What is it?

Spinal cord injury SCI occurs when the spinal cord gets damaged or traumatised following an accident (e.g. Road Traffic Accident (RTA), falls, sporting accidents, gun shot, explosion) or following disease process (e.g. Polio, Spinal Bifida, Transverse Myelitis).

The damage to the spinal cord might be due to severing (total or partial), crushing/compression, or over-stretching/tearing. It is not the same as having a “broken back/neck” as this refers to a fracture of one or more of the vertebrae (bones that make up the spine), which does not necessarily lead to spinal cord injury.

What happens?

When the spinal cord is injured the effect on the body tends to be loss of movement of the arms, legs and trunk and loss of sensation. This is not always a total loss and can often be only a partial loss. The parts of the body affected are dependent on the level in the spine that the injury occurred.

Also there may be impairment of the bodily functions associated with the bladder and bowel.

Total loss of movement and sensation is referred to as a complete SCI whereby both sides of the body below the level of injury are affected.

Partial loss of movement and sensation is referred to as an incomplete SCI whereby there may well be movement and/or sensation deficit in one limb or side of the body, but functional movement like walking might be possible.

What is the difference between Quadriplegia/ Tetraplegia and Paraplegia?

Quadriplegia/Tetraplegia describes injury sustained to the neck (cervical spine). The movement lost following SCI is dependent upon the level of trauma to the spinal cord. There are 7 bones or vertebrae in the neck numbered 1-7

Above the C4 level the individual is likely to have to be ventilated by a machine to assist breathing and have no muscle activity in the arms at all. Below C4 level down to T1 level there is likely to be increasing amounts of muscle activity and therefore arm movement.

Thus the lower the level of SCI the more movement should be available.

Paraplegia describes injury sustained in the upper to mid-back (Thoracic Spine) and lower back (Lumbar Spine). There are 12 vertebrae in the Thoracic spine and 5 in the Lumbar spine. Movement of the arms tends to be complete and often fully functional, but muscle activation in the trunk and legs becomes impaired. This affects the ability to balance in sitting, roll over in lying and move the legs.

Again the lower the level of SCI the more movement and functional ability should be available.

SCI suffered below the L1 and L2 vertebral level still causes a paraplegia but is known as Cauda Equina Syndrome. In this instance, if the damage to the nerves is not too severe, it can be possible for the nerves to regenerate and muscle function and/or sensation to return to a functional level.

Are there any other effects of SCI?

As previously mentioned, problems associated with higher spinal level of Quadriplegia causes loss of muscle function affecting the respiratory muscles and diaphragm and therefore the individual to lose the ability to breath for themselves. Usually the individual will have to breathe mechanically via a ventilator or can sometimes be fitted with a diaphragmatic pacemaker which will regulate that person’s breathing.

Other effects can include reduced postural blood pressure, whereby blood pressure drops as the individual is taken more vertically i.e. sitting up in bed. This can make the individual feel as though they are going to faint and feel very woozy. Furthermore individuals might experience problems associated with inability to regulate blood pressure adequately, and experience inability to regulate their body temperature effectively including an inability to sweat below the level of injury.

This can mean that the individual either doesn’t feel hot when the temperature is high, or conversely doesn’t feel cold when the temperature is low. Thus the individual can overheat and feel nauseous, headachy and very drowsy i.e. heatstroke, or can become very cold leading to hypothermia.

Neither extremes of temperature are good for one’s health, so the individual must be aware of his problem.

Other problems associated with Spinal Cord Injury include spasticity and muscle spasms whereby the individual suffers an extreme “cramp” in the paralysed muscles. These spasms can often be very severe and cause pain. Treatment is often via prescribed medication (muscle relaxants) or by passive movement of the limbs affected to keep the muscles stretched.

Another serious complication of SCI is that of the development of pressure sores (sometimes referred to as Bed Sores). A pressure sore can develop following long periods of being in one position i.e. lying or side lying and sitting. Due to being unable to move or shift one’s body weight combined with poor blood circulation, the skin tissue becomes starved of oxygen and other nutrients essential for healthy/strong skin. The tissue becomes weak and thin and can become red before eventually breaking down and developing an open wound, which could, in time, become infected.

Therefore it is very important for an individual suffering Spinal Cord Injury to check the skin regularly on a daily basis for any signs of a pressure sore developing and get any suspicious areas checked and treated immediately.

Problems with Bladder and Bowel are common following SCI whereby the individual is unable to pass urine and faeces, so that the bladder cannot be emptied naturally and the individual cannot pass a motion naturally. Catheterization is required when the bladder is not emptying properly, and an enema or suppository can be used to assist in the passing of a motion (occasionally manual evacuation might be required to assist in this).

Can Physiotherapy Help with Spinal Cord Injury?

Physiotherapy treatment is aimed at addressing the problems that can occur following SCI so that an individual can maximise their potential for recovery and therefore maximise their independence.

Whether the personal injury to that individual has resulted in quadriplegia/tetraplegia or paraplegia, treatment should be focused on what their needs are. Once the physiotherapist has made their assessment, and the individual has expressed what they would like to achieve, an appropriate course of physiotherapy can be agreed which will aid an overall rehabilitation and maximise recovery.

Depending on the level of Spinal Cord Injury and its nature, i.e. complete or incomplete, the problems associated with SCI can include:

• Muscle weakness/paralysis
• Reduced ability to breathe
• Loss of general mobility and balance
• Loss of functional movement
• Poor posture
• Pain

Physiotherapy treatment should be focused upon that individual and tailored specifically to their condition. A treatment programme is formulated following a thorough physical assessment which might include:

• Stretching activities to maintain muscle and tendon length and reduce or keep muscle spasms/spasticity to a minimum.
• Flexibility and strengthening exercises for the whole body.
• Breathing exercises to maximise lung function and prevent chest infection.
• Balance and posture exercises which can help to reduce pain associated with poor posture and balance impairment and ensure correct transfer techniques (in/out of wheelchair, bed, toilet/bath, car etc.)
• Functional activities to improve fundamental movement patterns such as rolling over and sitting up, and standing where appropriate.
• Walking re-education, if there is sufficient muscle activity and power in the legs.

Your physiotherapist might also be able to advise an individual on use of appropriate equipment such as wheel-chairs and pressure releasing cushions, exercise equipment and electrical muscle stimulators (EMS)/Functional Electrical Stimulation (FES) e.g. Odstock PACE, WalkAide, Bioness, Otto Bock ActiGait.

With appropriate treatment and by challenging an individual during recovery, together with sound advice and encouragement, Physiotherapy can indeed maximise your independence