Below are some frequently asked questions that people have following an injury. This information is only an overview. For more detailed information specific to your situation, you should speak with your medical team or contact your local Canadian Paraplegic Association office. In addition, the Canadian Spinal Research Organization publishes a comprehensive resource manual that provides information for people living with SCI, covering everything from what to expect in acute care and rehab to transportation and home modification. Free copies (shipping and handling is extra) are available at the CSRO website.

What is a spinal cord injury?

A spinal cord injury occurs when trauma or disease damages the spinal cord, resulting in partial or complete paralysis. The spinal cord begins at the base of the brain and extends approximately 45cm to 64cm inside the spinal column down the back, containing nerves that carry impulses from the brain to the rest of the body. It continues in the lower spine as the cauda equine, a bundle of free nerves travelling the remainder of the spinal canal. When the spinal cord or the cauda equine are damaged, nerves in the affected area are no longer able to send messages to and receive messages from the brain, resulting in loss of function and sensation.

The level of paralysis is determined by where the damage occurs in the neck or back. Paraplegia is the complete or partial loss of sensation and movement in legs and in part or all of the trunk, usually resulting from damage to the spinal cord or cauda equine in the back. Tetraplegia, or quadriplegia, is complete or partial paralysis of all four limbs and trunk (from the neck down) resulting from injury to the neck.

The severity of the paralysis is determined by the extent of damage to the spinal cord at any particular level. Generally, the injury is considered to be complete if there is complete loss of voluntary movement and sensation below the level of the injury; otherwise, the injury is considered to be incomplete.

How do different levels of injury affect the body?

The spinal cord is surrounded by the spinal column which consists of 33 vertebrae – rings of bone that surround the spinal cord. These vertebrae are divided into five segments:

Cervical – The upper seven vertebrae located in the neck (C1-C7). The nerves in this area control head and neck movement, the diaphragm, deltoids, biceps, and muscles controlling the wrist and hands. Damage to the cervical spinal cord generally results in full or partial tetraplegia.

• C1 – C3: Injury to the C1, C2 and C3 sections of the spinal cord typically results in loss of function to the neck and below, including loss of diaphragm function which necessitates a ventilator for breathing.
• C4: Significant loss of function at the shoulders and below.
• C5: Potential loss of functions in shoulders and biceps, complete loss of function below.
• C6: Limited wrist control and loss of much hand function.
• C7: Use of arms is retained, but results in a lack of hand dexterity.

Thoracic – The twelve vertebrae that extend through the chest area. (T1 – T12). Arm and hand function is unaffected.

• T1 – T8: Trunk stability is affected by the inability to control abdominal muscles. The higher the injury, the more severe the effects. Some impairment of respiratory muscle function is also seen due to loss of use of the intercostal muscles that move the ribs.
• T9 – T12: Results in variable loss of trunk and abdominal muscle control

Lumbar – The five vertebrae in the lower back. (L1 – L5). Injury to this area damages the very lowermost tip of the spinal cord (known as the conus medullaris) or the cauda equine which results in decreased control of hips and legs, as well as bladder, bowel and sexual function.

Sacral – The five vertebrae located in the pelvic area. (S1 –S5) As with Lumbar injuries, damage to the sacral nerves can result in decreased control of hips, legs, bladder, bowel and sexual function.

Coccygeal – Four fused vertebrae commonly referred to as the tailbone. An injury to the coccyx is not associated with any significant loss of nerve function.

What happens in acute care?

Acute care is the emergency medical treatment that occurs immediately following a spinal cord injury. Following an injury, first responders ensure that the neck and spine are immobilized to prevent further damage. Once stabilized, scans are taken at the hospital to diagnose the exact location of the injury, and neurological examinations are performed to measure the extent of motor function and sensation.

At this point, medication may be used to reduce swelling and compression on the spinal cord, and surgery may be required to reduce compression and maintain alignment of the spine and the spinal cord. Cervical injuries may require traction and surgical stabilisation, possibly subsequently followed by bracing for a while, while rods and screws may be used to stabilise a damaged spine in the case of thoracic and lumbar injuries.

Additional complications must also be addressed in this phase: for example, someone who sustains a spinal cord injury in an automobile accident may also have incurred traumatic brain injury, blunt abdominal trauma, chest or extremity injuries.

The length of stay in acute care depends on the severity of the injury. Once the patient is stabilized, rehabilitation will begin to maximise function and they will generally be transferred to a rehabilitation facility to receive comprehensive spinal cord injury rehab care.

What happens in rehab care?

Rehabilitation is the process of learning how to navigate through life with a spinal cord injury. Physiotherapy will help regain function where there is potential. A team of therapists will teach self-sufficiency in care so that you can be as independent as possible. You will receive help choosing equipment and assistive devices, and be prepared for your return home.

The rehab centre employs a team of professionals to help you during this process. This team may include:

• Physiatrist – Physiatrists are specialist medical doctors working in the field of rehabilitation treatment. The physiatrist leading the team will coordinate your rehabilitation and ensure that you receive proper medical treatment during the process.
• Physical Therapist (PT) – The physical therapist develops and implements a physical rehabilitation program to help you develop muscular potential and regain motor function.
• Occupational Therapist (OT) – The occupational therapist will teach you techniques to help you in your daily life, providing skills-training for tasks such as getting dressed, cooking, and getting around your home and community. They will also help you choose a wheelchair, as well as equipment and assistive devices to compensate for lack of motor function.
• Psychologist – A psychologist is available to help you work through the emotional and psychological difficulties you face following the drastic change of life resulting from a spinal cord injury. They will listen to your concerns and help you work toward through feelings such as fear, anguish and depression.
• Rehabilitation Counsellor – The rehabilitation counsellor will help you achieve your career, personal, and independent-living goals by providing relevant advice specific to your situation. They can prepare for your return home, and help you figure out what you need to return to work or school following discharge from rehab.
• Nursing Staff – Nursing staff will assist the physiatrist in providing your daily care and teach you how to care for yourself for your return home.