>> JUDY FORTIN: This section of the video will help you understand the nature of spinal
cord injury, its causes, effects and classifications the medical care team may use in reference
to your loved one.
Spinal cord injury occurs when there is any damage to the spinal cord which blocks communication
between the brain and the body.
After a spinal cord injury, a person’s sensory, motor and reflex messages are affected and
may not be able to get past the damage in the spinal cord.
Sensory messages involve feelings of hot, cold, touch, pain, pressure, and body position.
Motor messages tell the muscles in your arms, hands, fingers, legs, toes, chest and other
parts of your body how and when to move.
Reflex messages are involuntary, protecting your body by an instinctive reaction.
Also, since messages between the bowel and bladder and the brain may no longer travel
up and down the spinal cord, these functions may undergo dramatic changes.
>> DR.
BRUCE DOBKIN: Acquired spinal cord injuries can occur from either trauma or medical diseases
that affect the spinal cord.
In trauma, there may be collapse of the bony vertebrae around the canal that holds the
spinal cord.
The soft spinal cord can then be torn or punctured or bleed, and that leads to relative levels
of disconnection within the cord.
The cord may be completely cut.
It may be partially injured.
The amount of injury can be mild, moderate or very severe and complete.
Acquired non-traumatic causes of spinal cord injury run the gamut of potential diseases.
These might include cancer, or a tumor that presses on the spinal cord from outside the
cord.
It may be related to tumors that grow within the spinal cord and expand outwardly.
It may be due to bleeding into the spinal cord, and lack of blood flow into the spinal
cord, or a misconnection between the arteries and the veins… that sometimes you’re born
with.
There are also diseases like multiple sclerosis, that can affect the spinal cord, or viral
illnesses, that can lead to inflammation in the spinal cord.
>> JUDY FORTIN: You may hear the terms “complete” or “incomplete” used to describe the injury.
A complete injury means that there is no function or sensation below the level of the injury.
An incomplete injury means there is some function remaining below the primary level of the injury.
A person with an incomplete injury may be able to move one limb more than another, or
may be able to feel sensation in parts of the body that he or she can’t move.
Advances in trauma care and medical technology mean that incomplete injuries continue to
become more common than complete injuries.
>> ERIC LARSON: The most common causes of spinal cord injury are from some type of trauma
or disease.
Most traumatic spinal cord injuries are caused by motor vehicle accidents.
Falls, often among the elderly or from construction-related accidents, and violence including gunshot
wounds and stabbings, account for a number of spinal cord injuries.
Sports and athletic activities – especially football, gymnastics and diving into shallow
water account for more than 15% of spinal cord trauma.
Diseases, such as cancer, arthritis, osteoporosis and inflammation of the spinal cord are also
common causes of spinal cord injury, and these are classified as non-traumatic.
More than half of people affected by spinal cord injury in the United States are male.
The majority of people who sustain a spinal cord injury are young adults – between the
ages of 16 and 30, due in part to riskier behaviors.
>> JUDY FORTIN: The effects of spinal cord injury vary depending upon the patient’s
level of injury; in general, though, they affect a person physically and emotionally.
We’ll discuss in more detail the various levels of injury in Chapter Five.
Next, we want you introduce some terms you may hear during the trauma care stay.
>> DR.
JEFFERY SALOMONE: The first term is paralysis, or loss of motion.
Paralysis is a partial or complete loss of function, especially when involving the motion
or sensation in a part of the body.
Keep in mind that some people with spinal cord injury do see varying amounts of a return
in function as time progresses.
Paraplegia does not affect the arms but typically affects the trunk and both legs.
This is usually a result of injuries in the thoracic and lumbar levels.
This type of paralysis can affect all or part of the trunk, legs and pelvic organs depending
on the specific level of injury.
>> DR.
LEON HALEY: Tetraplegia, also called quadriplegia, refers to paralysis from approximately the
neck down.
Tetraplegia results from injury to the spinal cord in the neck and is associated with total
or partial loss of function in both arms and legs.
This type of paralysis means arms, trunk, legs and pelvic organs are all affected by
the spinal cord injury.
People with quadraplegia may have weak control or no control of their lungs and breathing
muscles.
They may need specific help with coughing and breathing, and in some high-level injuries,
may need a ventilator to breathe.
>> JUDY FORTIN: You’ll find out pretty quickly if your loved one has quadriplegia or paraplegia.
Also, during your loved one’s stay at the trauma care center, he or she may be given
a diagnostic test that gives you more information about their injury and chances for improvement.
This test is called the International Standards for Neurological Classification of Spinal
Cord Injury, which was created by ASIA -- the American Spinal Injury Association.
Your doctor may refer to this test simply as the ASIA exam, or the ASIA-ISCoS test.
It’s useful to correctly describe a spinal cord injury and help determine future rehabilitation
and recovery needs after discharge from the trauma care center.
>> DR.
WILLIAM DONOVAN: During the ASIA/ISCoS examination, a member of your health care team examines
your ability to feel, or your sensory function at multiple points on your body, as well as
your ability to move different muscles.
This examination may be conducted at any time after a spinal cord injury.
Ideally it is first given within 72 hours after the initial injury, at the trauma care
center.
>> JUDY FORTIN: To determine your loved one’s ASIA/ISCoS scores, the person giving the exam
tests the patient’s sensory and motor abilities and limitations.
He or she tests 28 points on both sides of the body to determine the sensation the patient
can feel, each with light touch and a pinprick.
The patient’s response is recorded on a three point scale (0, 1, 2) for a total of
112.
This total is called the Sensory Index Score (SIS).
The doctor will also test motor or movement ability of 10 different muscles on both sides
of the body, to see whether there is active movement, some movement without gravity or
any movement against resistance.
This total is called the Motor Index Score (MIS), scored on a 0-5 scale for a total of
100.
Together, the SIS and MIS determine the patient’s overall level of injury and how severe the
injury is.
>> DR.
WILLIAM DONOVAN: Then, an injury grade is assigned which ranges from A to E.
This is the opposite of the grading system that most of us are used to in school.
A grade of “A” indicates a complete lack of motor and sensory function below the level
of the injury.
Grade B means that the patient feels some sensation below that same level.
Grade C means some weak movement is also possible.
At grade D, there is further muscle function, so that typically the patient has a better
chance of walking again in some capacity, whether it be assisted or unassisted.
Grade E means that essentially all neurologic function has returned.
>> JUDY FORTIN: Be sure to get as much information as you can about what your ASIA/ISCoS score
means from the person performing your examination.
It is often impossible for your doctor to make an exact prognosis right away.
We understand this can be frustrating as you support your loved one at this stage of recuperation.
Recovery, if and when it occurs, typically starts between a week and six months after
an injury.
Some people experience small improvements for up to a year or longer.
Beyond the major impairments of your loved one’s spinal cord injury, there are a number
of other effects that he or she may experience.
They may include limited loss of movement in specific parts of the body, and loss of
sensation and ability to feel pain, heat, cold, and touch in the affected areas.
Some patients may report unusual or hypersensitive sensations.
They may feel pain in a part of the body where they cannot feel anything else.
>> DR.
LEON HALEY: Injuries to the spinal segments may affect the patient’s control of bowel
movements and urination.
Patients without full control of their bowel or bladder should start a program during their
hospital stay to train the bowel and bladder to empty at certain times and help avoid unwanted
accidents.
Persons with spinal cord injury may experience exaggerated reflex actions or spasms, which
are involuntary movements of a body part.
These can often be controlled or reduced with physical therapy and medications.
Sexuality may be affected by spinal cord injury.
Men may notice changes in erection, ejaculation and sperm count and may experience reduced
fertility.
Women may notice changes in lubrication, but there are no changes in the ability to become
pregnant.
There are resources available to help patients regain and maintain healthy sexuality and
fertility.
Some patients feel intense pain or stinging sensations caused by damage to the nerve fibers
in the spinal cord.
This can be treated with medication and therapy.
>> JUDY FORTIN: At this time, we’ll move on to Chapter 4.