Your spinal cord is an essential structure for muscle movement
and the control of many
internal organs, acting as a channel for messages between the
brain and body.
But what happens when it gets damaged?
The traumatic,
spinal cord
injury (or SCI) occurs
when the spinal cord becomes damaged, due to an external
force, resulting in impaired
or lost function of muscles and organs.
The location of the injury,
on the spinal cord,
will determine what parts of the body will be impacted.
This is because an individual will lose functioning or control
of muscles and organs controlled by the spinal cord at
the level of their entry and below. The first seven
vertebrae of the spinal cord located in the neck or
the cervical vertebrae.
A cervical,
SCI results in more function being lost as these vertebrae
are higher up on the spine,
and therefore more of the spinal cord will be unable
to send and receive signals.
Entries to the C1 to C4 vertebrae are the most
severe, as they can impair
function to the arms, trunk and legs. Individuals with
cervical SCIs,
will typically be tetraplegic,
which means that all four limbs are paralyzed.
They can no longer function. Individuals with cervical SCIs
may require assistance with everyday activities or 24 hour care.
The thoracic vertebrae refers to the next 12 vertebrae
and the upper and middle area of the back.
The thoracic SCIs vary greatly depending on the specific location
of the injury.
An injury in the T1 to T5 region will limit
functioning of the legs,
lower back and abdomen. Injuries
In the T6 to T12 region will reduce bowel and bladder
control and lower
limb functioning. Individuals with thoracic SCIs will typically be paraplegic,
meaning that only their legs are paralyzed.
The lumbar vertebrae are the next five vertebrae located in
the lower back. Injury to this area may
result of diminished hip and leg function,
voluntary control of the bowel
and bladder are also diminished or lost.
The last 5 vertebrae are the sacral vertebrae,
which run through the pelvis. Injury to this part of
the spinal cord may impact hip and leg function,
but individuals will often be able to walk.
However,
individuals may lose bowel or bladder control.
Within each of these types of SCI,
there are different classes of injuries and complete injuries refer
to one some motor or sensory function remains below the
injury site, because signals between the brain and certain areas
of the body can still be sent. Complete injuries are
when no function remains below the injury site.
The most common cause of SCIs are motor vehicle collisions
accounting for 38% of new SCIs each
year in the United States. Falls
are the leading cause in American individuals above the age
of 65,
making up 30% of new SCI cases.
Other common causes include violent interactions, sports-related accidents
and medical or surgical causes. About 50% of new injuries
occur in individuals aged 16 to 30 with men making
up 80% of these injuries.
Spinal cord injuries will cause a broad range of physical
effects.
The inability to move and control effective
muscles is one of the most well-known effects of a
spinal injury.
Unfortunately,
it is not possible to reverse the damage done by
an injury in the spinal cord.
However,
patients with an SCI can attend physical rehabilitation. Through physical
therapy patients can regain and strengthen muscle function and improve
motor balance. Individuals with an SCI may experience pain from overuse
of unaffected muscles.
This is called musculoskeletal pain.
For example,
pain may occur in the arms
do to wheelchair use.
Additionally,
patients with an SCI,
may suffer pain caused by nerve damage in the spinal
cord. This is called neuropathic pain,
which is when abnormal communication between damaged nerves and
the brain results in pain.
It is even possible that a patient feels pain in
an area
that otherwise has no sensation. Pain is a complicated issue
and patients may have to try different treatments before they
find one that works. Physical therapy, massages or acupuncture
as well as painkillers may be used to treat musculoskeletal
pain.
Neuropathic pain may be treated using anti-seizure medications or
antidepressants.
Autonomic Dysreflexia is a condition in which a patient's blood pressure
suddenly gets very high.
It is most common in individuals who have an injury
at T6 or higher. AD happens when a painful or
uncomfortable sensation occurs in an area in which a person
no longer can feel different sensations or control muscles.
For example,
this could be a prick to the legs of an individual who is
paralyzed in their lives.
The body wants to react to the stimulus and sends
a fight or flight response. In a person with normal
spinal cord functioning, the signal be counteracted by the brain.
When it realizes that,
it doesn't need to react severely because the stimulus will
likely not harm them.
However,
this counteraction does not happen in individuals with spinal cord
injuries and the brain reacts to the stimulus
as if it's incredibly dangerous,
this causes a spike in blood pressure,
which can be life-threatening. In order to manage AD,
a patient can try to remove whatever caused the AD.
If this doesn't help individuals can take medication to lower
their blood pressure.
Spinal injuries will often impair a person's ability to control
their bowel and bladder because information from the brain that
tells the bowel and bladder
when to hold onto, or release
their contents can no longer be sent properly.
To manage
limited bladder functioning,
a catheter may be used. Catheterization is when a tube
is inserted into the bladder to drain the bladder and
ensure that it doesn't get too full.
To manage a lack of
bowel control,
patients may collaborate with a health
professional to create a bell program where a patient works
on training their body to have regular bowel movements by
regulating timing, diet,
fluids and medication.
Lastly,
sexual functioning may be disrupted and individuals with an SCI.
For example,
men may have changes in erectile functioning and woman may
experience changes in lubrication. Speaking with a urologist and open
communication with sexual partners are important steps and having
for-filling intimate relationships. Individuals with an SCI
have to cope with their roles in society
changing drastically. Relationships with family and friends
may begin to shift. A spouse may become a caretaker
or it might become more difficult for an injured individual
to parent their children. Individuals in society may view those
with an SCI as a patient rather than a contributing
member of society. Individuals
with an SCI may loose part of their independence,
as their ability to carry out,
daily activities and functions become contingent on the help of
others.
Ultimately,
these shifts can cause depression and anxiety in injured
individuals.
Individuals.
With an SCI may also turn to substance used to
cope with the changes that they undergo.
Research has found that on average individuals with an SCI
experience,
higher levels of distress and lower levels of life satisfaction,
when compared to the general population.
However,
there is great,
individual variability,
and susceptibility to this distress.
Additionally, research indicates that while relationships with friends,
families and communities are worse than the first few years
after an injury, most individuals
by the fourth year
after an injury have a balanced emotional state,
and rewarding social life.
During the time after an SCI.
It is extremely important for individuals to get the psychological
and social support they need.
There are a number of available therapy options
to reduce the stress and improve functioning. For example, studies
Exploring cognitive behavioral therapy has shown promising results in improving
social and emotional well-being,
in individuals with an SCI. Medical interventions such as antidepressants
are also
viable options for injured individuals.
Social supports like support groups are common in the SCI
community and may provide injured
individuals with peer support, belonging and validation.
So far,
we have seen how individuals with an SCI
how to deal with incredible changes in multiple aspects of
their lives. Often
an SCI,
and the changes that follow, may lead an individual to
identify or be identified as disabled. The UN convention on
the rights of persons with disabilities defines people with disabilities
as those who have long-term
physical, mental,
intellectual or sensory impairments,
which in interaction
with various barriers,
may hinder their full and effective participation in society on
an equal basis with others.
This definition hints at the two main models of disability,
the medical model and the social model.
The medical model of disability explains that individuals with disabilities
are disabled because of their physical condition,
which is intrinsic to them.
For example,
someone who is paralyzed is disabled because they are unable
to move or use their legs.
The different treatments that were previously mentioned, such as physical
therapy or bowel programs, fall under the medical model because
these treatments focus on curing
an individual to relieve the negative effects of having a
disability. However there is another important model of disability,
the social model.
This model explains that disability is a product of societal
barriers, negative attitudes and exclusion.
For example,
a paralyzed individual may be considered disabled because staircases contribute
to their inability to access certain places and spaces.
Under this model.
There needs to be more than just physical treatments to
improve the well-being of individuals with disabilities.
For example,
an individual who has an SCI may find that they're
able to participate more fully and enjoyably in a workplace
that allows extra time off to attend medical
appointments, has elevators or wheelchair accessible ramps, and offer special
software
that enables them to work on a computer despite limited
hand functioning.
Ultimately, traumatic
spinal cord injuries are often life changing injuries that cause
large shift in a person's life,
both in regards to their physical condition,
as well as their experiences in society.
This video covered a lot of the baseline information
about spinal injuries.
That being said, there are many other effects that can
result from spinal cord injuries as well as other treatments
that Physicians
may recommend for spinal injuries.
Make sure to talk to your Healthcare team for specific
information about your own health.
If you are curious to learn more,
there are a multitude of other resources
we will link in the description.