Spinal Cord Injury (SCI): Anatomy, Levels, and Rehabilitation

Spinal Cord Injury (SCI)

Anatomy of SCI

Shifting and crushing injuries often involve two right angles. White matter, the fluid surrounding the spinal cord, can be pinched, leading to neuron loss. Even after correction, the cord may not fully recover, potentially resulting in loss of function below the injury site. The central canal may be affected. Improvement is possible over time, with the neck being the most susceptible area.

SCI Levels

Neck injuries are more common than thoracic injuries due to the ribs providing additional stability. Cervical injuries (C1-C3) can affect arms, hands, and breathing. C4 injuries impact neck and shoulder movement. C5 injuries limit elbow flexion and shoulder movement. C6 injuries allow wrist extension but limit finger movement.

Specific Injury Levels:

• Cervical: (Most common; C1-3: effect arms and hands, impaired breathing; C4: neck [shoulder shrug, neck and head]; C5: cant give elbow flex, some shoulder, bend elbows, neck; C6: can extend wrist but cannot open fingers, fingers want to close, good shoulder, straighten elbow, some finger (maybe), flex wrist)
• Thoracic: Anything below T1 typically results in paraplegia. T1-5 affects partial trunk movement, while T6-12 impacts partial trunk and abdominal movement.
• Lumbar: L1-3 affects partial hip and knee movement. L4-5 allows good hip and knee movement. S1-2 impacts leg, ankle, and foot function, potentially affecting bowel and bladder control.

Complete vs. Incomplete SCI

• Complete SCI: Indicates no useful motor or sensory function below the injury level.
• Incomplete SCI: Indicates some useful motor or sensory function below the injury level.

Etiology of SCI

Common causes include vehicular accidents (38%), falls (31%), violence (12%), sports injuries (9%), medical incidents (3%), and other factors (2%).

Demographics of SCI

SCI primarily affects young, active men, aged 16-30 and 31-45. Approximately 4 out of 5 cases involve men, with 65% being Caucasian.

Prognosis of SCI

Functional improvement may occur within the first year, potentially gaining a level or regaining motor/sensory function. Incomplete injuries generally have a better prognosis than complete injuries.

Common Functional Limitations

Individuals often need to learn to perform tasks with less assistance. Exposure to necessary activities is crucial. Sending patients home with inadequate support can be detrimental.

Factors Affecting Return to Work

Before injury, 56% are employed, but only 12% are working a year later. Only 1 in 7 individuals are employed a year post-injury.

Complications of SCI

Complications include reduced life expectancy and altered sexuality (sensory function is affected, sperm delivery may be impaired). Brain injuries and pressure ulcers are also common (37% sacrum, 16% heels, 9% ischium, 4% scapula).

Impairment, Disability, and Handicap

• Impairment: Any loss or abnormality of body structure or function.
• Disability: Any restriction or lack of ability to perform an activity.
• Handicap: A disadvantage resulting from an impairment or disability.

Psychosocial Aspects of SCI

Psychosocial models include:

• Shontz: Shock, realization, intrusive retreat, acknowledgment, adaptation, intervention.
• Falvo: Shock, reality, anger/depression, alternatives, acceptance.
• Kueder: Denial, anger, bargaining, depression, acceptance.

Continual adjustment and readjustment are necessary, learning to tolerate circumstances gradually. Sorrow may emerge at intervals. Support and resources are crucial.

Treatment Approaches

Implications include long-term treatment, a revolving door of care, and a humanistic/phenomenological approach. Resources are essential.

Models of Disability:

• Medical: Focuses on specific medical conditions viewed as problems.
• Social: Emphasizes societal and environmental barriers as primary contributors to disability.
• Biopsychosocial: Posits that complex interactions of biological, psychological, and social factors significantly influence an individual's ability to function.

Team Approaches:

• Multi-disciplinary: All professionals (nurse, social worker, psychologist, case manager, OT, physician, speech therapist, rehab counselor, PT, dietician) contribute to the individual.
• Inter-disciplinary: Professionals collaborate with each other.
• Trans-disciplinary: Similar to inter-disciplinary.