Spinal Cord Injury

SPINAL CORD INJURY
I. Basic Facts
Spinal cord injury occurs when there is any damage to the spinal cord that blocks communication
between the brain and the body. After a spinal cord injury, a person’s sensory, motor and reflex
messages are affected and may not be able to get past the damage in the spinal cord. In general, the
higher on the spinal cord the injury occurs, the more dysfunction the person will experience. Injuries
are referred to as complete or incomplete, based on whether any movement and sensation occurs at
or below the level of injury.
II. Causes
Traumatic injuries
 Motor vehicle accidents

 Football
 Falls
 Gymnastics
 Violence
 Diving into shallow water
Spinal cord injuries affect more men than women. The majority of people who sustain a spinal cord injury
are young adults between the ages of 16 and 30 because of riskier behaviors.
Non-traumatic injuries/illnesses
 Cancer Osteoporosis
 Multiple sclerosis
 Inflammation of the spinal cord
 Arthritis
III. Effects
The effects of spinal cord injury may include the following:
 Loss of movement
 Loss of sensation
 Loss of bowel and/or bladder control
 Exaggerated reflex actions or spasms
 Changes in sexual function, sexual sensitivity and fertility
 Pain or intense stinging sensation
IV. ASIA/ISCoS Exam and Grade
This is a system of tests used to define and describe the extent and severity of a patient’s
spinal cord injury and help determine future rehabilitation and recovery needs. It is ideally
completed within 72 hours after the initial injury. The patient’s grade is based on how much
sensation he or she can feel at multiple points on the body, as well as tests of motor function.
ASIA/ISCoS Exam Chart (ASIA Impairment Scale)
Grade A
Indicates a "complete" spinal cord injury where no motor or sensory function is preserved in the
sacral segments S4-S5. lack of motor and sensory function below the level of injury (including the
anal area)
Grade B
Indicates an "incomplete" spinal cord injury where sensory but not motor function is preserved below
the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and
if the person recovers any motor function below the neurological level, that person essentially becomes
a motor incomplete, i.e. ASIA C or D. Some sensation below the level of the injury (including anal
sensation).
Grade C
Indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological
level, and MORE than half of key muscles below the single neurological level of injury have a muscle
grade less than 3 (i.e. M 0 - no contraction, no muscle movement, M 1 - trace of contraction, but no
movement, or M 2 - movement with gravity eliminated). Some muscle movement is spared below the
level of injury, but 50 percent of the muscles below the level of injury cannot move against gravity.
Grade D
Indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological
level and at least half of the key muscles ( more than 50 percent of the key muscles) below the
neurological level have a muscle grade of 3 or more (I.e. M3, M4 or M5, muscle can movement against
gravity (3) or with additional resistance (4 & 5)). Most (more than 50 percent) of the muscles that are
spared below the level of injury are strong enough to move against gravity.
Grade E
If motor and sensation function all graded normal and the patient had neurological deficits from SCI
before, than the grade is E. Note: only patients with SCI receive any AIS grade. All neurologic
function has returned.
V. Levels of Injury
Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction
can occur.
High-Cervical Nerves (C1 – C4)
 Most severe of the spinal cord injury levels

 Paralysis in arms, hands, trunk and legs
 Patient may not be able to breathe on his or her own, cough, or control bowel or bladder
movements.
 Ability to speak is sometimes impaired or reduced.
 When all four limbs are affected, this is called tetraplegia or quadriplegia.
 Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and
getting in or out of bed
 May be able to use powered wheelchairs with special controls to move around on their own
 Will not be able to drive a car on their own
 Requires 24-hour-a-day personal care
Low-Cervical Nerves (C5 – C8)
 Corresponding nerves control arms and hands.

 A person with this level of injury may be able to breathe on their own and speak normally.
 C5 injury
o Person can raise his or her arms and bend elbows.
o Likely to have some or total paralysis of wrists, hands, trunk and legs
o Can speak and use diaphragm, but breathing will be weakened
o Will need assistance with most activities of daily living, but once in a power wheelchair,
can move from one place to another independently
 C6 injury
o Nerves affect wrist extension.
o Paralysis in hands, trunk and legs, typically
o Should be able to bend wrists back
o Can speak and use diaphragm, but breathing will be weakened
o Can move in and out of wheelchair and bed with assistive equipment
o May also be able to drive an adapted vehicle
o Little or no voluntary control of bowel or bladder, but may be able to manage on their
own with special equipment
 C7 injury
o Nerves control elbow extension and some finger extension.
o Most can straighten their arm and have normal movement of their shoulders.
o Can do most activities of daily living by themselves, but may need assistance with more
difficult tasks
 C8 injury
o Nerves control some hand movement.
o Should be able to grasp and release objects
o Can do most activities of daily living by themselves, but may need assistance with more
difficult tasks
Thoracic vertebrae are located in the mid-back.
Thoracic Nerves (T1 – T5)
 Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
 Arm and hand function is usually normal.
 Injuries usually affect the trunk and legs(also known as paraplegia).
 Most likely use a manual wheelchair
 Can learn to drive a modified car
 Can stand in a standing frame, while others may walk with braces
Thoracic Nerves (T6 – T12)
 Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of
injury.
 Usually results in paraplegia
 Normal upper-body movement
 Fair to good ability to control and balance trunk while in the seated position
 Should be able to cough productively (if abdominal muscles are intact)
 Little or no voluntary control of bowel or bladder but can manage on their own with special
equipment
 Most likely use a manual wheelchair
 Can learn to drive a modified car
 Some can stand in a standing frame, while others may walk with braces.
Lumbar Nerves (L1 – L5)
 Injuries generally result in some loss of function in the hips and legs.
 Little or no voluntary control of bowel or bladder, but can manage on their own with special
equipment
 Depending on strength in the legs, may need a wheelchair and may also walk with braces
Sacral Nerves (S1 – S5)
 Injuries generally result in some loss of functionin the hips and legs.
 Little or no voluntary control of bowel or bladder, but can manage on their own with special
equipment
 Most likely will be able to walk

Spinal Cord Injury

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SPINAL CORD INJURY

 Motor vehicle accidents

The effects of spinal cord injury may include the following:

ASIA/ISCoS Exam Chart (ASIA Impairment Scale)

 Most severe of the spinal cord injury levels

Low-Cervical Nerves (C5 – C8)

 Corresponding nerves control arms and hands.

Thoracic vertebrae are located in the mid-back.

Thoracic Nerves (T1 – T5)

Thoracic Nerves (T6 – T12)

Lumbar Nerves (L1 – L5)

Sacral Nerves (S1 – S5)

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