Spinal Cord Injury

What is Spinal Cord Injury?

As soon as you hear the term ‘Spinal Cord Injury’ most of you would have pictured a nasty scene of a motor accident on the A12. You are not far off; spinal cord injury refers to any damage to the spinal cord. Damage could result from mechanical trauma; such as a traffic accident or even falls or due to a less known source; infections or tumors.

Globally, this incurable condition affects 250,000 to 500,000 individuals every year, where 15% would go on to be paralyzed in all 4 limbs, taking a toll on their quality of life. However, this is the worst-case scenario. 65% of those affected will have some nerve function left, either in their arms or legs.

Related questions

How can clinicians work out the level of damage in victims of Spinal Cord Injury?

When an individual is suspected of immediate (acute) spinal cord injury, clinicians instantly carry out clinical examinations. Amongst others, a clinical test known as American Spinal Injury Association Scale (ASIA) is performed to work out the level of neurological damage. This test looks at two important factors that could have been disturbed by spinal cord injury- sensation and movement.

Two forms of sensation are tested; light touch by using cotton wool and pin prick sensation by the use of a safety pin. Testing occurs at 28 predetermined locations of the body. If any sensation is felt by the individual, it is graded on a scale from 0 to 2. As obvious as it may be, a score of 0 is given when no sensation is felt by the individual but when sensation is normal, then the highest score of 2 is given. The motor portion on the other hand, involves testing ten key muscles. The strength of the movement of the muscle is graded on a scale of 0 to 5 (0 meaning immobility and 5 being active movement). Following sensory and motor testing, the information can be used to determine a single neurological level of damage. Individuals are placed in the following categories: Grade A, B, C, D or E. Individuals placed in Grade A have no sensory or motor function (paralysis). Whilst the lucky few with a Grade E classification can function ‘normally’.

Many of you may question the necessity of such a lengthy process to determine the level of damage, however, the ASIA test does have its advantages. For instance, it helps determine the whereabouts of the injury, (if this could not be confirmed by other methods, like MRI scans). Moreover, by determining how much the individual has been affected, it aids clinicians with the prognosis of the affected individual. One of such treatments include Spinal Cord Rehabilitation.

Spinal Cord Rehabilitation- ‘Hocus Pocus’ or a scientific success?

Our fascinating bodies have a natural way to improve over time, due the property of the Central Nervous System known as plasticity. Plasticity refers to the rewiring of nerves after injury to adapt to the functional demands. The aim of rehabilitation is not only to encourage this rewiring but to also allow individuals to integrate back into society. A multidisciplinary team (a group of specialists) works towards this goal.

A crucial individual of the team is the physical therapist, whose main focus is to maximize movement in the individual. On the other hand, an occupational therapist will focus on the difficulties of daily activities in individuals and give them alternative approaches to perform mundane tasks. Moreover, psychologists help individuals come to terms with trauma and in rare cases, help individuals improve their cognitive abilities.

How can clinicians work out an individual has improved as a result of treatment?

Clinicians can identify whether rehabilitation or other treatment is working for individuals, by carrying out various tests, which detect improvements in daily activities of the patients. There are a number of methods to measure the improvements seen in those with SCI, such as the: Modified Barthel Index (MBI), Functional Independence Measure (FIM) and Spinal Cord Independence Measure (SCIM). Although all methods measure more or less the same issue; how individuals implement daily tasks, some tests are more effective than others.

The earliest developed method was MBI, which was originally used for individuals affected by stroke. This method consists of ten activities of daily living, which are rated on a scale of 0 to 5. The values assigned to each of the ten categories are based on the level of assistance required by the individual in performing the tasks. 0 is given to those who are fully dependent whereas 5 is given to those who are fully independent.

Unfortunately, this scale did have some weaknesses, because of its original use in stroke patients, which has led to some confusion in grading. For example, some individuals with SCI were independent in dressing the upper parts of their body but required significant amount of help to dress the lower extremities.

Due to these drawbacks, another method, known as FIM was developed. This only evaluates 6 areas of function, opposed to 10 with MBI. The 6 areas of function are rated on a 7-point scale, where 7 is complete independence and 0 requires total assistance.