Read this page for key information about spinal injuries
The spinal cord is an integral part of the central nervous system. It connects the brain to the rest of the body, sending the electrical signals that control our movements.
Spinal cord injuries (SCIs) damage the brain’s links to the body and so require immediate emergency medical attention. They become progressive disorders and also chronic conditions requiring continuous medical assistance.
Spinal cord injuries are indiscriminate – they can happen to anybody at any time.
- Compensation for a spinal injury
- Types of spinal injury
- Effects of spinal injury
- – Effects of complete paraplegia
- – Effects of complete tetraplegia
- – Effects of incomplete spinal cord injuries
- – Emotional effects of a spinal cord injury
- Medical information for spinal injury
- Rehabilitation for spinal injury
Compensation for a spinal injury
3 of the main stages of a spinal injury compensation claim are as follows;
- Establishing who was at fault (‘negligence’)
- Connecting the accident with the injury (‘causation’)
- Establishing the amount of compensation (‘quantum’)
The first stage relates to the accident circumstances and so the individual’s injury is not the primary focus. This means that the actual process involved in investigating the circumstances can be similar from case-to-case. The complexity comes from the unique circumstances surrounding each incident, and the interpretation of these circumstances.
The second stage will often involve the gathering of medical expert opinion to prove that the negligent act was the cause of the injury and the symptoms that have developed. For detailed information about these first two stages, please visit the legal expertise page.
It is in the 3rd stage of 'quantum' where a spinal injury claim has its own set of unique considerations, compared to other forms of injury. The legal representative will look to prove the value of the case and the compensation that is due by setting out what they seek to claim in a document known as the ‘Schedule of Loss’.
Schedule of Loss
The Schedule of Loss describes the problems a person will have now and in the future due to their injury. It will detail the cost to the injured party of the problems caused by the injury. Each item claimed for in the Schedule of Loss is called a ‘Head of Loss’.
The sum total of these costs makes up a very large portion of the total compensation a client will claim and ultimately receive.
Heads of Loss
For each symptom or problem caused by the injury, the legal team will try to find a solution so that the person is put back into the position they would have been if the accident hadn’t happed, as far as possible. The most obvious example would be if the client is unable to work again because of the injuries sustained, then the legal team would ensure that there is a Lost Earnings Head of Loss, which explains and proves the extent of that client’s lost earnings.
It requires a high degree of expertise and medical knowledge to be able to correctly identify all of the Heads of Loss that are unique to a spinal injury claim. This is what makes a serious injury lawyer different to a personal injury ’specialist’.
Examples of Heads of Loss that are often pursued in spinal injury compensation claims include the following:
In a spinal injury compensation claim it is important for the lawyer to seek an expert opinion on the home environment of their client. This is so that consideration may be given to the technological assistance the client may require to manage the climate in their house, and to open gates, doors, windows and curtains.
A client undertaking a spinal injury claim is also likely to benefit from computer hardware. A specialised laptop PC, including certain additional facilities will make operation more efficient, comfortable, and sustainable for the injured user. Examples of these extra facilities include features such as touch screen, cursor controlled devices, a mounting system for wheelchair use and so on.
Additional holiday costs
A client with a spinal cord injury will have much higher costs of going on holiday, and this needs to be considered during their compensation claim. This will include the need for them to be accompanied by carers on their holiday and additional disability related expenses for holiday and travel.
The person undertaking a spinal injury claim is likely to need an extensive equipment package in the future. For example, they may require several different types of wheelchair, depending on the activities they are undertaking. Each type of wheelchair will come with its own particular set of components, and everything from insurance costs to a pump for the tyres must be considered.
Types of spinal injury
There are two main types of spinal injury and each is categorised by the extent of the injury sustained, also known as its ‘completeness’.
Due to a post-injury swelling known as ‘spinal shock’, it isn’t possible to quickly determine the type of injury that has been suffered.
However within approximately six to eight weeks, a diagnosis confirms whether it is a complete spinal cord injury or an incomplete spinal cord injury, and each type of injury has distinct features.
Complete spinal cord injury
Of the two main types, a complete spinal cord injury is the most severe.
In such cases, there is sufficient trauma to cause damage across the whole width of the spinal cord resulting in a complete and permanent loss of function and sensation below the level of injury.
Depending on where the site of injury is, the eventual condition is known as either complete paraplegiaor complete tetraplegia.
Generally, complete paraplegia is the result of complete damage to the spinal cord anywhere below the neck.
Specifically this is caused by injury to the cord in the spinal column’s middle section, known as the thoracic region, or further below this in what are known as the lumbar and sacral regions.
This injury causes a complete loss of movement and feeling in the legs and in most circumstances the trunk, whilst normal use of the arms will continue.
The extent of this paralysis is affected by the site of the injury to the spinal cord, which in turn determines how the injury is classified. In the thoracic region, the first vertebra (bone) beneath the neck is called the T1, beneath this the T2 and so on down to T12. So for example, complete injury to spinal nerves at the T4 bone is known as T4 paraplegia.
The same applies below this in the lumbar region, where the first vertebra is called the L1 running downwards to L5, and then below this again in the sacral region (S1 to S5). For example, following the same system a complete injury to the spine at the L2 region is known as L2 paraplegia and so forth.
This classification system shows that the higher up the spine a complete injury occurs, the more severe the loss of function and sensation is in the lower body.
Complete Tetraplegia is the most extreme level of paralysis, where there is loss of function and sensation in the arms, body and legs.
This happens after there has been severe injury to the spinal cord in the neck, also known as the cervical region. Depending on which part of the cord has sustained complete damage, the extent of arm paralysis will vary and this dictates how the injury is classified.
There are eight levels of complete tetraplegia, and each one refers to where the spine has been injured in relation to eight nerves that are protected by seven vertebrae in the neck. Each nerve is numbered in order, starting with C1 being closest to the skull and then continuing down the spine to C8, hence if the site of complete injury is at C4 it is known as C4 Tetraplegia.
The higher the site of injury to the spinal cord in the neck, the more severe the loss of function and sensation in the entire body.
Incomplete spinal cord injury
Incomplete spinal cord injuries are much more common.
In such cases, areas of the spinal cord remain intact meaning that rather than a complete loss of function, some limited mobility or sensation (or both) will remain.
Immediately post-injury it can seem that complete paralysis has occurred. Then after six to eight weeks a small amount of movement may return without any feeling, or alternatively some feeling may return but with little or no mobility.
Incomplete spinal cord injuries vary greatly from case to case because of the many ways in which which the spine can be damaged, the different parts of the cord that can be affected and also the force of impact that caused the injury.
However, there are five main categories of incomplete spinal cord injury:
Anterior Cord Syndrome: Injury to the front of the spinal cord.
Central Cord Syndrome: Injury to the centre of the spinal cord.
Posterior Cord Syndrome: Injury to the back of the spinal cord.
Brown-Sequard Syndrome: Injury to the one side of the spinal cord.
Cauda Equina Syndrome: This final category of injury is one to a group of nerves in the lower region of the spine.
Effects of spinal injury
Spinal cord injuries (SCIs) have a profound effect on people’s lives.
They can cause irreparable and catastrophic physical damage that changes the course of life in an instant.
Levels of mobility, functionality and independence can all change to such an extent that the long-term emotional and psychological impact affects not only those injured, but their friends, family and carers as well.
Effects of complete paraplegia
Complete paraplegia is caused by complete damage across the spinal cord anywhere below the neck region, specifically to the following regions of the spine:
- Thoracic (T1 to T12 bones, known as vertebrae) – the upper middle region.
- Lumbar (L1 to L5) – the lower middle region.
- Sacral (S1 to S5) – the lower region.
The main effects of this injury are the loss of movement and feeling in the legs (and also usually the trunk of the body), whereas the arms and hands can still be used as normal.
Injury to the higher thoracic region (the T1 to the T6 vertebrae) causes a complete loss of function and sensation below the mid-chest. As a result, abdominal muscle is diminished meaning there is little trunk control and poor balance when sitting; the bladder and bowel functions will no longer work properly and function in the reproduction area is also lost.
Meanwhile, complete damage further down the spinal cord in the lower thoracic region (T9 to the T12) still means a loss of function and sensation in the legs, but abdominal muscle strength is preserved so there is good balance when sitting along with some general movement of the trunk.
The loss of function and sensation in the legs suffered by complete paraplegics can often be the catalyst for further secondary medical complications. Although not an exhaustive sample, some are listed below:
Fortunately through medical care and rehabilitation, there are methods to help minimise the chances of these complications. For example, to assist people with standing for short periods can help prevent pressure sores and Deep Vein Thrombosis (DVT).
A complete spinal cord injury resulting in complete paraplegia requires a stay in a specialist spinal hospital for approximately five months. During this time, extensive rehabilitation, skill-building and physiotherapy is undertaken in order to fully prepare paraplegics for day to day life with their new physical challenges.
Upon leaving hospital care, complete paraplegics can usually remain fully independent with the ability to provide full self-care such as feeding, grooming, bathing, dressing and so forth. Most use a self-propelled (manual) wheelchair for mobility but some people who have suffered complete lower spinal injuries may be able to stand (with assistance) for short periods of time.
In fact, it is not unknown for some to be able to walk supervised for short distances, aided by such equipment as long leg braces and a weight-taking walker. If the spine’s site of damage is between the T6 and T12 vertebrae, the patient may even be able to use apparatus to walk independently, although it takes a great deal of strength and determination to do so.
Therefore, it is key to understand that complete paraplegia does not necessarily mean the complete loss of all leg function, and there are rehabilitation methods and equipment that can help people maintain their independence, and in some cases perhaps achieve what at first may seem like the impossible.
Effects of complete tetraplegia
Complete tetraplegia is the most severe, and debilitating level of paralysis.
It is the loss of function and sensation in the arms, legs and body caused by complete damage to the spinal cord in the neck (cervical region).
The primary effects of complete tetraplegia vary depending on which part of the spinal cord has sustained injury.
The eight classifications of tetraplegia refer to the site of injury as the eight nerves protected by the seven vertebrae (bones) in the neck. From the top nerve (C1) to the bottom (C8), the higher the injury occurs then the greater the physical impact is on the rest of the body.
The table below provides a general picture of the extent of the effects. For example, it is clear that C1 tetraplegia has the largest amount of physical effects whereas C8 tetraplegia, whilst still extremely debilitating, generally has the least:
Effects and/or Remaining Abilities
Types of Tetraplegia
Complete paralysis of the arms, body and legs
C1, C2, C3
Complete paralysis of the body and legs but with limited arm function
C4, C5, C6, C7, C8
Ability to move the head and neck
Severely limited: C1, C2, C3
In some cases fully: C4
Fully, with good muscle strength: C5, C6, C7 & C8
Ability to move shoulders
Good: C5, C6, C7 & C8
Ability to bend elbows
C5, C6, C7 & C8
Ability to lift hands (wrist extension)
C6, C7 & C8
Cannot breathe unaided (machinery assistance required)
In some cases: C3
Ability to breathe without assistance
In some cases: C4
C5, C6, C7 & C8
Build-up of waste in windpipe. Assistance required for coughing
C1, C2, C3, C4 & C5
In some cases: C6, C7 & C8
Loss of bowel and bladder functionality
C1, C2, C3, C4, C5, C6, C7 & C8
Ability to bend and straighten elbows
C7 & C8
Partial finger movement, grip and mobility
C7 & C8
May transfer body independently depending on upper body strength
C7 & C8
The near complete loss of function, sensation and mobility of complete tetraplegics can cause many secondary medical complications, some of which are listed below:
These complications range from the mild to the life-threatening and although not all are guaranteed to occur, steps must be taken to minimise their chances, such as regularly moving the patient to prevent pressure sores or reacting quickly to Autonomic Dysreflexia to prevent strokes.
A high level of care and assistance is required after a complete spinal cord injury in the neck and usually, a six to eight month stay in a specialist spinal hospital is required for rest and rehabilitation.
Following discharge, it is fortunate that there are constant technological advances that continue to improve the lives of those with complete tetraplegia: from breathing apparatus, powered wheelchairs and automatically opening doors, to equipment activated by mouth, chin, head and even blink control. In some cases, reconstructive hand surgery may be possible to improve function, such as grip and release, or even the attachment of a bionic glove.
C1 to C4 tetraplegics will generally require the most personal care and assistance, but for those with some arm movement present - or enough to use assistive equipment - it could even be possible to perform daily activities to a high enough standard to live independently.
Effects of incomplete spinal cord injuries
An incomplete spinal cord injury is when the cord becomes partially damaged.
It is the most common type of spinal injury and the one where either limited movement or feeling (or both) can remain below the point of damage.
The effects of an incomplete injury differ depending on several factors:
- How the spinal cord was damaged.
- The area of the spinal cord affected.
- The strength of the injury-causing impact.
However, there are five general classifications of injury and this section discusses each in turn:
Anterior Cord Syndrome
This injury happens when an impact is strong enough to damage the artery that runs along the front of the spinal cord, perhaps by a fragment of broken bone or a slipped disc.
As well as a loss of strength beneath the point of injury, there is also a loss of feeling of temperature and pain.
Some sensations are preserved, however, such as the feeling of vibration and the awareness of positioning. For some people, it may be possible to later recover some movement.
Central Cord Syndrome
This is an injury to the nerves at the centre of the spinal cord, usually the result of trauma, that prevents the brain sending information down the spinal cord to the rest of the body.
These nerves are critical in enabling normal use of the arms and hands, so the main effect of central cord syndrome is that all arm function is lost. Depending on the severity of the nerve damage, there may also be a loss of bladder and bowel control.
Some function can be preserved in the legs, and during the recovery process it may be possible to improve this gradually.
Posterior Cord Syndrome
Posterior Cord Syndrome is an incomplete injury to the back of the spinal cord. The resulting effects are characterised by a lack of limb control and coordination.
Below the site of injury, there will still be good muscle power and sensations of temperature and pain are usually preserved.
Brown-Sequard Syndrome is a rare condition. It is the result of an injury to one side of the spinal cord that in effect, causes an inverted mirror image of complications.
Beneath the site of damage to the cord, the effects can be a complete loss of movement on one side of the body but with preserved sensations of pain and temperature. However, on the other side of the body the opposite is true in that sensations of pain and temperature are lost but normal movement is preserved.
Cauda Equina Syndrome
The cauda equina is a mass group of nerves in the lower back area. Once trauma is suffered the nerves are compressed, which at the very least causes strong lower back pain.
More extreme is the partial, or in some cases the complete loss of movement and feeling as well as bladder and bowel dysfunction.
However, if the nerves have not suffered too much trauma and damage, it is possible for them to regrow and encourage some recovery of movement.
Emotional effects of a spinal cord injury
After a spinal cord injury, a patient may be unconscious, in shock or require such extensive surgery that it may be some time until they have a full understanding of the seriousness of the situation.
In the meantime, family and friends are usually acutely aware of all that has happened and are soon facing up to the emotional consequences of the injury.
Naturally, no one person will react to such life-changing spinal cord injuries in in exactly the same way as another, but usually people experience several common and unifying emotional reactions.
This section looks at some of these stages and effects:
Life Changing Event
After being injured, feelings of fear will undoubtedly surface. What does the future hold? How will life be affected? How will everybody cope? There is fear of pain and of the ability to adapt to these new circumstances. These feelings of uncertainty are completely natural and unfortunately, very difficult to push to one side.
Feelings of sadness, confusion and worry can take turns throughout this whirlwind of emotions, and it can be somewhat overwhelming. Negative body image, a loss of financial independence and suicidal thoughts can take over, so it is imperative that there is personal and professional support available through this turbulent time.
Family and friends will have had more time to take stock of the situation, but by no means does this make coping any easier. Initial shock can give way to feelings of despair and fear of the suffering their loved ones may endure, or even fear of death.
There may be feelings of guilt, thoughts of past wrongdoings or regret for the things neglected before the injury, as well as anger at the unfairness of the situation. These are normal feelings of grief, important emotions to embrace and experience rather than to supress, no matter how painful they may be.
The important thing is that they are all linked. The injured person’s ability to adapt to their new condition is heavily dependent on the love and support they receive from the people closest to them. Together, these challenges can be confronted.
Confronting the Challenge
The spinal cord injury rehabilitation process begins in the hospital, not only in a physical sense but in an emotional one too. The aim is to make sure that recovery improves a sense of well-being and an ability to reintegrate back into the world.
There may be anxieties about leaving the comfort, security and support of the hospital and fear of becoming a burden on loved ones at home. It may be necessary to prepare for the new way in which people could react to extreme physical changes – these people could even be immediate family members. Controlling coping with these situations is key, especially in maintaining strong relationships with loved ones.
Spinal cord injuries are so all-encompassing that symptoms of depression can develop. They may be persistent feelings of sadness, sorrow, loss of sleep and fluctuating weight and appetite to name a few. Feelings of anxiety can also inhibit the ability to function socially through symptoms such as a pounding heart, breathing difficulties, sweating and feeling faint.
It is important to seek professional treatment and help for any of these symptoms and not to suffer in silence. Help will improve the capacity for rehabilitation and to strengthen relationships. Healing is a long process, but acknowledging the injury and its effects can help to overcome these obstacles and make plans to re-join the world.
Hopefully, with care and assistance, it will be possible to adapt to the debilitating emotional effects of a spinal cord injury.
The people that manage this tend to feel an empowering emotion of triumph; a feeling that their disabilities are not going to hinder them and a sense of courage to face adversity head-on.
Meanwhile, family and friends can recognise the inspirational value in these triumphs thus improving their own senses of well-being and emotional stability.
Those unable to confront their emotions and accept their injuries often withdraw from society so it is vital that strong support from the close-community, health care professionals and family are always available for the journey ahead.
It may be a long road, but it’s one to take together.
Medical information for spinal injury
The spinal column is an incredible feat of engineering. Not only is it the weight-bearing structure that supports our frame, it is also the pathway used by the brain to communicate with every single part of the body; sending and receiving the electric impulses that control movement, feeling and general well-being.
There are three main functions of the spine:
- To house and protect the spinal cord and its associated nerves.
- To support the frame of the body in an upright position.
- To provide motion throughout the body.
Consisting of thirty three bones called vertebrae, the spine runs from the base of the skull down to the pelvis. Apart from the very top two vertebrae, the anatomy of each individual bone is essentially the same, differing only in size and shape.
The vertebrae are held together by a combination of ligaments and muscles which allow flexibility and are separated by cartilage discs that act as shock absorbers. Two joints at the back of each bone allow for maximum movement, and pairs of spinal nerves exit holes at each level of the spine, sending the brain’s electric information to and from the various parts of the body.
A healthy spine is straight when viewed from the front. When viewed side-on, a fully grown spine has three obvious curves that form an “S” shape. The neck and lower back curve slightly inwards (concave) and the upper back curves out (convex).
Regions of the spine
All thirty three vertebrae are divided into five separate regions, each with different specific functions. The regions are:
- Cervical (neck) – Seven vertebrae, which in descending order are named C1 to C7.
- Thoracic (upper to mid back) – Twelve vertebrae, T1 to T12.
- Lumbar (lower back) – Five vertebrae, L1 to L5.
- Sacrum (pelvis area) – Five fused vertebrae, S1 to S5.
- Coccyx (tailbone) – The four fused vertebrae of the tailbone.
Only the top twenty four vertebrae can move, with the fused bones of the bottom two regions providing structural support.
This section looks at the five regions in turn:
The cervical spine, or the neck, supports the full weight of the skull and has the greatest range of movement.
Essential to this flexibility are the specialist roles played by the top two vertebrae, known as the Atlas (C1) and the Axis (C2) respectively. Shaped unlike any of the other vertebrae, the two bones are pivots: the Atlas connects to the skull and allows up and down nodding movements whilst the Axis enables a side-to-side shaking of the head motion.
Contrasting with the cervical region, the twelve bones of the thoracic region of the spine have very limited movement.
With larger vertebrae than those in the neck, the main function of the thoracic region is to connect to the ribcage, which in turn protects the internal organs.
The vertebrae in the lumbar region of the spine are larger, wider and broader still than those in the two regions above it. It is tremendously strong, carries most of the body’s weight and absorbs the stress from weight-bearing (lifting and carrying).
There is a greater range of motion possible in the lumbar region than there is in the thoracic region, however not as much as in the cervical region.
Immediately beneath the 24 individual vertebrae, there are the five fused bones of the sacrum. This is a triangular shaped ‘bone’ situated behind the pelvis. Its purpose is to connect the spine to the hip bones (known as the iliac).
The final part of the spine is the coccyx - four fused bones often referred to as the tailbone. This is an important attachment for various ligaments and tendons throughout the pelvis area.
The spinal cord
Housed inside the spine is the single most important structure that links the brain to the body -the spinal cord.
It is a slim, white, cylindrical cord consisting of millions of nerve fibres and is approximately the diameter of a human finger. It is surrounded by a protective, cushioning liquid called Cerebral Spinal Fluid (CSF) which prevents the vertebrae from damaging the cord.
It begins immediately below the brain stem and on average, descends 43cm to the first lumbar vertebrae (L1). At this point it ends at a region called the conus medullaris before blending into a mass group of nerves at the base of the spine called the cauda equinas.
The spinal cord makes up a relatively small part of the Central Nervous System (a mere 2%), but its significance cannot be understated:
It is the brain’s connecting road to the body, down which it sends and receives all of its electrical information.
Thirty one pairs of spinal nerves, also known as nerve roots, branch off from the spinal cord, pass through holes in the vertebrae before branching out yet again to control all the different parts of the body as part of the Peripheral Nervous System. Nerves relaying information from the brain to the body are called Motor Neurones and nerves carrying information in the other direction are known as Sensory Neurones.
Depending on the location of where spinal nerves branch out from the spinal cord, different parts of the body are controlled. Following the same logic as the vertebrae categorisation, these are divided into four regions:
- Cervical Nerves: Although there are only seven vertebrae in the neck, there are eight pairs of spinal nerves numbered C1 to C8. These enable breathing in addition to providing movement and feeling to the head, neck, shoulders, arms and hands.
- Thoracic Nerves: Twelve pairs of spinal nerves (T1 to T12) in the upper back that connect muscles in the back, chest and upper abdomen.
- Lumbar Nerves: Five pairs of spinal nerves (L1 to L5) supplying the lower back and regions of the thighs and legs.
- Sacral Nerves: Five pairs of spinal nerves (S1 to S5) that supply the buttocks, the bladder, bowel, the sexual region and most of the legs and feet.
Rehabilitation for spinal injury
Improvements in emergency response and medical treatments have greatly increased the chances of surviving a spinal cord injury.
As a result, many more people must cope with severe injuries and complications for the rest of their lives. And with most spinal injuries happening to people below the age of 30, rehabilitation programs are all the more vital.
Three of the main goals of rehabilitation are:
- To improve the quality of life after injury.
- To maximise independence.
- To keep levels of activity as high as possible, despite reduced function.
Every spinal injury is unique, so rehabilitation programs are customised specifically to cater for the level of injury suffered and to set achievable goals.
A typical rehabilitation program involves several specialists that combine counselling and emotional support with physical therapy and skill-building exercises. As an example, a spinal cord injury rehabilitation program may include some of - but not limited to - the following specialists:
- Physiatrist (physical medicine specialist - usually leads the rehabilitation program)
- Social Workers
- Physical and Occupational Therapists
- Recreational Therapists
- Rehabilitation Nurses
Spinal cord injury rehabilitation programs are a team effort, and the injured person is just as much a part of the team as the medical staff. Everybody works together to help make the many important decisions that will improve day to day life.
Generally, spinal cord injury rehabilitation programs can be divided into three stages:
- Acute Rehabilitation – This is the short-term treatment administered immediately after the injury, usually in hospital.
- Inpatient Rehabilitation – Various intensive therapies conducted in hospital.
- Outpatient Rehabilitation – Continuous therapy after leaving hospital, either at home or in another rehabilitation centre, or both.
Stages of therapy
This is the first stage of rehabilitation, which begins as soon as medical attention can be paid to the spinal cord injury.
In order to prevent any further injury, the spine is immobilised and realigned if necessary. Respiratory help is provided if there has been sufficient spinal cord damage in the upper neck.
Depending on the extent of the injury suffered, there may be a period spent in an intensive care unit, but in any case the patient will most likely be transferred to a specialised spinal hospital.
Where possible, a steroid called methylprednisolone may be administered to reduce damage to spinal nerve cells and to decrease the inflammation around the cord known a spinal shock. This makes it easier for medical specialists to do three things quickly:
- Complete a full neurological assessment.
- Diagnose the severity of the injury.
- Predict the most-likely extent of recovery.
Once this has been determined, the next stage of the rehabilitation process begins.
As soon as the Consultant allows, inpatient rehabilitation can begin. At this stage, the primary focus can include:
- To attempt to improve function and strength in the legs and where possible, the arms.
- Improve communication skills.
These are two of the most important areas of function affected by a spinal cord injury so must be attended to as soon as possible. Meanwhile, every care is taken to minimise secondary complications.
As function improves, the rehabilitation team addresses the wider-range of issues such as mobility, bowel and bladder training, diet and nutrition, exercise, sexual function and general daily living. Family members are encouraged to participate in some of these therapies so they become familiar and understand their loved one’s needs and prepare for life outside the hospital.
And that is the aim: going home.
The inpatient rehabilitation phase is a time for learning and re-learning: learning how to adapt to new circumstances and re-learning how to perform day-to-day tasks, living as independently as possible in the home.
If the patient has shown sufficient improvement following the first two phases, they can be discharged from hospital and begin outpatient rehabilitation.
Throughout this phase, the team works continuously to improve all aspects of life; be it through rehabilitation sessions at home or at designated medical centres.
The number of rehabilitation sessions required depends on the patient’s personal situation. Some may require weekly sessions, some daily, and some even several times per day.
The general aim is to gradually reduce the number of sessions as the patient’s condition improves, enabling them to live at the optimum level of independence.
Types of therapy
As discussed previously, a spinal cord injury rehabilitation program requires a whole team to provide separate specialist therapies.
This section takes a general look at some of the main types of these therapies and discusses what is involved in each:
The nature of the physical therapy will depend upon the level of the spinal cord injury. Each therapy plan is specific to the needs of the individual.
Physical therapists may work to strengthen the patient’s muscle groups and focus on improving general motor skills. This can be a very painful and fatiguing experience, especially soon after the injury. In early stages, therapists may also assist with breathing and where necessary, help patients to develop coughing techniques that clear the windpipe.
As conditions improve and the patient moves out of the acute phase, various techniques may be used to attempt to improve movement, for example people with incomplete spinal cord injuries may take part in treadmill training and gait training.
There may be retraining for bowel and bladder management and over time, coping strategies may be developed for spasms, autonomic dysreflexia and pain symptoms such as pins and needles sensations and chronic aches.
Physical therapy is very important because not only does it endeavour to improve physical functionality, it can be a communal therapy. More so than many other therapies, it encourages the patient and their family to get involved, to provide valuable input and define achievable goals in order to cope with their situation in the best way possible.
Occupational therapists teach the skills that promote as high a level of independence as possible. Inpatient occupational therapy prepares the patient for life outside the hospital by improving the skills that are the foundation of functionality, such as the general techniques/guidance for self-grooming, strength, coordination, balance, feeding, dressing and how to use necessary adaptive equipment.
Outpatient occupational therapy continues the skill building exercises, but constantly re-evaluates the patient’s needs and the areas they need to focus on such as changes in motor function, posture, hand and arm problems and changes in sensation.
Psychological therapy during the inpatient and outpatient phases of rehabilitation provides emotional support for both the patient and their family as they come to terms with life-changing injuries.
After a spinal cord injury, people are understandably susceptible to depression. It is an all-encompassing illness that affects a person’s ability to function so when physical abilities are already limited by injury, it is vital to address and treat depression if it arises.
Social workers assist the patient and family by planning and implementing strategies that cater for all future needs, such as arranging for assistive equipment, the regularity of home visits and identifying local community resources.
Vocational rehabilitation assesses whether the patient’s physical and mental abilities are strong enough to return to the workplace and if so, assists with finding work and making any necessary adaptations to the workplace.
For those unable to re-join the workforce, alternatives are offered such as recreational therapy programs. These involve athletic pursuits that encourage an active body and mind as well as providing great opportunities for social interaction.
It is clear that no matter the severity of the injury, the level of rehabilitation required after a spinal cord injury is high. A a strong rehabilitation team is vitalt, and together with a strong and committed patient, they may make significant gains.
Future spinal cord research
Past research has led to a vast increase in human survival rates after spinal cord injuries and an incredible improvement in successful rehabilitation methods. With continued research, the goal is to discover complete ways to repair an injured spinal cord.
However this is, of course, not an easy task. The spinal cord is part of the Central Nervous System and is connected to the brain, an incredibly complex organ of which we have a relatively small understanding in comparison to other parts of the body.
The spinal cord’s complexity is further increased due to its behaviour both during and after injury. At a cellular level, the spinal cord’s environment constantly shifts and changes for weeks (or possibly months) on end before finally settling.
Despite such complexity, there are four main areas of research for spinal cord repair:
- Preventing damage to surviving nerve cells.
- Replacing damaged nerve cells.
- Stimulating the regrowth of nerve fibres (also known as axons).
- Retraining neural circuits to provide normal body functionality.
In addition, there are other various secondary effects that will need to be managed:
Controlling inflammation – currently this is often minimised with methylprednisolone, but there is ongoing research to find a more efficient method that also harnesses the cell repairing benefits of inflammation. One proposal is an induced mild state of hypothermia, cooling the body to protect its spinal cord tissue and nerve cells.
Preventing excitotoxicity – this is to prevent the spine’s dead nerve cells from releasing a cell-destructing amino acid called glutamate, or perhaps by immunising surrounding cells.
Preventing apoptosis – Apoptosis is when healthy cells self-destruct after injury, often referred to as programmed cell death. However, not enough is known to understand this process fully, but the goal is to find way to prevent it from happening.
Meanwhile, some experiments have attempted to transplant cell grafts into the injured spinal cord, behaving like bridges and linking together the previously broken nerve fibres; others are bringing together computer interfaces and prosthetics in a huge step forward for bioengineering.
Spinal Cord Regeneration – One of the most well-known methods of spinal cord regeneration, and one that has shown hugely positive results in early tests, is through the use of stem cells.
Stem cells are able to divide and bring forth nearly all the types of cells within the human body and though stem cell research is considered controversial in some quarters, astonishing breakthroughs in nerve cell and fibre regrowth have been confirmed by Harvard Medical School, the University of California and King’s College London amongst others.
Their three main findings indicate that the central nervous system’s long-standing barriers may not be standing for much longer:
- It is possible to grow nerve fibres back into the spinal cord.
- The nerve fibres are able to reconnect with nerve cells.
- The ability to feel can be regained.
This has only scratched the surface of the complexities that stand in the way of discovering full spinal cord regeneration and repair, but researchers and medical experts are optimistic that recent discoveries will soon be transferred from the lab to humans.
At the time of writing, a major breakthrough seems to be tantalisingly close to coming into view.
If you have any questions that have not been answered in the above sections, please contact us so that we can answer them for you. If we are unable to answer your questions personally, we will be able to point you in the right direction through the medical and professional relationships that we have built up over 25 years.