Spinal Cord Injury (SCI)
A spinal cord injury (SCI) occurs when there is damage to the spinal cord, which is a bundle of nerves and support cells protected by the bones of the spine (vertebra). The spinal cord serves as the central pathway for nerve signals between the brain and the rest of the body, facilitating communication for movement, sensation, and other bodily functions. Injuries to the spinal cord can result in a range of functional impairments, depending on the location and severity of the damage.
Spinal cord injuries can be classified into two main categories:
- Complete Spinal Cord Injury:
- In a complete spinal cord injury, there is a total loss of sensory and motor function below the level of the injury. This means that the individual has no sensation or voluntary muscle control in the areas of the body served by the damaged spinal cord segment.
- Incomplete Spinal Cord Injury:
- In an incomplete spinal cord injury, there is some degree of remaining sensory and/or motor function below the level of the injury. The extent of impairment can vary, and individuals with incomplete injuries may retain partial sensation or movement.
Causes of spinal cord injuries include:
- Traumatic Injuries: Most spinal cord injuries result from trauma, such as motor vehicle accidents, falls, sports injuries, or acts of violence. These injuries can lead to fractures, dislocations, or compression of the spinal cord.
- Non-Traumatic Injuries: Spinal cord injuries can also occur due to non-traumatic factors, such as infections, tumors, degenerative disc disease, and vascular disorders.
Common symptoms and effects of spinal cord injuries may include:
- Paralysis: Loss of voluntary muscle control in the affected areas. Paralysis can be tetraplegia (affecting arms and legs) or paraplegia (affecting the lower body).
- Sensory Changes: Altered or loss of sensation, including touch, temperature, and proprioception (awareness of body position in space).
- Loss of Bowel and Bladder Control: Spinal cord injuries can affect the ability to control bowel and bladder function.
- Impaired Breathing: Depending on the level and severity of the injury, respiratory muscles may be affected, leading to breathing difficulties.
- Spasticity: Involuntary muscle contractions and spasms.
- Changes in Sexual Function: Spinal cord injuries can impact sexual function, fertility, and reproductive health.
The management and rehabilitation of spinal cord injuries involve a multidisciplinary approach, including medical care, physiotherapy, occupational therapy, exercise physiology and psychological support.
Spinal cord injuries (SCIs) are typically caused by trauma that damages the spinal cord or by non-traumatic conditions that affect the spinal cord.
Here are common causes of spinal cord injuries:
1.Traumatic Injuries:
- Motor Vehicle Accidents: Car, motorcycle, and pedestrian accidents are leading causes of traumatic spinal cord injuries. High-speed impacts or collisions can result in fractures, dislocations, or compressions of the spine.
- Falls: Falls from heights, such as slips, trips, or falls from ladders or stairs, can cause spinal cord injuries.
- Sports Injuries: Injuries during contact sports, diving, or high-impact activities can lead to spinal cord damage.
- Diving into Shallow Water: Jumping or diving into shallow water, where the head strikes the bottom, can cause spinal cord injuries
- Violence: Acts of violence, including gunshot wounds or knife injuries, can cause traumatic spinal cord injuries.
- Electrical Injuries: Severe electrical shocks can cause damage to the spinal cord and other parts of the nervous system.
- Surgical Complications: While rare, surgical procedures on or near the spinal cord carry a risk of complications that could lead to injury
2. Non-Traumatic Causes:
- Infections: Infections such as meningitis, tuberculosis, or viral infections affecting the spinal cord can lead to inflammation and injury.
- Tumors: Spinal cord tumors, whether primary or metastatic, can compress or invade the spinal cord, causing damage.
- Degenerative Disc Disease: Progressive wear and tear on the spinal discs over time can lead to conditions like spinal stenosis, which may contribute to spinal cord compression.
- Vascular Disorders: Conditions such as arteriovenous malformations (AVMs) or blood vessel blockages can affect the blood supply to the spinal cord.
- Autoimmune Disorders: Conditions like transverse myelitis, which involves inflammation of the spinal cord, can lead to damage and impair function.
- Genetic Disorders: Rare genetic conditions may predispose individuals to spinal cord abnormalities.
Approximately 20,000 people live with a Spinal Cord Injury in Australia.
The diagnosis of a spinal cord injury (SCI) involves a combination of medical history, physical examination, and diagnostic imaging. Early and accurate diagnosis is crucial for determining the severity of the injury and planning appropriate treatment..
Often the American Spinal Injury Association (ASIA) Impairment scale will be used to classify spinal cord injury. This scale quickly outlines the severity and classification of the injury.
- ASIA – A: Complete
- AISA – B: Sensory Incomplete
- ASIA – C: Motor Incomplete
- ASIA – D: Motor Incomplete
- ASIA – E: Normal with prior deficits
Prognosis of Spinal Cord Injury:
The prognosis of a spinal cord injury depends on various factors, including the level and severity of the injury, the completeness of the injury, and the individual’s overall health. Prognostic factors include:
- Level of Injury:
- The level of the spinal cord where the injury occurred influences the areas of the body affected. Injuries higher on the spinal cord often result in more extensive impairments.
- Completeness of Injury:
- Whether the injury is complete (total loss of function below the level of injury) or incomplete (some degree of retained function) is a critical factor.
- Severity of Injury:
- The severity of the injury, as determined by imaging and neurological assessments, affects the degree of impairment.
- Age:
- Younger individuals may have a better chance of recovery due to the body’s greater capacity for healing and neural plasticity.
- Time to Treatment:
- Early and aggressive medical intervention can positively impact the outcome by minimising secondary damage and facilitating rehabilitation.
- Rehabilitation and Support:
- Access to comprehensive rehabilitation services, including physiotherapy, occupational therapy, and psychological support, can significantly influence the long-term outcomes.
The symptoms of a spinal cord injury (SCI) can vary widely depending on the location and severity of the injury. It’s important to note that not all spinal cord injuries result in immediate and obvious symptoms, and some symptoms may develop over time. The following are common signs and symptoms of a spinal cord injury:
- Loss of Movement:
- Depending on the level and severity of the injury, there may be a partial or complete loss of movement (paralysis) in the affected areas of the body. This can manifest as tetraplegia (affecting arms and legs) or paraplegia (affecting the lower body).
- Loss of Sensation:
- Reduced or loss of sensation in the areas below the level of the injury. This can include loss of touch, temperature sensation, and proprioception (awareness of body position in space).
- Difficulty Breathing:
- Respiratory muscles may be affected, leading to difficulty breathing, especially if the injury is high in the cervical (neck) region.
- Spasms and Spasticity:
- Involuntary muscle spasms or increased muscle tone (spasticity) may occur.
- Changes in Reflexes:
- Changes in reflexes, including hyperactive reflexes or the absence of reflexes, may be observed.
- Loss of Bowel and Bladder Control:
- Impaired control over bowel and bladder function is common in spinal cord injuries.
- Pain or Intense Sensations:
- Some individuals may experience neuropathic pain, which can be described as burning, tingling, or shooting pain. Alternatively, they may experience heightened sensations in certain areas.
- Changes in Sexual Function:
- Spinal cord injuries can affect sexual function, fertility, and reproductive health.
- Autonomic Dysfunction:
- Dysfunction of the autonomic nervous system may lead to changes in blood pressure, heart rate, and body temperature regulation.
- Loss of Sweating:
- Impaired ability to sweat below the level of the injury, leading to difficulties with temperature regulation.
How Can We Help?
Physiotherapy & Exercise Physiology
Physiotherapy and Exercise Physiology is a vital component of spinal cord injury (SCI) rehabilitation, focusing on enhancing mobility, strength, and overall well-being. The primary objectives include promoting independence, preventing complications, and optimizing the individual’s quality of life.
Mobility training is central to physiotherapy, encompassing techniques for transfers, standing exercises, and, where applicable, walking. Strengthening exercises counteract muscle weakness and atrophy resulting from reduced physical activity. Range of motion exercises address joint flexibility, minimising the risk of contractures and maintaining functional movement.
Functional Electrical Stimulation (FES) is utilised to activate weakened muscles, contributing to functional movements like cycling or standing. Cardiovascular conditioning, respiratory exercises, and postural training are integral components to enhance cardiovascular health, respiratory function, and prevent musculoskeletal issues.
Pain management strategies, including manual therapy and relaxation techniques, are incorporated to address discomfort associated with muscle tightness or joint stiffness. Education on proper techniques for daily activities empowers individuals and caregivers for independent living.
Physiotherapists collaborate with other healthcare professionals to ensure a coordinated rehabilitation approach. The individualised and multidisciplinary nature of physiotherapy in SCI rehabilitation is essential for adapting interventions based on progress and specific needs, ultimately restoring function and improving the overall quality of life for those affected by spinal cord injuries. Through a holistic approach that combines targeted exercises, education, and support, physiotherapy plays a pivotal role in the comprehensive care of individuals with spinal cord injuries.
Occupational
Therapy
Occupational therapists play a crucial role in spinal cord injury (SCI) rehabilitation by focusing on restoring individuals’ independence in daily activities and enhancing their overall quality of life. Their primary goal is to help individuals with SCI achieve maximum functional ability and adapt to the challenges posed by their injuries.
Occupational therapists assess the impact of SCI on activities of daily living (ADLs) such as dressing, grooming, eating, and bathing. They work closely with individuals to develop personalised strategies and adaptive techniques, considering the unique needs and abilities of each person. This may involve training in the use of assistive devices, adaptive equipment, and techniques to optimize independence.
Environmental modifications are also addressed to create accessible and supportive living and working spaces. Occupational therapists collaborate with individuals to set realistic goals, develop problem-solving skills, and promote a sense of control and empowerment.
Additionally, occupational therapists provide emotional support and address the psychological aspects of adapting to life with SCI. They play a key role in helping individuals reintegrate into their communities, workplaces, and social environments.
Speech
Pathology
Speech Pathologists perform assessments and provide treatment for swallowing, motor speech, voice, and cognitive–communication disorders that may result from the Spinal Cord Injury and/or co-occurring brain injuries.
