May 30, 2017

Understanding SCI

A spinal cord injury may result in partial or complete loss of the ability to move without assistance, making it one of the most devastating injuries affecting physical, mental and emotional health.

A SCI may affect not only a person’s ability to walk or move without a wheelchair, but also may lead to other complications in cardiovascular and respiratory function, muscle composition, bone and fat mass, or pressure sores, skin damage due to inability to sense when to make a weight shift to relieve pressure. These life-altering changes may affect one’s sense of independence, self-esteem, and quality of life.

According to the National Spinal Cord Injury Association:

  • Approximately, 450,000 people live with SCI in the U.S.
  • The majority of SCIs (82 percent) involve males between the ages of 16-30
  • Quadriplegia is slightly more common than paraplegia

Most of these injuries result from traumatic events such as:

  • motor vehicle accidents
  • violence
  • falls

The body’s command center called the central nervous system consists of the brain and spinal cord so a traumatic injury to either one may have catastrophic consequences. While the brain controls our thoughts, the spinal cord is a pathway for connecting those thoughts to limbs and organs. The severity of SCI varies by the point of injury and whether or not the severing of this relationship was complete.

The spinal cord injury level or type is determined by the point of injury to the spinal cord. The spinal cord consists of the cervical (neck) region, thoracic (chest), lumbar (lower back) and sacral (pelvis) regions. Generally, a higher level of injury is more severe. The paralysis is known as Quadriplegia (derived from the Greek for four) since it causes some level of impairment in all four limbs if the injury is in the cervical region. It’s known as paraplegia (derived from the Greek for two) since it causes some level of impairment of the legs if the injury occurs in the thoracic region or below.

The level of impairment will vary depending on if that section is broken completely or not.

Fortunately, most of the time severing of the spinal cord is not complete. This is called an “incomplete” SCI or partial paralysis because it still allows for some feeling or movement below the point of injury.

However, sometimes severing of the spinal cord is “complete,” resulting in a complete loss of feeling or movement below the point of injury.  Christopher Reeve, the man people came to know for his performance as Superman, suffered a complete SCI after injuring his neck in a horse-riding accident. After the accident, he was paralyzed from the neck down and unable to breathe without a ventilator for years, but prior to his death at age 52 in 2004, he became known for pushing the boundaries of spinal cord research and though unable to walk again, recovering some function beyond what was expected.

Reeve started an activity-based program including training on a functional electrical stimulation bicycle where electrodes stimulate the leg muscles. Dr. John McDonald claims that this program helped Reeve get “significant function back” seven years after his injury. According to a 2002 article in People magazine, progress included being able to “move fingers on his left hand . . . breathe independently for up to 90 minutes at a time and distinguish between hot and cold, sharp and dull over much of his body.”

Roger Ebert, the film critic, who died on April 4 at age 70 after a battle with a brain tumor, said in a tribute to Reeve that he “became famous playing a character who could fly around the world, and as a man whose wheelchair did not limit his flights of idealism.”

RESEARCH

A few of the key areas of research have been controlling inflammation, innovative rehabilitation exercises, and promoting regeneration. The discovery that the steroid drug methylprednisolone could reduce damage to nerve cells in 1990 when patients were given the drug within the first eight hours after the injury gave doctors an additional treatment option, according to the National Institutes of Health. Innovative rehabilitation exercises, such as the functional electronic stimulation bike that Reeve used, focus on repetitive and structured stepping routines with a goal to help the spinal cord below the point of injury control movement without input from the brain. Investigation into the regenerative potential of stem cells is complicated and therapies aren’t expected until much more research is done.

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