips, legs and feet. An individual with a level from T2 to S5 has paraplegia. The higher the spinal cord injury is on the vertebral column,
or the closer it is to the brain, the more effect it has on how the body
moves and what one can feel. More movement, feeling and voluntary control
of the body's systems are present with a lower level of injury. For example,
a person with a C-5 level of injury has a decrease or loss of feeling and
movement below the 5th cervical spinal cord segment. An injury at the T-8
level means the individual has a decrease or loss of feeling and movement
below the eighth thoracic spinal cord segment. Someone with a T-8 level
of injury would have more feeling and movement than someone with a C-5 level
of injury. Some people with an incomplete injury may have feeling, but little
or no movement. Others may have movement and little or no feeling. Incomplete
spinal injuries differ from one person to another because the amount of damage
to each person's nerve fibers is different. This fact makes it impossible
to accurately predict how much of an individual's sensory and motor function
will return. There is a greater chance of return of some or all of a person's
motor and sensory function if an individual is incomplete at the time of
injury. Some individuals have involuntary movements, such as twitching or shaking. These movements are called spasms. Spasms are not a sign of recovery. A spasm occurs when a wrong message from the nerve causes the muscle to move. The individual often can not control this movement. In addition to movement and feeling, a spinal cord injury affects
how other systems of the body work. An individual with SCI learns new ways
to manage his/her bladder and bowel. His/her skin and lungs often need special
care and attention to stay healthy. There may also be changes in sexual function.
Achievement of functional goals can also be affected by other factors, such as an individual's body type and health related issues. By striving to reach these functional goals, the hope is to give individuals with SCI the opportunity to achieve Maximum Independence. The chart, "Functional Goals
for Specific Levels of Complete Injury", shows the expected functional
goals for a person with a complete injury at a particular level. Motor
and sensory functions improve with lower levels of injury. ResourcesConsortium for Spinal Cord Medicine. Outcomes following traumatic spinal cord injury: Clinical practice guideleines for health-care professionals. 1999. [Available on www.pva.org/prof/9811cpgs/trauma.htm].Corbet B, Dobbs J, and Bonin B. Spinal Network: The Total Wheelchair Book, 3rd Ed. 1998. [Available from: Spinal Network, P.O. Box 8987, Malibu, CA 90265-8987. 800-543-4116 Online: http://www.newmobility.com/bookstore]. Hammond M, Umlauf R, Matteson B, and Perduta-Fulginiti S. Yes, You Can! A Guide to Self-Care for Persons with Spinal Cord Injury. 2nd Ed. Washington, DC: Paralyzed Veterans of America, 1993. [Cost: $12 Order from PVA]. International Standards for Neurological and Functional Classification of SCI, Rev. 1996. [Available from: American Spinal Injury Association. Online: http://www.asia-spinalinjury.org/publications/index.html]. An Introduction to Spinal Cord Injury: Understanding the Changes, 1998 Ed. [Available from: Paralyzed Veterans of America. Cost: First copy free, additional are $1.50. Online: http://www.pva.org/sci/98scigd/98scigd1.htm]. Kirshblum SC and O'Connor KC. Levels of spinal cord injury and predictors of neurologic recovery. In: Kraft GH and Hammond MC, eds. Physical Medicine and Rehabilitation Clinics of North America, Topics in Spinal Cord Injury Medicine. Philadelphia: W.B. Saunders Co., 2000; 11(1):1-28. Learning about Spinal Cord Injury. 1991. Booklet. Available from Medical RRTC on Secondary Conditions of SCI. [Cost: $3 +s/h]. "Locating Information About SCI" Spinal Cord Injury InfoSheet #1. Level - Consumer. [Available from RRTC on Secondary Conditions of SCI. Online: http://main.uab.edu/show.asp?durki=21478 or via FAX: 205-975-8376 / #101]. Spinal Cord Injury: Facts and Figures at a Glance. January 2000. National Spinal Cord Injury Statistical Center. Birmingham, AL. [Available at www.spinalcord.uab.edu/show.asp?durki=21446 ]. Spinal Cord Injury Patient Education Manual. 1998. [Available from Penn State Geisinger Rehabilitation Center, 500 University Dr., Hershey, PA. 17033 717-531-8521. Online: http://www.collmed.psu.edu/sciweb/]. Take Control: Multimedia Guide to Spinal Cord Injury-Vol.1. 1996. [CD-Rom programs Available from Arkansas Spinal Cord Commission, 1501 N University Ste 400, Little Rock, AR 72202, 501-296-1788, Email: arkscc@aol.com ]. Organizations: American Spinal Injury Association 345 East Superior Ave, Rm 1436, Chicago, IL 60611 312-238-1242 http://www.asia-spinalinjury.org National Spinal Cord Injury Association (NSCIA) 870 Georgia Ave, Ste 500, Silver Spring, MD 20910 800-962-9629 or Email: nscia2@aol.com http://www.spinalcord.org National Spinal Cord Injury Hotline 2200 Kernan Dr., Baltimore, MD 21207 800-526-3456 - Email: SCIHOTLINE@aol.com http://scihotline.org Paralyzed Veterans of America 801 18th St NW, Washington, DC 20006 800-424-8200 or Email: info@pva.org http://www.pva.org RRTC on Aging with Spinal Cord Injury Rancho Los Amigos Medical Center 7601 E Imperial Hwy, 800 West Annex, Downey, CA 90242-3456 562-401-7402 *Taken from: Medical RRTC on Secondary Conditions of SCI UAB Spain Rehabilitation Center 619 19th Street South - SRC 529 Birmingham, AL 35249-7330 (205) 934-3283 or (205) 934-4642 (TTD only) Revised: June, 2000 |
![[See Figure A]](aspine.gif){kind=link}
![[See Figure C]](dspine.gif){kind=link}
![[See Figure B]](bspine.gif){kind=link}