The following are the more common questions and answers that we often discuss with clients, occupational therapists and medical experts about spinal cord injuries. The more you know about your injury, the better prepared you will be to adapt to its effects and prevent complications, both now and in the future – and our Ontario spinal cord injury lawyers, along with your medical team and experts can help. If you have any questions concerning your injury, the cause of your injury, the financial implications of your injury or whether or not you would be entitled to compensation, call us 24/7 at 905-333-8888 and we would be more than happy to help answer any questions that you may have.
Spinal cord injury (SCI) is a complex condition that can affect nearly every aspect of your life—from how you get around and do routine tasks to how you interact with your family and friends. The changes you experience and the ways in which those changes affect your life depend greatly on not only the type and extent of your injury, but also your personality (for example, whether you like to do everything yourself or are willing to let others help you). It also depends on your determination. As you continue on your journey with your SCI, it is helpful to know as much as you can about your injury and how it affects your physical abilities, health, emotional well-being, and relationships with other people. The more you know about your injury, the better prepared you will be to adapt to its effects and prevent complications, both now and in the future – and our Ontario spinal cord injury lawyers, along with your medical team and experts can help.
The nervous system is the electrical system of the body, carrying messages that control most, if not all, information about bodily functions. The nervous system is divided into three major divisions, based on the location of the nerves as follows:
Central nervous system—the brain and spinal cord. Taken together, the nerves that branch off the brain and spinal cord to go to all of the parts of the body are called the peripheral nervous system.
Peripheral nervous system—the peripheral or spinal nerves;
Autonomic nervous system—sympathetic nervous system and parasympathetic nervous system.
The brain and spinal cord make up the central nervous system. The autonomic nervous system is made up of the sympathetic nervous system and the parasympathetic nervous system, which work together to control most organ functions such as sweating, heart rate, blood pressure, digestion of food, bowel movements, emptying your bladder, and more.
Your spinal cord is a soft, rope-like structure that is made up of millions of nerves. It runs from the base of the brain to the lower part of the back. Its purpose is to carry information between the brain and, by way of the peripheral nerves, to other parts of the body, such as the arms, legs, and all of the organs in the body. Some of the nerves in the spinal cord send messages telling a particular body part to move in a certain way. Other nerve fibers send messages about heat, cold, or pain. Some tell your bladder or bowel to “hold on a little longer,” or “it’s OK to go now.” Still others control your body’s involuntary (autonomic) activities, such as your blood pressure, body temperature, and sweating. In addition, information from various parts of your body travels back to the brain by way of the spinal cord.
Here’s an example of how the brain, spinal cord, and peripheral nerves work together: When you sit down, your brain sends messages down the spinal cord and then to the peripheral nerves going to the muscles, telling your legs to bend and your arms to stabilize your body. Then, if you accidentally sit on a tack, peripheral nerves from your rear end send a message via the spinal cord, telling your brain that there is something painful down there. The cycle repeats itself, with the brain sending another message down the spinal cord and through the peripheral nerves, telling the legs to stand back up. Your nervous system is able to control many of these sequences for different body parts and functions continually throughout the day.
The spinal cord is surrounded and protected by 29 vertebrae—the small back bones that make up the spinal column. The vertebrae are stacked one on top of another and each has a hole, creating a canal through which the spinal cord passes. The vertebrae are cushioned from one another by spongy material called disks. Ligaments (very tough and strong ropes) hold the vertebrae in the proper alignment.
The spinal cord emerges from the base of the skull and ends at the lower part of the back.
The peripheral nerves (also called spinal nerves) are paired and travel to various parts of the body. There are 31 pairs of spinal nerves, which are numbered according to sections of the spinal column
Your spine is made up of several sections:
Cervical Spine – the cervical or neck section (C1 to C8) which includes 8 nerves and 7 vertebrae in the neck area.
The thoracic or chest section – (T1 to T12) which includes 12 nerves and 12 vertebrae in the chest and abdomen (belly) area.
The lumbar or low back section – (L1 to L5) which includes 5 nerves and 5 vertebrae in the lower back. The spinal cord ends at the L2 level. Beyond this point, a collection of many nerves form the cauda equina, or “horse’s tail,” which is just what the bundle of nerves looks like.
The sacral section – (S1 to S5) includes the lowest nerves exiting the spinal cord in the pelvic area (area of the buttocks). The sacrum is actually several vertebral bones that are fused, or attached, to form one large bone with 5 nerves emerging from holes in each side of the bone.
There are approximately 4300 new spinal cord injuries each year in Canada
Globally, there are approximately 40 to 80 spinal cord injury cases per million annually. In Canada, the occurrence is approximately 1,298 cases per million. Currently there is approximately 90,000 Canadians who are living with a spinal cord injury. There is approximately 4,300 new spinal cord injury cases each year in Canada. There are approximately 11,000 new SCI cases caused by trauma each year in the United States with over 250,000 Americans living with SCI today.
Non-traumatic spinal cord injuries may be caused by degenerative changes of the spine, neoplastic tumours, vascular insults, autoimmune disorders and infections.
Traumatic spinal cord injuries are caused by violence or accidents such as bicycle accidents, car accidents, trucking accidents or pedestrian accidents. Traumatic SCI is most likely to occur in young adults (15 to 29 years) and the elderly (over 60 years), whereas non-traumatic SCI is more common in the elderly.
A 2013 medical study in the Journal of Neurotrauma indicates that the most common causes of spinal cord injury were car accidents, pedestrian accidents, falls, gunshot wounds, motorcycle accidents, diving accidents, and medical/surgical complications. Car accidents were the leading cause of spinal cord injury until age 45, whereas falls were the leading cause after age 45 years. Gunshot wounds, motorcycle crashes, and diving were more common in males than females, more common on weekends and warmer months, which seemed to correspond the increase of motorcycle accidents and diving accidents – and diving-related SCIs. Level and completeness of injury are also associated with etiology of injury.
The spinal cord is one of the most fragile organs of the body. That’s why there are so many bones and ligaments that protect it. When an injury to the back or neck causes a vertebra to break or a ligament to tear, the backbone can pinch the spinal cord. Similarly, a tumor or infection may put pressure on the spinal cord or even cause a vertebra to break. This pinching or pressure may cause bruising, swelling, or bleeding of the spinal cord. Only rarely is the spinal cord actually severed or cut. This type of injury to the spinal cord may temporarily or permanently impair some or all of the communication between the brain and various parts of the body. Then, the ability of the nervous system to send and receive messages back and forth between the brain and your arms, legs, bowel, bladder, and other body organs is lost to some degree. In turn, the ability to move, feel, and control involuntary (autonomic) body functions can be impaired. An important point to remember (and one that will be discussed in greater detail later in this chapter) is that since the nerves that control bowel and bladder function originate in the lowest, or sacral, portion of the spinal cord, nearly all spinal cord injuries result in some type of change in bowel and/or bladder function.
The severity of your spinal cord injury is according to the level and completeness of the injury. The higher on the spinal cord your injury occurs, the greater the effect on movement, sensation, and other bodily functions.
Tetraplegia – (formerly called quadriplegia) refers to an injury to the cervical (neck) section of the spinal cord. It can involve either partial or complete loss of movement and/or feeling in the head, neck, shoulders, upper chest, arms, and legs.
Paraplegia – refers to an injury in the thoracic, lumbar, or sacral sections of the spinal cord. It can involve either partial or complete loss of movement or feeling in the chest, stomach, hips, legs, and feet. Tetraplegia is slightly more common than paraplegia.
In addition to being described according to the level of injury, SCI is described according to the severity of the injury.
A complete spinal cord injury – is one that results in no voluntary movement and no measurable feeling below the level of injury. An important point is the term “voluntary” movement or movement that you are able to start, stop and completely control. Often after a spinal cord injury you will experience spasms, or parts of your body moving or “jumping” without your controlling this movement. This is called “involuntary” movement. Similarly, “feeling” is defined as some sensation found by your doctor during neurologic testing. Many people have involuntary movements or experience “feelings” in their legs or other body parts, yet the injury is still called “complete.” The fact that you have a complete injury doesn’t mean these movements or feelings don’t exist; they just can’t be measured accurately during neurologic testing.
An incomplete spinal cord injury – is one in which there is some measurable feeling and/or voluntary movement below the level of the injury. A doctor or health care professional who specializes in treating people with SCI can help you determine if your injury is complete or incomplete.
After you’ve been found to have an SCI, your injury will be classified according to the level and extent of the injury. To do this, a comprehensive, standardized examination is done to determine your sensory, motor, and neurologic status. You may have heard this terminology already, but the standardized examination used is called the “ASIA exam.” Doctors classify SCI according to the “International Standards for Neurological and Functional Classification of Spinal Cord Injury,” which is also known as the American Spinal Injury Association (ASIA) Impairment Scale. ASIA is an organization that is dedicated to the treatment and care of people with spinal cord injuries. ASIA has developed a very detailed and specific test that is used by health care professionals to determine exactly where in your spinal cord the injury is located and its effect on the rest of your body. This test is typically done by a physician or other health care professional who has experience in SCI. Although it may seem strange, one of the most important parts of the test is a rectal exam to check for feeling or sensation and movement or tightening in and around the anal area. Any feeling or movement in this area signifies that there is some communication passing beyond the area of the SCI to the lowest area of the spinal cord.
The ASIA Impairment Scale includes five SCI categories, shown below.
After a SCI, your function depends on both the location (neck, chest, or low back) and severity (complete or incomplete) of the injury. For example, many people with an injury to the neck have resulting tetraplegia, but more often than not, tetraplegia is incomplete. If this incomplete tetraplegia has an ASIA C or D level of impairment, then walking may be possible. On the other hand, most of the injuries to the upper chest and back that result in paraplegia are often complete (ASIA A). In this case, walking is less likely.
Soon after your injury, you probably had many questions about your recovery: Am I going to walk again? Am I going to be able to urinate again? Will I be able to move my bowels normally again? Will I be able to be intimate with my partner? Because all spinal cord injuries are different, each person’s recovery varies, and no one can say for sure how much you will recover. Recovery after SCI varies, but there are some consistencies. Most recovery occurs in the first three months to six months after injury, with small amounts of further recovery possible for up to 18 months to 24 months. The more incomplete your injury, the more likely you are to have the greatest amount of recovery. Also, if you have tetraplegia at C5 or below, you are more likely to have more recovery than if you were to have paraplegia in the upper thoracic area.
The probable reason for this difference is that when tetraplegia occurs, it is more often an incomplete injury; while higher paraplegia is usually complete. Some of the factors associated with better recovery are:
· Incomplete injury
· Certain types of incomplete syndromes termed Brown-Sequard Syndrome or Central Cord Syndrome
· The ability to feel painful or pin-stick sensation No bleeding into the cord (your doctor can check this with an MRI)
Your spinal cord injury can change many functions of your body’s systems. It can also lead to other problems or complications called “secondary complications.” These are complications that are related to or secondary to the SCI. To anticipate and manage these changes successfully, you must first understand how your body and abilities have changed. Below is an overview of physical changes you may experience.
Paralysis—the inability to move parts of the body—is the most familiar and visible effect of SCI. As described above, the muscles in the body communicate with the brain through nerve connections in the spinal cord. Without those connections, the muscles are unable to receive the input they need to work. Depending on the level of injury, this condition may lead to an inability to walk, sit at the edge of the bed, write, or even breathe without assistance. Some, but not all, spinal cord injuries result in total paralysis below the level of injury. If some strength remains in the affected area, then medical rehabilitation can help rebuild those muscles that are still functioning and help you relearn how to use them. If no movement remains below the level of the injury, then the goals of rehabilitation are to strengthen intact muscles above the injury level and to find ways to compensate for those that are unable to move. For example, if you have no movement in your legs, you may work on strengthening your arms and upper body in order to learn to use a wheelchair instead of walking. In many cases, rehabilitation will include some strengthening and retraining of muscles that have become weaker because of the SCI and finding new ways to use the muscles that are working normally above the level of the SCI.
When we move, our bodies normally send sensory information to the brain to help create smooth, coordinated movement. If that sensory feedback is lost after SCI, then your muscles are unable to perform as they did previously. Sensation changes might include a change in the ability to:
· Feel objects
· Feel pain Sense where your body parts are in space
Loss of the ability to feel an object or to feel pain can put you at risk for injury. Think about stepping on a sharp object in bare feet or sitting in one position for too long. Under normal circumstances, messages would be sent to your brain through the nerves in your spinal cord, signaling pain and causing you to move away from the sharp object. Following SCI, those messages may not reach the brain and the sensation of pain may not be perceived. Feeling where your body parts are in space, or “proprioception,” is another type of sensation that may change after an SCI. This loss may make it difficult to understand where your leg is when you try to walk or to know where your arm is when you try to dress. You may need to watch your leg while walking or watch your arm while dressing to understand where they are in space.
Some of the more common changes and or secondary complications that you might experience could be:
Your spinal cord is the major pathway connecting your brain to the rest of your body. When that pathway is damaged, any or all of the muscles below the level of injury can be affected, leading to an inability to use those parts of the body. There’s no doubt that you will require life-long rehabilitation to learn new ways to adapt your activities of daily living so that you can become as independent and functional as possible. Having a SCI is a catastrophic event that changes your life and presents you with rehabilitative challenges you never thought you would have to face – all of which can be better handled with proper funding and financial resources. Recurring annual costs of caring for accident victims with chronic spinal cord injury is an incredibly massive economic burden. If your spinal cord injury was caused by the carelessness or negligence of someone else, let us help recover the compensation you deserve to help financially protect your future, family, health and loved ones. Call our Hamilton spinal cord injury lawyer today – we serve provincewide – at 905-333-8888 or fill in a contact form and one of us will get back to you without any delay.
Special thanks to Dr. Suzanne Groah for the insighful information.