What Is Spinal Cord Injury

What is Spinal Cord Injury? A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.

Is there any treatment? Improved emergency care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and even restore limited abilities. Respiratory complications are often an indication of the severity of spinal cord injury About one-third of those with injury to the neck area will need help with breathing and require respiratory support. The steroid drug methylprednisolone appears to reduce the damage to nerve cells if it is given within the first 8 hours after injury. Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support.

What is the prognosis? Spinal cord injuries are classified as either complete or incomplete. An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury. A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day.

What research is being done? The National Institute of Neurological Disorders and Stroke (NINDS) conducts spinal cord research in its laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country. Advances in research are giving doctors and patients hope that repairing injured spinal cords is a reachable goal. Advances in basic research are also being matched by progress in clinical research, especially in understanding the kinds of physical

rehabilitation that work best to restore function. Some of the more promising rehabilitation techniques are helping spinal cord injury patients become more mobile. http://www.ninds.nih.gov/disorders/sci/sci.htm

What is Spinal Cord Injury? Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. Frequent causes of damage are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida, Friedreich's Ataxia, etc.). The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves. A person can "break their back or neck" yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized. What is the spinal cord and the vertebra? The spinal cord is about 18 inches long and extends from the base of the brain, down the middle of the back, to about the waist. The nerves that lie within the spinal cord are upper motor neurons (UMNs) and their function is to carry the messages back and forth from the brain to the spinal nerves along the spinal tract. The spinal nerves that branch out from the spinal cord to the other parts of the body are called lower motor neurons (LMNs). These spinal nerves exit and enter at each vertebral level and communicate with specific areas of the body. The sensory portions of the LMN carry messages about sensation from the skin and other body parts and organs to the brain. The motor portions of the LMN send messages from the brain to the various body parts to initiate actions such as muscle movement. The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and Parasympathetic Nervous Systems. The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience. The vertebra are named according to their location. The eight vertebra in the neck are called the Cervical Vertebra. The top vertebra is called C-1, the next is C-2, etc. Cervical SCI's usually cause loss of function in the arms and legs, resulting in quadriplegia. The twelve vertebra in the chest are called the Thoracic Vertebra. The first thoracic vertebra, T-1, is the vertebra where the top rib attaches. Injuries in the thoracic region usually affect the chest and the legs and result in paraplegia. The vertebra in the lower back between the thoracic vertebra, where the ribs attach, and the pelvis (hip bone), are the Lumbar Vertebra. The sacral vertebra run from the Pelvis to the end of the spinal column. Injuries to the five Lumbar vertebra (L-1 thru L-5) and similarly to the five Sacral Vertebra (S-1 thru S-5) generally result in some loss of functioning in the hips and legs.

What are the effects of SCI? The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common. The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses. Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers. Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs. Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder,. Sexual functioning is frequently with SCI may have their fertility affected, while women's fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain How many people have SCI? Who are they? Approximately 450,000 people live with SCI in the US. There are about 10,000 new SCI's every year; the majority of them (82%) involve males between the ages of 16-30. These injuries result from motor vehicle accidents (36%), violence (28.9%), or falls (21.2%).Quadriplegia is slightly more common than paraplegia. Is there a cure? Currently there is no cure for SCI. There are researchers attacking this problem, and there have been many advances in the lab (see research updates ). Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug SygenÆappears to reduce loss of function, although the mechanism is not completely understood. Do people with SCI ever get better? When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to go down and

people may regain some functioning. With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning. Does everyone who sustains SCI use a wheelchair? No. Wheelchairs are a tool for mobility. High C-level injuries usually require that the individual use a power wheelchair. Low C-level injuries and below usually allow the person to use a manual chair. Advantages of manual chairs are that they cost less, weigh less, disassemble into smaller pieces and are more agile. However, for the person who needs a powerchair, the independence afforded by them is worth the limitations. Some people are able to use braces and crutches for ambulation. These methods of mobility do not mean that the person will never use a wheelchair. Many people who use braces still find wheelchairs more useful for longer distances. However, the therapeutic and activity levels allowed by standing or walking briefly may make braces a reasonable alternative for some people. Of course, people who use wheelchairs aren't always in them. They drive, swim, fly planes, ski, and do many activities out of their chair. If you hang around people who use wheelchairs long enough, you may see them sitting in the grass pulling weeds, sitting on your couch, or playing on the floor with children or pets. And of course, people who use wheelchairs don't sleep in them, they sleep in a bed. No one is "wheelchair bound." Do people with SCI die sooner? Yes. Before World War II, most people who sustained SCI died within weeks of their injury due to urinary dysfunction, respiratory infection or bedsores. With the advent of modern antibiotics, modern materials such as plastics and latex, and better procedures for dealing with the everyday issues of living with SCI, many people approach the lifespan of non-disabled individuals. Interestingly, other than level of injury, the type of rehab facility used is the greatest indicator of long-term survival. This illustrates the importance of and the difference made by going to a facility that specializes in SCI. People who use vents are at some increased danger of dying from pneumonia or respiratory infection, but modern technology is improving in that area as well. Pressure sores (learn more about pressure soars here) are another common cause of hospitalization, and if not treated - death. Overall, 85% of SCI patients who survive the first 24 hours are still alive 10 years later. The most common cause of death is due to diseases of the respiratory system, with most of these being due to pneumonia. In fact, pneumonia is the single leading cause of death throughout the entire 15 year period immediately following SCI for all age groups, both males and females, whites and non-whites, and persons with quadriplegia. The second leading cause of death is non-ischemic heart disease. These are almost always unexplained heart attacks often occurring among young persons who have no previous history of underlying heart disease. Deaths due to external causes is the third leading cause of death for SCI patients. These include subsequent unintentional injuries, suicides and homicides, but do not include persons dying from multiple injuries sustained during the original accident. The majority of these deaths are the result of suicide. Do people with SCI have jobs?

People with SCI have the same desires as other people. That includes a desire to work and be productive. The Americans with Disabilities Act (ADA) promotes the inclusion of people with SCI to mainstreamin day-to-day society. Of course, people with disabilities may need some changes to make their workplace more accessible, but surveys indicate that the cost of making accommodations to the workplace in 70% of cases is $500 or less. Choosing a rehabilitation center is very important. Not all rehabilitation centers have a spinal cord injury program. Do as much research as possible, don't be afraid to ask questions. Since each individuals needs will vary, with the help of the NSCIA, I have put together some questions and information to help get you started, but keep in mind its just a reference to help get you started. A good rehabilitation center does not necessarily need to adhere to all of these guidelines. Feel free to print this page out and take it with you on your visit, or keep it handy when you make your phone inquiries. I have also started to put a list of rehabilitation centers across the nation specializing in the care and needs of spinal cord injuries. Along with locations and contact information. • • •

Here is a list of 18 model spinal cord injury centers Department of veterans affairs: spinal cord injury centers Discuss rehabilitation or post your questions on our community message boards

Some questions to consider when inquiring about a rehabilitation center • • • •

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Are the beds for people with SCI in the same area of the facility? Are there people in the SCI program of the same age and sex as the person considering admission? Do the people in the SCI program have similar levels and kinds of spinal cord injury e.g., quadriplegia, paraplegia, incomplete and complete? What is the average number of people admitted annually to the SCI program? (program staff should treat people with SCI on a regular basis to acquire and maintain expertise.) Is the SCI program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? Has it been designated as a Model Spinal Cord Injury Center by the National Institute of Disability Research and Rehabilitation (NIDRR)? Click here for a current list of Model spinal cord injury centers) Is the SCI program part of a SCI rehabilitation system operated by the state? Are there treatment specialists in the SCI program who speak the primary language of the individual seeking treatment? Will the treatment team develop a rehabilitation plan with both short and long term goals? Will an experienced case manager be assigned to help family members obtain medical payments and other benefits from public and private insurance? Will a team member be assigned to coordinate treatment and act as a contact for staff and family members?

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Is the physician in charge a Physiatrist? If not, what credentials does he/she have? How long has the physician in charge been directing programs specializing in SCI? Is there physician coverage seven days a week? Twenty-four hours a day? Do the regular nursing staff and other specialists responsible for providing treatment in the SCI program have specific training in treating SCI? Is the nursing staff employed by the hospital or employed through an outside agency? Does the program ensure the availability of rehabilitation nursing and respiratory care on a twenty-four hour basis? Are there consultants available at the facility or nearby medical centers? These should include neurosurgery, neurology, urology, orthopedics, plastic surgery, neuropsychology, internal medicine, gynecology, speech pathology, pulmonary medicine, general surgery and psychiatry. How often and for how long each day will participants get treatment by specialists such as occupational and physical therapists? Treatment should be no less then three hours per day. Are other specialties such as driver education, rehabilitation engineering, chaplaincy, and therapeutic recreation available if needed? Are activities planned for SCI program participants on weekends and evenings? How much time is spent teaching SCI program participants and their families about sexuality, bowel and bladder care, skin care and other essential self-care activities? Does the SCI program offer training in the management and hiring of personal care assistants? If so, how much time is spent by staff on this topic?

SPECIAL PROGRAMS Pediatric Programs •

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Because incidence rates of SCI among children are relatively low, rehabilitation hospitals and programs usually do not maintain a separate program or unit exclusively for children with SCI. As an alternative, caregivers may consider facilities/programs which place children with SCI in rehabilitation units with other children with chronic disabilities. Hopefully, this will provide families and children with opportunities to share common experiences and information with each other, and may lead to the development of support networks in the community. It is possible that children may be placed in units with other children who are too ill for rehabilitation. Children generally derive greater benefit if they undergo rehabilitation with other children who are actively involved in the rehabilitation process. Are the beds for children with spinal cord injuries in one area or in the same location as children with similar disabilities? Are children of the same sex and similar age currently in the program/facility? Is the physician in charge an individual with experience in rehabilitation? Does this physician have experience with children? If not, what are his/her qualifications? Do the other staff members specialize in pediatrics?

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How many children with SCI does the program/facility admit on an annual basis? Does the program/facility offer educational programs for children and young adults undergoing treatment? If not, does the facility coordinate tutoring programs with local schools? If so, who is responsible for payment? Are there child life or therapeutic recreation specialists on staff? (Child life specialists develop programs for children and families which strive to maintain normal living patterns and minimize the clinical environment. Therapeutic recreation specialists focus on teaching persons with disabilities new leisure and sports skills to maximize their independence). Are young siblings and friends allowed to visit the unit? Does the program/facility offer adaptive technology to help children communicate and learn? Is counseling available for siblings and families members? Is the equipment used by therapists, appropriate for children? Does the facility/program provide patient education materials for children and family members?

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Is the physician who directs the program a board certified Pulmonologist or a Physiatrist? Does he/she have experience with SCI? Are ventilator users treated on the same unit? How long has the facility been providing treatment for ventilator users? If the treatment team determines that an individual cannot breathe independently, what kind of services are offered to assist them in living as independently as possible? Are people in the unit similar in age to the person considering admission? Will they have the opportunity to meet ventilator users who have returned to the community and maximized their independence?

Special Considerations Psycho social/Counseling Services •

What types and how many hours of psycho social services are available? These should include peer support, individual and group psychotherapy, couples, vocational and substance abuse counseling? Does the facility offer sexuality and fertility counseling? Facility Policies/Family Members

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Do facility policies encourage family members including siblings regardless of age, to participate in rehabilitation programs? Are there living arrangements for family members participating in training? What other services, parking, meals and etc. are provided? Are counseling and other social services available to family members?

Discharge Planning •

Are SCI program participants given educational self-care manuals when they are

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discharged? Will staff members develop a formal discharge plan with program participants and their families? Does the facility and discharge planner work with local Independent Living Centers? Do they incorporate referrals to these centers into their discharge planning? Is there an independent living unit available for program participants and families to practice selfcare skills? Can family members stay there also? If the facility does not have an independent living unit do they encourage overnight therapeutic leave prior to discharge? Will someone be assigned as a liaison to provide follow-up services? Will a staff member visit or make arrangements for someone locally to evaluate the home for modifications? Will the follow-up plan include: Referral to an appropriate physician and other medical specialists in the community? Regular follow-up visits with this physician or a spinal cord injury unit physician? Regular urological evaluations? Scheduled equipment evaluations? If appropriate, a thorough vocational evaluation and referrals to a vocational rehabilitation program?

http://www.spinalinjury.net/html/_finding_a_rehab.html

Definition In 1995, actor Christopher Reeve fell off a horse and severely damaged his spinal cord, leaving him paralyzed from the neck down. From then until his death in 2004, the silver screen Superman became the most famous face of spinal cord injury. Most spinal cord injury causes permanent disability or loss of movement (paralysis) and sensation below the site of the injury. Paralysis that involves the majority of the body, including the arms and legs, is called quadriplegia or tetraplegia. When a spinal cord injury affects only the lower body, the condition is called paraplegia. Christopher Reeve's celebrity and advocacy raised national interest, awareness and research funding for spinal cord injury. Many scientists are optimistic that important advances will occur to make the repair of injured spinal cords a reachable goal. In the meantime, treatments and rehabilitation allow many people with spinal cord injury to lead productive, independent lives.

Symptoms

CLICK TO ENLARGE Spinal cord injuries

Spinal cord injury symptoms depend on two factors: •

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The location of the injury. In general, injuries that are higher in your spinal cord produce more paralysis. For example, a spinal cord injury at the neck level may cause paralysis in both arms and legs and make it impossible to breathe without a respirator, while a lower injury may affect only your legs and lower parts of your body. The severity of the injury. Spinal cord injuries are classified as partial or complete, depending on how much of the cord width is damaged. In a partial spinal cord injury, which may also be called an incomplete injury, the spinal cord is able to convey some messages to or from your brain. So people with partial spinal cord injury retain some sensation and possibly some motor function below the affected area. A complete spinal cord injury is defined by total or near-total loss of motor function and sensation below the area of injury. However, even in a complete injury, the spinal cord is almost never completely cut in half. Doctors use the term "complete" to describe a large amount of damage to the spinal cord. It's a key distinction because many people with partial spinal cord injuries are able to experience significant recovery, while those with complete injuries are not.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms: • • • • • • •

Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord Loss of movement Loss of sensation, including the ability to feel heat, cold and touch Loss of bowel or bladder control Exaggerated reflex activities or spasms Changes in sexual function, sexual sensitivity and fertility Difficulty breathing, coughing or clearing secretions from your lungs

Emergency signs and symptoms Emergency signs and symptoms of spinal cord injury after a head injury or accident may include: • •

Fading in and out of consciousness Extreme back pain or pressure in your neck, head or back

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Weakness, incoordination or paralysis in any part of your body Numbness, tingling or loss of sensation in your hands, fingers, feet or toes Loss of bladder or bowel control Difficulty with balance and walking Impaired breathing after injury An oddly positioned or twisted neck or back

Causes Your brain and central nervous system Together, your spinal cord and your brain make up your central nervous system, which controls most of the functions of your body. Your spinal cord runs approximately 15 to 17 inches from the base of your brain to your waist and is composed of long nerve fibers that carry messages to and from your brain. These nerve fibers feed into nerve roots that emerge between your vertebrae — the 33 bones that surround your spinal cord and make up your backbone. There, the nerve fibers organize into peripheral nerves that extend to the rest of your body. Injury may be traumatic or nontraumatic A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It may also result from a gunshot or knife wound that penetrates and cuts your spinal cord. Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord. Nontraumatic spinal cord injury may be caused by arthritis, cancer, blood vessel problems or bleeding, inflammation or infections, or disk degeneration of the spine. Damage to nerve fibers Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site. Spinal injuries occur most frequently in the neck (cervical) and lower back (thoracic and lumbar) areas. A thoracic or lumbar injury can affect leg, bowel and bladder control, and sexual function. A cervical injury may affect breathing as well as movements of your upper and lower limbs. The spinal cord ends at the lower border of the first vertebra in your lower back — known as a lumbar vertebra. So injuries below this vertebra actually don't involve the spinal cord. However, an injury to this part of your back or pelvis may damage nerve roots in the area and may cause some loss of function in the legs, as well as difficulty with bowel and bladder control and sexual function. Common causes of spinal cord injury The most common causes of spinal cord injury in the United States are:

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Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for almost 50 percent of new spinal cord injuries each year. Acts of violence. About 15 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds. Falls. Spinal cord injury after age 65 is most often caused by a fall. Overall, falls make up approximately 22 percent of spinal cord injuries. Sports and recreation injuries. Athletic activities such as impact sports and diving in shallow water cause about 8 percent of spinal cord injuries. Diseases. Cancer, infections, arthritis and inflammation of the spinal cord also cause spinal cord injuries each year.

Treatments and drugs Fifty years ago, a spinal cord injury was usually fatal. At that time, most injuries were severe, complete injuries and little treatment was available. Today, there's still no way to reverse damage to the spinal cord. But modern injuries are usually less severe, partial spinal cord injuries. And advances in recent years have improved the recovery of people with a spinal cord injury and significantly reduced the amount of time survivors must spend in the hospital. Researchers are working on new treatments, including innovative treatments, prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury. In the meantime, spinal cord injury treatment focuses on preventing further injury and enabling people with a spinal cord injury to return to an active and productive life within the limits of their disability. This requires urgent emergency attention and ongoing care. Emergency actions Urgent medical attention is critical to minimizing the long-term effects of any head or neck trauma. So treatment for a spinal cord injury often begins at the scene of the accident. If you suffer a head or neck injury, you'll likely be treated by paramedics and emergency workers who will attend to three immediate concerns: • • •

Maintaining your ability to breathe Keeping you from going into shock Immobilizing your neck to prevent further spinal cord damage

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.

In the emergency room, doctors focus on maintaining your blood pressure, breathing and neck stabilization and avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities. You may be sedated so that you don't move and sustain more damage while undergoing diagnostic tests for spinal cord injury. If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury. Early stages of treatment In the early stages of paraplegia or quadriplegia, your doctor will treat the injury or disease that caused the loss of function. Immediate treatment may include: •

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Medications. Methylprednisolone (Medrol) is a treatment option for acute spinal cord injury. This corticosteroid seems to cause some recovery in people with a spinal cord injury if given within eight hours of injury. Methylprednisolone works by reducing damage to nerve cells and decreasing inflammation near the site of injury. Immobilization. You may need traction to stabilize your spine and bring the spine into proper alignment during healing. Sometimes, traction is accomplished by placing metal braces, attached to weights or a body harness, into your skull to hold it in place. In some cases, a rigid neck collar also may work. Surgery. Often, emergency surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity. Controversy exists regarding the best time to perform surgery. Some surgeons believe it should be performed as soon as possible in most circumstances, while others believe it's safer to wait for several days before attempting any surgery. Research has not clearly proved which approach is better.

Ongoing care After the initial injury or disease stabilizes, doctors turn their attention to problems that may arise from immobilization, such as deconditioning, muscle contractures, bedsores, urinary infection and blood clots. Early care will likely include range-of-motion exercises for paralyzed limbs, help with your bladder and bowel functions, applications of skin lotion, and use of soft bed coverings or flotation mattresses, as well as frequently changing your position. Hospitalization can last from several days to several weeks, depending on the cause and extent of the paralysis and the progress of your therapy. But treatment doesn't stop when you check out of the hospital. Here are some of the ongoing treatments you can expect.

Rehabilitation. During your hospital stay, a rehabilitation team will work with you to improve your remaining muscle strength and to give you the greatest possible mobility and independence. Your team may include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, dietitian recreation therapist and a doctor who specializes in physical medicine (physiatrist) or spinal cord injury. During the initial stages of rehabilitation, therapists usually emphasize regaining leg and arm strength, redeveloping fine-motor skills and learning adaptive techniques to accomplish day-to-day tasks. A program typically includes exercise, as well as training on the medical devices you'll need to assist you, such as a wheelchair or equipment that can make it easier to fasten buttons or dial a telephone. Therapy often begins in the hospital and continues in a rehabilitation facility. As therapy continues, you and your family members will receive counseling and assistance on a wide range of topics, from dealing with urinary tract infections and skin care to modifying your home and car to accommodate your disability. Therapists will encourage you to resume your favorite hobbies, participate in athletic activities and return to the workplace, if possible. They'll even help determine what type of assistive equipment you'll need for these vocational and recreational activities and teach you how to use it. Medications. You may benefit from medications that manage the signs, symptoms and complications of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning. You may also need short-term medications from time to time, such as antibiotics for urinary tract infections. New technologies. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some apparatuses may also restore function. These include: •

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Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injury more mobile and more comfortable. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help. Computer devices. Computer-driven tools and gadgets can help with daily routines. You can use voice-activated computer technologies to answer and dial a phone, or to use a computer and pay bills. Computer-controlled technologies can also help with bathing, dressing, grooming, cleaning and reading. Electrical stimulation devices and neural prostheses. These sophisticated devices use electrical stimulation to produce actions. Some are implanted under the skin and connect with the nervous system to supplement or replace lost motor and sensory functions. Others are outside the body. They are often called functional electrical stimulation (FES) systems, and they use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand, walk, reach and grip.

These systems are composed of computer-controlled electrodes that are taped to the skin or implanted under the skin and controlled by the user. One of the systems allows someone with a spinal cord injury to trigger hand and arm movements. These devices require more research, but they've gained a great deal of attention, in part because the actor Christopher Reeve was able to rely primarily on an FES bicycle that used computercontrolled electrodes to stimulate his legs to cycle. He also had a system implanted to stimulate his breathing. Prognosis and recovery It's often impossible for your doctor to make a precise prognosis right away. Recovery, if it occurs, typically starts between a week and six months after injury. Impairment remaining after 12 to 24 months is likely to be permanent. However, some people experience small improvements for up to two years or longer. At one point, Christopher Reeve made national headlines when he regained the ability to move his fingers and wrists and feel sensations more than five years after he was paralyzed in a horse accident. But many not-so-famous folks with a spinal cord injury have made similar strides away from the media spotlight. And doctors are researching ways to improve late recovery.

Prevention Following this advice may reduce your risk of a spinal cord injury: •

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Drive safely. Motor vehicle accidents are the leading cause of spinal cord injuries. Wear a seat belt every time you drive. Make sure that your children wear a seat belt or, if they're very young, use an age- and weight-appropriate child safety seat. Children under age 12 should always ride in the back seat to avoid air bag injuries. Don't drive while intoxicated. Be safe with firearms. Lock up firearms and ammunition in a safe place to prevent accidental discharge of weapons. Store guns and ammunition separately. Prevent falls. Use a stool or stepladder to reach objects in high places. Add handrails along stairways. Place nonslip mats on your bathroom and shower floor. For young children, use safety gates to block stairs and consider installing window guards. Take precautions when playing sports. Always wear recommended safety gear. Avoid headfirst moves, such as diving into shallow water, spear tackling in football, sliding headfirst in baseball and skating headfirst into the boards in ice hockey. Use a spotter in gymnastics.

Spinal cord injury ARTICLE SECTIONS • •

Definition Symptoms

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Tests and diagnosis Complications

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Causes

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When to seek medical advice

Risk factors

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Treatments and drugs

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Coping and support

Prevention

Coping and support An accident that results in paralysis is a life-changing event. The sudden presence of disability can be frightening and confusing. You may wonder how spinal cord injury will affect your everyday activities, job, relationships and long-term happiness. Recovery from such an event takes time, but many people who are paralyzed move on to lead productive and fulfilling lives. The will to live in humans is amazingly strong, and the creativity with which many affected people lead their lives is great. It's essential to stay motivated and get the support you need. Grieving If you're newly injured, you and your family will likely experience a period of mourning and grief that's similar to the period after the death of a loved one. Although the grieving process is different for everyone, it's common to experience denial or disbelief, then sadness, anger, bargaining, and, finally, acceptance. The grieving process is a common, healthy part of your recovery. It's natural — and important — to grieve the loss of the way you were. But it's also necessary to set new goals and find a way to move forward with your life. Taking control One of the best ways to regain control of your life is to educate yourself about your injury and your options for reclaiming an independent life. A wide range of driving equipment and vehicle modifications is available today. The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to assert your autonomy. Because the costs of a spinal cord injury can be overwhelming, you may want to find out if you are eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area. Talking about your disability Your friends and family may respond to your disability in different ways. Some may be unfazed by your injury. Others may be uncomfortable and unsure if they are saying or doing the right thing. And some may have a difficult time adjusting to the change. They may grieve for the loss of the way your life was before the accident. They may be scared about the financial challenges and stress that are sure to arise. Or they may be nervous about their new role as caregiver.

Educating people about your disability is often the best solution. Children are naturally curious and sometimes adjust rather quickly if their questions are answered in a clear, straightforward way. Adults can also benefit from learning the facts. Explain the effects of your injury and what your family and friends can do to help. At the same time, don't hesitate to tell friends and loved ones when they're helping too much. Although it may be uncomfortable at first, talking about your injury often strengthens your relationships with family and friends. Dealing with intimacy Many men and women with a spinal cord injury wonder if they can maintain a romantic, intimate relationship with a partner. The answer is yes. However, people with a spinal cord injury often need to address physical and emotional changes that can affect sexuality. You may need medical treatments or medications to have sexual intercourse. In some cases, intercourse may not be possible and you and your partner may need to explore and experiment with different ways to be romantic and intimate. A professional counselor can help you and your partner communicate your needs and feelings so that you're more comfortable talking about sex and discovering what is fulfilling for both of you. Taking care of yourself As you adjust to your disability, allow yourself time to rest and time to process your thoughts and feelings about your disability. This is also a good time to concentrate on eating a healthy diet and reducing stress. Good nutrition will help you build enough strength to fully participate in daily activities. A balanced diet will also help you fight infections and maintain proper body weight. Plus, it will help maintain regular bladder and bowel functioning and assist in preventing pressure ulcers. Looking ahead By nature, a spinal cord injury has a sudden impact on your life and the lives of those closest to you. When you first hear your diagnosis, you may start making a mental list of all of the things you can't do anymore. However, as you learn more about your injury and your treatment options, you may be surprised at all of the things you can do. Thanks to new technologies, treatments and devices, people with a spinal cord injury play basketball and participate in track meets. They paint and take photographs. They get married, raise children and have rewarding jobs. Today, advances in stem cell research and nerve cell regeneration give hope for a greater recovery for people with a spinal cord injury. Several experimental treatments are being tested around the world. At the same time, new medications are being developed for people with long-standing spinal cord injuries. No one knows exactly when new treatments will become available, but you can remain hopeful about the future of spinal cord research, while living your life to the fullest today.

http://www.mayoclinic.com/health/spinal-cord-injury/DS00460/DSECTION=copingand-support

Spinal Cord Injury : Quadriplegic and Paraplegic Injuries Paraplegic and Quadriplegic (Tetraplegic) are terms used to describe the medical condition, for a person who has been paralysed due to a spinal cord injury. This classification depends on the level and severity of a persons paralysis, and how it affects their limbs. This website provides Patient Information about acute spinal cord injuries, as well as treatment, symptoms, information on long term rehabilitation issues and Peer Support, to help improve the quality of life of those affected by a spinal cord injury.

What is a Spinal Cord Injury ? A Spinal Cord Injury (SCI) is typically defined as damage or trauma to the spinal cord that in turn results in a loss or impaired function resulting in reduced mobility or feeling. Typical common causes of damage to the spinal cord, are trauma (car/motorcycle accident, gunshot, falls, sports injuries, etc), or disease (Transverse Myelitis, Polio, Spina Bifida, Friedreich's Ataxia, etc.). The resulting damage to the spinal cord is known as a lesion, and the paralysis is known as Quadriplegia or Quadraplegia / Tetraplegia if the injury is in the Cervical (neck) region, or as Paraplegia if the injury is in the Thoracic, Lumbar or Sacral region. It is possible for someone to suffer a Broken Neck,or a Broken Back without becoming paralysed. This occurs when there is a fracture or dislocation of the vertebrae, but the spinal cord has not been damaged.

What is a Complete and Incomplete Spinal Cord Injury

There are typically two types of lesions associated with a spinal cord injury, these are known as a complete spinal cord injury and an incomplete spinal cord injury. A complete type of injury means the person is completely paralysed below their lesion. Whereas an incomplete injury, means only part of the spinal cord is damaged. A person with an incomplete injury may have sensation below their lesion but no movement, or visa versa. There are many types in incomplete spinal cord injuries, and no two are the same. Such injuries are known as Brown Sequard Syndrome, Central Cord Syndrome, Anterior Cord Syndrome and Posterior Cord Syndrome.

What is Spinal Cord Injury Rehabilitation Someone with a spinal cord injury will have a long road of rehabilitation ahead of them, usually at a Spinal Cord Injury Treatment Unit and Rehabilitation Centre or Spinal Injury Unit, and it is important that they keep their sense of humor on their bad days to help them maintain a positive attitude. Generally, Paraplegics will be in hospital for around 5 months, where as Quadriplegics can be in hospital for around 6 - 8 months, whilst they undergo rehabilitation. Both Paraplegics and Quadriplegics should have some kind of rehabilitation and physiotherapy before they are discharged from hospital, to help maximise their potential, or help them get used to life in a wheelchair, and to help teach techniques which make everyday life easier. Disabled sports, and wheelchair based sports can be an excellent way to build stamina, and help in rehabilitation by giving confidence and better social skills. The ultimate reward for many disabled sportsmen and women, is to win at the Paralympic Games, which will be coming to London in 2012.

Spinal Cord Injury Cure and Treatment

A cure for long term paralysis is still some years in the future, but clinical trials are taking place with Olfactory Ensheathing Glial (OEG) cells and Embryonic Stem Cell based Therapy.

Paraplegic and Quadriplegic Discussion Forum If you have any spinal cord injury related questions, please visit our Discussion Forums and join in on the many topics there. We will do our best to help you, or at the very least, put you in contact with someone who can if we can't. The discussion forum is intended to be a free flow of information between spinally injured people, carers, and their friends, and everyone is welcome. Even if you don't have any questions, take a look at the forum anyway, as you may be able offer help and advice to others who have questions. More >>>

Quadriplegic, Tetraplegic, Paraplegic and What it Means

Quadraplegic is derived from two separate words from two different languages, Latin and Greek. The word “Quadra”, meaning “four” which is derived from latin, relates to the number of limbs. “Plegic”, is derived from the Greek word “Plegia”, meaning paralysis. Put the two together, and you have “Quadraplegia”. “Tetra” is derived from the Greek word for “Four”. “Para” is derived from the Greek word for "two" Hence: Tetraplegic and Paraplegic. In Europe, the term for 4 limb paralysis has always been tetraplegia. The Europeans would never dream of combining a Latin and Greek root in one word. In 1991, when the American Spinal Cord Injury Classification system was being revised, the difference in names was discussed. The British are more aware of Greek versus Latin names. Since Plegia is a greek word and quadri is Latin, the term quadriplegia mixes language sources. Upon review of the literature, it was recommended that the term tetraplegia be used by the American Spinal Cord Association so that there are not two different words in English referring to the same thing. http://www.apparelyzed.com/