Spinal Cord Injury

Spinal cord injury can occur as a result of trauma following a road or workplace accident or as a result of tumours or infarcts (lack of blood supply) to the spinal cord. Injury is named by the lowest level that has full normal function. For example, when someone is considered a C5 quadriplegia, it means that the lowest level with full feeling and movement corresponds to the patch of skin and key muscle group associated with that level of nerve supply. In this case it is the bicep muscle and feeling on the outside of the elbow. The American Spinal Injury Association (ASIA) uses a detailed and standardised scale to determine this, and it helps us predict functional outcomes

Spinal cord injury can be classified as complete or incomplete. Complete injuries result in complete paralysis below their level of injury, without sparing at the end of the cord (sacral sparing), also known as ASIA A. Some people have partial paralysis either in the form of preserved sensation or movement in their lower parts of their body. This means that they can be classified as an ASIA B, C or D which are all forms of incomplete injury.

Sometimes partial paralysis follows a set of patterns, known as a syndrome:

Anterior Cord Syndrome

Anterior cord syndrome means that there has been damage to the front part of the spinal cord, usually disruption in the anterior spinal artery, the main blood supply to the spinal cord. The result of this is that the tracts that lie in the front of the spinal cord become injured, resulting in a loss of movement and feeling of temperature and pain. However, the tracts that transmit information about our body position (proprioception) and light touch are preserved.

Central Cord Syndrome

The most common of spinal syndromes, central cord syndrome, refers to injury to the inner part of the spinal cord, most frequently as a result of hyperextension injury of the neck especially in older people. The result is such that the arms are disproportionately affected by paralysis, whereas the lower trunk and legs progressively are spared. This is due to the anatomical organisation of the spinal tracts.

Brown Sequard Syndrome

This syndrome is related to the loss of movement and sensation on one side of the body, due to the injury affecting one side of the spinal cord. It is almost like getting a stroke on one side of the spinal cord, except that on the other side there is also a loss of pain, crude touch and temperature sensation as well, usually 2-3 levels further down. This is because the tracts that transmit pain, crude touch and temperature cross at the spinal cord level.

Common challenges:

Difficulty with breathing, coughing and sleeping
Difficulty with sitting balance
Reduced hand dexterity and strength
Loss of the ability to stand or walk
Spasms, high tone and difficulty with transferring
Neuropathic pain
Autonomic dysreflexia
Significant paralysis leading to inability to stand or walk
Numbness or altered sensation and proprioception
Bladder and bowel dysfunction
Pressure areas and fragile skin

The role of the neurological physiotherapist in spinal cord injury

Neurological physiotherapists are physiotherapists with additional training and expertise in treating problems related to the brain, spinal cord, inner ear and nerves. Neurological physiotherapists apply their neuroscience knowledge and spasticity management skills to predict the likelihood of recovery given the type of injury and the distribution of symptoms. From here we can provide a framework to commence rehabilitation and therapy for maximising function at a given level of injury and severity.

Many spinal cord injured individuals desire the ability to walk again, but lack the postural control to do so. This directly impacts on the spinal cord’s ability to access any preserved reflexive patterns and rhythm to walking (central pattern generators) and can have a profound effect on the recovery process. Therefore it is important that postural control is heightened for control and development of movement. Our neurological physiotherapists apply the principles of sensory feedback, postural adjustments to help individuals with spinal cord injury control their tone and regain as much motor control as possible through spasticity management. This may be in the form of intensive therapy or spinal cord injury physio.

What our skilled therapists can offer for spinal cord injury physio:

Thoroughly assess your neurological systems to determine potential for recovery
Review and prescribe wheelchairs, seating and any other equipment you may need
Design a personalised neurological rehabilitation program that is holistic and considers the 24-hour routine
Provide hands-on treatment to teach the individual how to move better or more efficiently
Provide advice on facilitating skill development and transfer into the individual’s daily life and education to caregivers
Liaise with the other health professionals or funding bodies as required to assist in your rehabilitation or health and well-being

Frequently Asked Questions

What is a spinal cord injury?

Spinal Cord Injury refers to damage to the spinal cord that results in a loss of function, such as mobility or sensation. The severity of the injury can vary widely, from temporary impairment to permanent disability, depending on the location and extent of the damage.

What are the common causes of spinal cord injury?

Spinal Cord Injury is commonly caused by trauma such as vehicle accidents, falls, sports injuries, or violent encounters. It can also result from diseases like polio, spina bifida, or tumours pressing on the spinal cord.

What are the symptoms of spinal cord injury?

Symptoms of Spinal Cord Injury can range from pain or pressure in the neck, head, or back, impaired breathing, inability to move parts of the body, loss of bladder or bowel control, to numbness or tingling in the extremities. The severity of symptoms depends on the level and extent of the injury.

How is spinal cord injury diagnosed?

Spinal Cord Injury is diagnosed through a comprehensive medical evaluation that includes a physical examination, imaging tests such as X-rays, MRI, or CT scans to visualize the extent of injury to the spinal cord, and possibly neurological tests to assess sensory function and motor skills.

What treatment options are available for spinal cord injury?

Treatment for Spinal Cord Injury may include emergency interventions to stabilize the spine, surgery to address any structural damage, medication to reduce inflammation, and long-term rehabilitation therapies aimed at maximizing independence and quality of life.

Can someone with spinal cord injury regain mobility?

The potential for someone with Spinal Cord Injury to regain mobility varies greatly and depends on the severity and location of the injury. While some individuals may experience significant recovery, others may require assistive devices like wheelchairs. Rehabilitation plays a crucial role in enhancing mobility and adapting to changes.

What rehabilitation services are recommended for spinal cord injury patients?

Rehabilitation for Spinal Cord Injury patients typically involves a multidisciplinary approach, including physical therapy to strengthen muscles and improve mobility, occupational therapy to assist with daily activities, speech therapy if needed, and psychological support to address the emotional impact of the injury.

Are there any complications associated with spinal cord injury?

Spinal Cord Injury can lead to several complications, including respiratory issues, chronic pain, bladder and bowel dysfunction, pressure sores, and increased risk of infections. Managing these complications is a critical part of care for individuals with SCI.

Is there a cure for spinal cord injury?

Currently, there is no cure for Spinal Cord Injury. However, ongoing research into stem cell therapy, neurodegeneration, and rehabilitation techniques offers hope for future advancements that may improve outcomes for individuals with spinal cord injuries.

Where can individuals with spinal cord injury find support?

Individuals with Spinal Cord Injury can find support through specialized rehabilitation centres, SCI advocacy and support groups, and online communities. These resources can provide valuable information, emotional support, and advocacy for individuals and their families navigating the challenges of SCI.