Everyday Quad

Spinal cord injury (SCI) occurs when the bony protection surrounding the cord is damaged by way of fractures, dislocation, burst, compression, hyperextension or hyperflexion.

The most common cause of spinal cord dysfunction is trauma, including motor vehicle accidents, falls, shallow diving, acts of violence, and sports injuries. Damage can also occur from various diseases acquired at birth or later in life, from tumors, electric shock, and loss of oxygen related to surgical or underwater mishaps.

The spinal cord does not have to be severed in order for a loss of function to occur. It can be bruised, stretched, or crushed.

Since the spinal cord coordinates body movement and sensation, an injured spinal cord loses the ability to send and receive messages from the brain to the body’s system that controls sensory, motor, and autonomic function.

Some of the resultant types injury go by the terms cauda equina, conus medularis, central and anterior cord syndrome, or Brown-Sequard syndrome.

The location of the spinal cord injury dictates the parts of the body that are affected.

After a complete neurological examination, the doctor will assign a level of injury and determine if the injury is complete or incomplete. The initial level of injury and function may also change upon discharge to rehabilitation.

It is important to remember that these are general guidelines and that individual outcomes will vary.

Cervical level injuries cause paralysis or weakness in both arms and legs, resulting in quadriplegia (also known as tetraplegia). This area of the spinal cord controls signals to the back of the head, neck, shoulders, arms, hands, and diaphragm.

Since the neck region is so flexible it is difficult to stabilize cervical spinal cord injuries. Individuals may be placed in a brace or stabilizing device.

All regions of the body below the level of injury or top of the back may be affected. At times, a cervical injury is accompanied by the loss of physical sensation, respiratory issues, inability to regulate body temperature, bowel, bladder, and sexual dysfunction.

Thoracic level injuries are less common because of the protection given by the rib cage.

Thoracic injuries can cause paralysis or weakness of the legs (paraplegia) along with loss of physical sensation, bowel, bladder, and sexual dysfunction.

In most cases, arms and hands are not affected. This area of the spinal cord controls signals to some of the muscles of the back and part of the abdomen.

With these types of injuries most patients initially wear a brace on the trunk to provide extra stability and help build up core muscles.

Lumbar level injuries result in paralysis or weakness of the legs (paraplegia). Loss of physical sensation, bowel, bladder, and sexual dysfunction can occur. However, shoulders, arms, and hand function are usually unaffected.

The lumbar area of the spinal cord controls signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the leg. These injuries often require surgery and external stabilization.

Sacral level injuries primarily cause loss of bowel and bladder function as well as sexual dysfunction. These injuries can cause weakness or paralysis of the hips and legs.

The sacral area of the spinal cord controls signals to the thighs and lower parts of the legs, the feet, and genital organs.

One of the terms you will hear often in reference to your spinal cord injury is 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. Additionally, some sensation (even if it’s faint) and movement is possible below the level of injury.

A complete injury is indicated by a total lack of sensory and motor function below the level of injury.

The absence of motor and sensory function below the injury area does not necessarily mean there are no remaining intact axons or nerves crossing the injury site, just that they are not functioning appropriately as a result of the trauma.

In the world of spinal cord injury, incomplete tells us a lot and very little at the same time. It tells us that a person does not have total paralysis or loss of sensation, that his or her spinal cord was not totally damaged or disrupted. But that’s all it tells us. Incomplete injuries run the gamut:

• They can be so mild that they cause almost no muscle weakness or visible signs that a spinal cord injury ever even happened.
• They can be so severe that they leave the individual looking and feeling not very different from someone who has a complete injury—except, perhaps, for some areas of preserved sensation.
• Typically, they fall somewhere in between.

The Facts

There’s almost always hope of recovering at least some function after a spinal cord injury. But is there more hope after an incomplete injury? Perhaps—at least early on. Here’s what we know:

• Spinal cord injuries that did not cause total paralysis have the best chance of additional recovery. In a large study of all new spinal cord injuries occurring in the state of Colorado, only one in seven of those who had complete paralysis immediately after injury got a significant amount of movement back. But, of those who still had some movement in their legs immediately after injury, three out of four got significantly better.
• People whose spinal cord injuries did cause complete paralysis may still have a good chance of muscle recovery if they have sensation in the lower part of their body just after injury. About 2/3 of those with neck injuries who can feel the sharpness of a pin-stick in their legs eventually get enough muscle strength to be able to walk. Of those with neck injuries who can only feel light touch, about 1 in 8 may eventually walk.
• The sooner that muscles start working again after a spinal cord injury, the better the chances are of additional recovery—especially for walking. However, when muscles come back much later—after the first several weeks—researchers report that they are more likely to be in the arms than in the legs.

Will I Walk Again?

How long do these better odds of recovery go on? How long should a person with an incomplete injury—or even one with a complete injury for that matter—continue to hope for recovery?

There’s no easy answer. Certainly, by two or three years after the injury, the chances of paralyzed muscles starting to work again on their own are pretty small. What about one month, two months or six months after the injury? It’s a little harder to predict, but there are two rules of thumb:

• As long as you’re seeing some improvement and additional muscles recovering function, your chances of seeing more improvement are better.
• The longer you go without seeing improvement, the lower the odds are of improvement just starting to happen on its own.

Dilemmas

So, at the same time that an incomplete injury is a good thing, it does create some predicaments.

• How do you deal with the fact that no one can give you a really good prediction of what to expect a year or two into the future? As any spinal cord injury can be life-changing, you need to plan for the future. Should you go ahead and modify your house or should you wait? Should you buy a van or hang on to that four-door sedan with the stick shift a little longer?
• How long should you let your life stay on hold while you watch to see what kind of recovery you’ll get? Do you quit your job to focus on therapy for the next six months or year? Do you postpone a big trip, a graduation, a move—on the chance it might be easier later on—or do you go ahead and do it now?

Possible Guidelines

There really aren’t any easy answers. And, unfortunately, people with incomplete injuries may face other, more immediate challenges as well:

• For some, the length of inpatient hospitalization may be shorter, while more time may be spent in outpatient therapy. This is good—it gets you home faster. But, at the same time, it sometimes causes you to miss out on inpatient programs classes, and even chances to interact with other people with spinal cord injuries and professionals whose experiences you might benefit from.
• Compared with people with complete spinal cord injuries, there are—and probably always will be—fewer people with injuries just like yours who are going through the same things you are.
• You may feel neglected or overlooked. Often rehab, as well as building adaptations and specialized equipment (and even many community programs), seem as if they’re designed for the person with the complete injury. This can be a particular problem if, for example, your incomplete injury affects your mobility but doesn’t require you to use a wheelchair all of the time; or if your legs work pretty well, but your arms are not too cooperative.
• Even more concerning, benefit programs may be harder to qualify for. Doctor charges, hospital bills and therapy sessions can be just as expensive as if your injury is a complete one, but because your condition may be changing, you may not qualify immediately for benefits like Social Security, Medicaid or vocational rehabilitation. Why? Programs for people with disabilities have limited resources and tight purse strings, so they often prefer to spend their money on people who they think are the most likely to be permanently disabled. When there is an incomplete injury, they may want to take a wait-and-see approach. That waiting and seeing can go on for months—or even longer.

Perhaps Worst of All…

All these things are bad enough, but there’s a double whammy: You may have days when you think—there may even be days when it seems that others are actually telling you—that you have no right to feel sad, depressed or frustrated. No matter how bad or overwhelming all of the things we just described may be, no one allows you to forget that “it could have been worse.” It may be your own conscience that tells you, or it may be a well-meaning visitor: “Just look around you. See all the people who have worse problems than yours?”

This doesn’t help a whole lot. It’s like being caught between a rock and a hard place. When you’re feeling low, you’re reminded how much worse it could have been… When you’re feeling up and ready to move on with your life, you’re told to be patient and wait and see… If someone thinks you’re spending too long waiting and seeing, you’re told to “get on with it.” If it’s any consolation, you’d be surprised at how much even people with complete injuries hear the same things and put up with the same feelings. It seems there’s always someone who’s willing to point out that “it could have been worse.”

What Can You Do?

Know that you’re allowed to feel the way you feel. You don’t need to feel grateful that your life isn’t even more overwhelming or topsy-turvy than it already is. You don’t need to feel guilty for thinking about—and missing—what’s been lost.

At the same time, know—believe—that things will get better. Whether you get a lot of recovery or just a tiny bit more, it’s going to get easier. Try to find a balance between “wait and see” and “get on with it.” You don’t want to try and conquer the world tomorrow, yet you can’t put your whole life on hold either. Check with others around you—your therapists, friends, family, etc.—to get a feel for what they think is a good balance.

Realize that no matter how much recovery you have, your life will be different in some way. There will be problems you’ll want to take steps to avoid; there will be adjustments that are unavoidable. With the right planning, different doesn’t need to mean worse.

Getting Some Perspective

Remember: Most people with spinal cord injuries—whether complete or incomplete—do cope. In fact, most are satisfied with their lives. In research done several years ago, even people with very high tetraplegia who depended on mechanical ventilators were happy. Over 90% were glad to be alive; more than 85% said their quality of life was at least average. Many said it was excellent! It’s very likely that you will feel this way too.

Possible Guidelines

There really aren’t any easy answers. And, unfortunately, people with incomplete injuries may face other, more immediate challenges as well:

• For some, the length of inpatient hospitalization may be shorter, while more time may be spent in outpatient therapy. This is good—it gets you home faster. But, at the same time, it sometimes causes you to miss out on inpatient programs classes, and even chances to interact with other people with spinal cord injuries and professionals whose experiences you might benefit from.
• Compared with people with complete spinal cord injuries, there are—and probably always will be—fewer people with injuries just like yours who are going through the same things you are.
• You may feel neglected or overlooked. Often rehab, as well as building adaptations and specialized equipment (and even many community programs), seem as if they’re designed for the person with the complete injury. This can be a particular problem if, for example, your incomplete injury affects your mobility but doesn’t require you to use a wheelchair all of the time; or if your legs work pretty well, but your arms are not too cooperative.
• Even more concerning, benefit programs may be harder to qualify for. Doctor charges, hospital bills and therapy sessions can be just as expensive as if your injury is a complete one, but because your condition may be changing, you may not qualify immediately for benefits like Social Security, Medicaid or vocational rehabilitation. Why? Programs for people with disabilities have limited resources and tight purse strings, so they often prefer to spend their money on people who they think are the most likely to be permanently disabled. When there is an incomplete injury, they may want to take a wait-and-see approach. That waiting and seeing can go on for months—or even longer.

Perhaps Worst of All…

All these things are bad enough, but there’s a double whammy: You may have days when you think—there may even be days when it seems that others are actually telling you—that you have no right to feel sad, depressed or frustrated. No matter how bad or overwhelming all of the things we just described may be, no one allows you to forget that “it could have been worse.” It may be your own conscience that tells you, or it may be a well-meaning visitor: “Just look around you. See all the people who have worse problems than yours?”

This doesn’t help a whole lot. It’s like being caught between a rock and a hard place. When you’re feeling low, you’re reminded how much worse it could have been… When you’re feeling up and ready to move on with your life, you’re told to be patient and wait and see… If someone thinks you’re spending too long waiting and seeing, you’re told to “get on with it.” If it’s any consolation, you’d be surprised at how much even people with complete injuries hear the same things and put up with the same feelings. It seems there’s always someone who’s willing to point out that “it could have been worse.”

What Can You Do?

Know that you’re allowed to feel the way you feel. You don’t need to feel grateful that your life isn’t even more overwhelming or topsy-turvy than it already is. You don’t need to feel guilty for thinking about—and missing—what’s been lost.

At the same time, know—believe—that things will get better. Whether you get a lot of recovery or just a tiny bit more, it’s going to get easier. Try to find a balance between “wait and see” and “get on with it.” You don’t want to try and conquer the world tomorrow, yet you can’t put your whole life on hold either. Check with others around you—your therapists, friends, family, etc.—to get a feel for what they think is a good balance.

Realize that no matter how much recovery you have, your life will be different in some way. There will be problems you’ll want to take steps to avoid; there will be adjustments that are unavoidable. With the right planning, different doesn’t need to mean worse.

Getting Some Perspective

Remember: Most people with spinal cord injuries—whether complete or incomplete—do cope. In fact, most are satisfied with their lives. In research done several years ago, even people with very high tetraplegia who depended on mechanical ventilators were happy. Over 90% were glad to be alive; more than 85% said their quality of life was at least average. Many said it was excellent! It’s very likely that you will feel this way too.