Non-Traumatic Spinal Cord Injury - an overview (2022)

Spinal cord injury

S Paddison, F Middleton, in Physical Management in Neurological Rehabilitation (Second Edition), 2004

INCIDENCE AND AETIOLOGY

At the annual conference of the International Spinal Cord Society (2001) it was estimated that approximately 17.2 people per million of the population in Europe suffer a traumatic SCI per annum and 8.0 per million experience a non-traumatic SCI.

The ratio of male to female cases is approximately 5:1, and varies with age. The greatest incidence is in the age range of 20-39 years (45%), then 40-59 years (24%), and 0-19 years (20%), with those over 60 years showing the lowest incidence of 11% (Gardner et al., 1988). The incidence and aetiology vary greatly from country to country, with no clear data recorded in the UK.

Spinal cord damage can result from trauma (84% of cases) or non-traumatic causes (16%). The main causes of traumatic injury are shown in Figure 8.1. Gunshots andstabbings also make small but increasing contributions (Whalley Hammell, 1995; Harrison, 2000). A significant number of patients with mental health problems will sustain injury from jumping from a height.

Non-traumatic causes include: developmental anomalies (e.g. spina bifida) and congenital anomalies (e.g. angiomatous malformations); inflammation (e.g. multiple sclerosis); ischaemia (e.g. cord stroke); pressure on the cord due to expanding lesions (e.g. abcess or tumour extrinsic or intrinsic to the spinal cord). Each condition has distinct management needs and features. Their management will benefit from the knowledge and skills derived from an understanding of traumatic SCI, which is the focus of this chapter.

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Spinal Cord Injury

M. Wirz, V. Dietz, in Handbook of Clinical Neurology, 2012

Influence of age on outcome and length of stay for rehabilitation

There is increasing evidence that elderly SCI patients undergo a substantial motor and functional recovery and may profit from inpatient rehabilitation (Hagen et al., 2005). However, in the discussion regarding the association between age and rehabilitation outcome one has to take into account that the neurological level and severity of a SCI differs with age. In addition, only selected, highly functioning patients might be referred to a comprehensive rehabilitation program, while less capable patients are discharged to nursing homes (McKinley et al., 2003).

It has been shown that elderly patients tend to have more frequently concurrent morbidities and pre-existing medical conditions, which might preclude the attainment of maximal possible capacity levels (Penrod et al., 1990; DeVivo et al., 1992a; Roth et al., 1992; Scivoletto et al., 2003; Irwin et al., 2004).

The question as to whether age affects motor, sensory, and functional recovery within the whole SCI population can hardly be answered definitively from the available literature. No association between age and motor and sensory recovery was found within a cohort of 485 subjects with SCI (Furlan et al., 2010). However, there are also observations that age is associated with a less favorable outcome pertaining to walking in certain subgroups (Kay et al., 2007). A recent study, including a sample of 237 subjects with traumatic SCI, even describes a positive relationship between age and neurological improvement (i.e., increase in motor score) but a negative association with functional measures (i.e., daily life activities and walking ability), as shown in Figure 5.3 (Jakob et al., 2009). However, in patients with a cervical SCI, despite a significant recovery, smaller or delayed gains in motor and functional scores and in bladder control are reported for elderly subjects (Roth et al., 1990; Spivak et al., 1994; Tow and Kong, 1998; Newey et al., 2000; Dai, 2001; Pollard and Apple, 2003; Dvorak et al., 2005; Aito et al., 2007).

Non-Traumatic Spinal Cord Injury - an overview (1)

Fig. 5.3. Correlations between age and changes in ASIA motor score and Spinal Cord Independence Measure (SCIM) for a sample of 237 subjects for the period between the first and sixth months, and the sixth and twelfth months after an acute traumatic spinal cord injury (level of significance: * p≥0.05; **p≤0.01; ***p≤0.001; from Jakob et al., 2009).

Studies controlling for age-related injury characteristics revealed that older patients undergo a slower motor recovery, which occurs to a smaller extent and with less improvement in functional outcome or skin management (Kennedy et al., 2003; McKinley et al., 2003). In patients suffering a SCI at an age of 40 years and beyond, poorer general health and reduced daily life activities are reported, as compared to their younger counterparts (Krause, 1998).

Patients with a non-traumatic SCI etiology are on average significantly older than traumatic SCI patients. In these cases, age does not seem to influence the extent of recovery (New and Epi, 2007) or the effect of age could not be delimited (McKinley et al., 1999a, 2001, 2008).

There is no clear influence of age regarding length of stay (LOS) in acute care and rehabilitation. LOS seems to depend more on the completeness of a SCI or the surgical intervention (Roth et al., 1992; Aito et al., 2007; Jakob et al., 2009). Again, when comparing young with old subjects with SCI one should be aware that the groups may differ not only because of their age but also because of a variety of other characteristics, for example young patients may have experienced a more severe trauma resulting in an increase of LOS, while older patients might be selected according to the potential to profit from rehabilitation (McKinley et al., 2003). In addition, an age-dependent limitation of functional gain may contribute to a shorter rehabilitation LOS (Scivoletto et al., 2003). In paraplegic patients, age is significantly correlated with the LOS (Seel et al., 2001; McKinley et al., 2003). Nevertheless, it has been previously found that LOS was similar (New et al., 2002; New and Epi, 2007), or even shorter (McKinley et al., 2001), in groups of older patients with non-traumatic SCI compared to those with traumatic SCI. An exception to this seems to be observed in subjects suffering a SCI in which the injury was due to an infection. In these cases the acute LOS is longer, while LOS is shorter during rehabilitation (McKinley et al., 2008).

Reasons as to why older patients might show less improvement after a SCI include a smaller reserve capacity for improvement in the elderly and a lack of the ability to transfer rehabilitation gains in the clinic to the home environment (McKinley et al., 2003; Adkins, 2004; Furlan and Fehlings, 2009; Jakob et al., 2009). Nevertheless, in paraplegic patients there exists no relationship between age and improvement of motor function, but older patients show less improvement in functional outcome (Seel et al., 2001; Jakob et al., 2009).

Adapted rehabilitation strategies may account for the fact that the transfer from the recovery of sensorimotor deficit to the acquirement of skills during rehabilitation is more challenging for older subjects. The early supported discharge is an actual concept where patients are discharged from hospital at the earliest time; this is combined with continued rehabilitative training at the patient's home. In stroke, this rehabilitation approach demonstrated a reduction in the length of hospital stay combined with less expense and a reduction in mortality rate. However, those patients who were able to undergo the early supported discharge program were less likely to live alone and suffered only mild to moderate strokes (Langhorne et al., 2005; Thorsen et al., 2006; Langhorne and Holmqvist, 2007; Pessah-Rasmussen and Wendel, 2009; Rousseaux et al., 2009).

Discharge to a nursing home after rehabilitation depends on various factors besides age, such as the location or the completeness of the SCI, the person's ability to independently perform activities of daily living, and the socioeconomic characteristics of the community (DeVivo et al., 1990; Roth et al., 1992; Alander et al., 1994; DeVivo, 1999; McKinley et al., 2003; Hagen et al., 2005). No difference in the discharge disposition between different age groups was described for subjects with paraplegia, although a difference in the ability to independently perform activities of daily living was observed (Seel et al., 2001).

In the population of non-traumatic SCI, younger subjects are more likely to be discharged to the home environment as compared to elderly subjects (New and Epi, 2007). However, when comparing traumatic and non-traumatic SCI there is no difference in the rate of discharge disposition (McKinley et al., 2001). In contrast, patients suffering infection-related spinal cord damage are generally older and are less likely to be discharged home (McKinley et al., 2008).

In summary, when subjects experience a SCI at an older age, the cause is likely to be a fall or a motor vehicle accident. These patients tend to have an incomplete cervical lesion with a rather good prognosis for regaining motor function and independence in activities of daily living. A typical clinical presentation is the central cord syndrome. Subjects with complete tetraplegia have a poor prognosis pertaining to recovery and survival. The frequency of non-traumatic SCI etiology increases with age. These cases show an increase in mortality rate and a higher incidence for being discharged to a nursing home.

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(Video) International Non-Traumatic Spinal Cord Injury Study Group Overview & Current Results

Spinal cord injury and disease

Val Hopwood PhD FCSP Dip Ac Nanjing, Clare Donnellan MSc MCSP Dip Shiatsu MRSS, in Acupuncture in Neurological Conditions, 2010

Part 1 Spinal cord injury (SCI)

This is clearly a devastating event which can have a major effect on the quality of the future existence of the patient. A complex neural network involved in transmitting, coordinating and modifying the sensory, motor and autonomic signals is abruptly disrupted.

Definition

SCI is defined in several ways; most simply, it is defined by the resulting loss of function. Paraplegia is the impairment or loss of motor, sensory or autonomic function of thoracic, lumbar or sacral segments of the spinal cord. Upper-limb function is spared but the trunk, pelvis and lower limbs will be affected.

Tetraplegia or quadriplegia will show similar damage, affecting the upper limbs as well. In high cervical lesions respiration will also be impaired.

Incidence and mortality

SCIs affect only a small percentage of the population, with a male-to-female ratio of 5:1. A total of 17.2 people per million of the population in Europe suffer a traumatic SCI and 8.2 per million experience a non-traumatic SCI (figures from 2001: [1]).

Risk factors

It is difficult to describe these causes as ‘risk’ exactly because this injury is so often the result of an accident: about 80% of SCIs are due to trauma. Gunshots and stabbings can cause this type of damage and falling from a height, whether accidentally or deliberately, is also a cause. However diseases where there is degeneration of the spinal structures such as cervical spondylosis also contribute to the statistics.

Diagnosis and prognosis

Diagnosis is dependent upon the completeness of the lesion and must take into account the infinite variations of this. Prognosis is irretrievably linked with this. The most useful current classification is the American Spinal Injuries Association (ASIA) Impairment Scale (Table 9.1). This scale is reasonably predictive of diagnosis and makes for a logical subclassification of incomplete spinal column injuries into clinical syndromes:

Central cord: upper limbs are more profoundly affected than the lower limbs. The condition is typically seen in older patients with cervical spondylosis. A hyperextension injury compresses the cord in a spinal canal that is already limited by osteophytes and other degenerative changes.

Brown-Séquard: this is an incomplete lesion often affecting the cervical spinal. The hemisection damage to the cord is commonly caused by a stabbing injury, although it may result from infection or local inflammation. It is characterized by ipsilateral hemiplegia with contralateral pain and temperature sensation deficits. This is because of the crossing of the fibres of the spinothalamic tract. The associated morbidity and mortality will be related to the accompanying injuries. Morbidity is associated with the resulting paralysis whereas mortality may be the direct result of serious haemorrhage.

Anterior cord syndrome: characterized by ventral cord damage affecting spinothalamic and corticospinal tracts. There is complete motor loss below the lesion and usually loss of pain and temperature sensation. Since the posterior tracts are preserved there will still be some proprioception and vibratory perception. Motor recovery is generally poor unless evident within the first 24 hours.

Conus medullaris and cauda equina syndromes are quite similar in that they offer a confusing mixture of signs and symptoms. The conus medullaris is the distal part of the spinal cord and injuries to this area often produce a mixture of upper motor neurone (UMN) and lower motor neurone (LMN) symptoms. Cauda equina lesions are predominantly LMN since they affect the peripheral nervous system [2].

Medical treatment

Early interventions

A recent study by Tederko et al. [3] came to the following conclusions:

The primary zone of traumatic spinal damage enlarges due to local vascular disturbances, hypoxia, and the resulting inflammation. Secondly, inflammation in the region of secondary injury, apart from having a destructive impact, is the source of substances which may induce neural tissue repair, and finally the administration of methylprednisolone and surgical decompression of the spinal cord within several hours after SCI improves functional and neurological outcomes in patients with incomplete neurological deficits.

There are a number of things that must be checked and corrected, if possible, in the first 24–48 hours after injury. Haemorrhage from associated injuries must be dealt with quickly. Sympathetic paralysis below the level of the lesion can lead to neurogenic shock and hypotension. Thromboembolism can be prevented by elastic stockings and low-dose anticoagulants. Initial bladder management usually involves catheterization.

Pharmacology

Methylprednisolone is given at the time of the acute injury for up to 48 hours as one of the strategies for neuroprotection [4].

Surgery

Surgery, other than that required to stabilize the fracture site, is relatively rare. If pressure sores become serious, with infection, slow healing or infected bone, then surgery will be indicated.

SCI and physiotherapy

The following is a list of common medical problems which will delay or impede rehabilitation but is by no means exhaustive:

Respiratory difficulty in the early stages is dealt with by assisted coughing to clear secretions and breathing exercises to prevent atelectasis or infection.

Pressure sores: denervated skin is at risk from pressure damage within 30 minutes of injury. This means that pressure care is most important in this group of patients and a vigilant watch is kept for any areas of reddened skin. Where the patient retains the ability, pressure lifting is taught, with the patient lifting the buttocks clear from the wheelchair or chair every 30 minutes.

Unilateral lower-extremity swelling with associated deep-vein thrombosis (DVT): prophylaxis, wearing pressure stockings and mobilizing as early as possible may help to prevent this.

General mobility and independence will be enhanced by strengthening the unaffected muscles and encouraging standing and wheelchair use.

Heterotopic ossification with possible fractures: calcification occasionally occurs in UMN-disordered muscles and may be confused with a DVT as the signs are often swelling and local heat. Most patients experience a degree of osteoporosis 2 years after injury, probably due to long periods of immobilization. Extra care must be taken during transfers and, if weight-bearing standing is undertaken after a long period, careful work progressing with the use of a tilt table is necessary.

Spasticity: this is a common problem depending on the level of injury. Lower vertebral injuries, from the level of T12 downwards, give rise to LMN injuries and are generally classified as peripheral nerve damage presenting with flaccid paralysis or muscle weakness only. UMN injury, at the level of T12 or above, will involve damage to the cord itself and may present with a varying amount of spasticity in affected muscles.

Autonomic dysreflexia: hypertension produced by a dysfunction in the sympathetic nervous system. This reaction may include palpitations, sweating, headache, piloerection and capillary dilation above the level of the lesion. Autonomic dysreflexia can occur with any noxious stimulus such as bladder or rectal distension. If it occurs during treatment, the patient should be sat up, given appropriate medication and the underlying cause treated. This hypertension can be sufficient to induce cerebral haemorrhage so it should always be treated as an emergency. Very mild symptoms can indicate the need for toileting.

Pain: where pain is present initially, for instance in fractured ribs, treatment including the application of transcutaneous electrical nerve stimulation may be used. Common syndromes include mechanical instability, muscle spasm, visceral pain and central dysaesthesia syndrome – pain associated with the central nervous system and spinothalamic pathways.

Contractures and malposition of the joints will be prevented by passive movements daily through full range.

Given the complexity of the possible changes, a clear knowledge of anatomy and associated nerve roots is vital. In order to know what can reasonably be expected by way of recovery, accurate location of the level of the spinal cord lesion is very important. Table 9.2 offers the range of possible goals and should be considered in conjunction with Table 2.2 in Chapter 2.

Management of psychological issues will be necessary and must take place with the help of qualified personnel. However the use of acupuncture may be valuable as long as the other staff know that it is being used. Maintaining a positive approach with realistic expectations is essential but hard to do.

Acupuncture in SCI

The use of acupuncture under these circumstances is by no means common and there has been little research. Acupuncture has been considered for pain control, a logical enough application, and also for bladder control, which might cause more comment.

The studies have been small but suggestive of a positive role for acupuncture [5]. A group of 22 patients with SCI who experienced moderate to severe pain of at least 6 months’ duration were given a course of 15 acupuncture treatments over a 7-week period. In a more general review of complementary therapies for SCI, Nayak et al. suggest that, while acupuncture may have a place in pain control, massage has been shown to be even better and is apparently rarely used [6].

The combination of acupuncture technique and ‘moving cupping’ (see Chapter 12) could be very useful.

The same research group also looked into the effect of acupuncture on autonomic dysreflexia [7], and decided that, although none of their – admittedly small – sample of 15 patients went on to develop symptoms of autonomic dysreflexia, three of the total did display an acute elevation of blood pressure, making it desirable to monitor this type of patient carefully in future.

(Video) Spinal Cord Injury | Levels of injury

Achieving bladder control is an important issue for both the patients and their carers and there has been a preliminary study which offered a role for acupuncture. The potential mechanism, through afferent stimulation at the same segmental level using the points CV 3 and CV 4 and also reflex stimulation of the splanchnic nerves at sacral level using BL 32, seems logical in both anatomical and traditional Chinese medicine (TCM) terms. The trial has been criticized for general lack of rigour but they did observe in post hoc analysis that those patients receiving acupuncture within the first 3 weeks did better with achieving bladder balance [8].

Body acupuncture

Acupuncture points, mainly on Yang meridians, can be used, as in all neurological diseases, to tackle the superficial musculoskeletal symptoms. Both pain and movement problems can be addressed. The points can be selected according to symptoms and Table 9.3 gives some of the alternatives.

Many problems are directly caused by the medical interventions and points for these have also been listed. Electroacupuncture may be used at some of the points; the recommended frequency for body points is 2 Hz while that for scalp points is 100 Hz, although they may be alternated.

As with all the conditions in this book, there is a danger of the list of acupoints becoming endless, so only the most specific points are given. These are selected for completeness from both Western medicine approaches and those more traditionally Chinese. Those that relate directly to the following TCM syndromes are also mixed in.

Scalp acupuncture

The authors have been unable to find any convincing evidence for the use of scalp acupuncture in SCI. There is some anecdotal evidence, provided by practitioners of Yamamoto New Scalp Acupuncture (YNSA), of success with neurological conditions, but this technique of scalp acupuncture is slightly different to the Chinese version (see Chapter 12) and has a very limited evidence base. The main claim seems to suggest a change in neuroplasticity.

TCM approach

TCM regards injury to the spinal column as a direct injury to the Du meridian; thus points associated with that meridian, such as SI 3 Houxi and BL 62 Shenmai, can be used. The Huatuojiaji points are seen as valuable, being closely situated as they are, and this fits well with the neuroanatomy of the problem. The Huatuojiaji points are described as being able to ‘activate the primordial energy’ in the Du meridian [9]. Generally one would not needle the Du points but some authorities recommend this, choosing points above and below the level of damage and combining these with Huatuojiaji points.

The paralysed state is seen as a combination of obstruction to the meridian and the sudden stagnation of the Qi/Blood circulation, thus depriving the four limbs of nutrients and limiting normal movement. Needling the back Shu points and powerful points on the limbs themselves can be helpful. Passive and active movements are seen as part of the therapy.

Normal applications of acupuncture for pain, muscle hypertonicity, respiratory discomfort, insomnia and anxiety will include the usual points.

The most likely TCM syndromes involved will be Qi and/or Blood deficiency and Liver and Kidney Yin deficiency [10].

In practical terms this means that the symptoms of these syndromes, described elsewhere in this book, can be tackled with acupuncture and have a chance of influencing the well-being of the patient.

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Pain and spinal cord imaging measures in children with demyelinating disease

Nadia Barakat, ... David Borsook, in NeuroImage: Clinical, 2015

5 Conclusions

Pediatric transverse myelitis is relatively uncommon. As a result, we know very little about the distinguishing characteristics of this population. Correct diagnosis for myelitis is limited by the lack of injury classification standards specific to non-traumatic SCI, and the lack of imaging techniques to define the extent of injury and preserved neurological function. Additionally, pain represents a major problem in pediatric myelitis and an obstacle to effective rehabilitation outcomes. However despite its high prevalence, very little has been described regarding the management of chronic pain in children with inflammatory demyelinating insults to the spinal cord.

Emerging quantitative MRI techniques offer unique possibilities in examining white matter integrity and myelin content in the spinal cord. DTI and MTI can be used to assess axonal integrity and the degree of demyelination. These quantitative imaging techniques may also be useful for monitoring the efficacy of new therapeutics for myelitis. However, the many advantages of quantitative imaging are accompanied by various technical challenges. The pediatric spinal cord is small in volume and subject to susceptibility and motion artifacts that must be addressed to optimize diagnostic quality. Furthermore, for these quantitative imaging techniques to be used in clinical settings, their reliability and sensitivity have to be established in pediatric myelitis.

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Physical activity self-management interventions for adults with spinal cord injury: Part 1–A systematic review of the use and effectiveness of behavior change techniques

Jennifer R. Tomasone, ... The SCIRE Research Team, in Psychology of Sport and Exercise, 2018

1.1.1 Inclusion/exclusion criteria

Articles had to: (a) be published in a peer-reviewed journal; (b) examine interventions that had a behavioral component aimed at enhancing LTPA behavior and/or LTPA SM strategies in any setting (e.g., health care/rehabilitation, community, home); and (c) include adults (≥18 years) with traumatic or non-traumatic SCI. For objective 1, all study designs with quantitative data related to the outcomes were included, while for objective 2, only studies using experimental and quasi-experimental designs were included.

For both objectives, exclusion criteria included: (a) studies with qualitative analyses only; (b) retrospective or case study designs (due to the potential for multiple biases and confounders); (c) editorials, commentaries, abstracts, conference abstracts/proceedings, and dissertations; (d) interventions that were not designed to enhance LTPA behavior or SM; (e) studies that included ≤ 3 participants with SCI; and (f) studies in which the results for the subsample of participants with SCI were not presented separately from those of other participants.

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(Video) Understanding the Symptoms After a Non-Traumatic Spinal Cord Injury

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Physical activity self-management interventions for adults with spinal cord injury: Part 2 – Exploring the generalizability of findings from research to practice

Shauna M. Burke, ... The SCIRE Research Team, in Psychology of Sport and Exercise, 2018

1 Methods

Full details regarding the literature search strategy and selection, inclusion/exclusion criteria, and screening process are reported in Tomasone et al. (2018). The following sections contain a brief overview of the methods used for both reviews, as well as those that are unique to this study.

1.1 Literature search strategy and selection

A comprehensive search strategy, developed in consultation with a university health sciences librarian, combined controlled vocabulary and keywords relevant to SCI, physical activity, self-management, and interventions. The systematic search strategy was executed in five electronic databases: MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials. Hand-searching methods (e.g., scanning the table of contents of relevant journals) were also employed, and limits related to language (English), date of publication (1980–September 2017) and subjects (human) were applied.

1.2 Inclusion/exclusion criteria

To be included in the systematic review, studies had to: a) be published in a peer-reviewed journal; b) contain an intervention or utilize strategies that had a behavioral component targeting LTPA behavior and/or LTPA self-management skills in any setting (e.g., health care, community, home); c) include adults (18 years or older) with traumatic or non-traumatic SCI; and d) report quantitative data related to LTPA and/or its antecedents (e.g., self-efficacy, goal setting, action planning, etc.; Tomasone et al., 2018). Studies were excluded if they: a) reported qualitative analyses/data only; b) used retrospective or case study designs; c) were an editorial, commentary, abstract, conference abstracts/proceedings, or dissertation; d) included ≤3 participants with SCI; and e) did not report the results for participants with SCI separately from those of other participants.

1.3 Screening process

All references resulting from the database searchers were exported and managed using the Covidence online systematic review tool. Two authors (AA, BB, and/or CC) independently screened each article by title and abstract. Eligible full texts were then retrieved and examined independently by two authors (AA, BB, and/or CC) using the abovementioned inclusion/exclusion criteria. Disagreements at all levels of screening were resolved through discussion and consensus among author reviewers.

1.4 RE-AIM evaluation and PRECIS assessment

In line with its overall aim, the RE-AIM framework was used to determine the degree to which authors of peer-reviewed publications in this area reported on important program elements (including external validity) across five broad dimensions, as it is expected that more robust reporting enhances the potential for intervention replicability and translation (Gaglio, Phillips, Heurtin-Roberts, Sanchez, & Glasgow, 2014). The PRECIS-2 tool, on the other hand, was used to assess specific research design components with a focus on an applicability, or the degree to which trials were more pragmatic (i.e., “undertaken in the ‘real world’ and with usual care …”) or explanatory (i.e., “undertaken in an idealised setting, to give the initiative under evaluation its best chance to demonstrate a beneficial effect”) (Loudon et al., 2015, p. 1). Together, the use of these tools allow for a comprehensive evaluation of the potential for generalizability of findings from research to practice (Gaglio et al., 2014).

Data pertaining to the RE-AIM and PRECIS-2 dimensions were gathered using an extraction tool developed by Harden, Burke, et al. (2015) and Harden, Gaglio, et al. (2015), modified to reflect the use of PRECIS-2 rather than the original PRECIS tool. All extractions were performed independently by one author (NS) and subsequently reviewed and verified by a second author (JM) to reduce error and bias. When disagreements occurred (i.e., <3.0% for both the RE-AIM evaluation and PRECIS-2 assessment), they were resolved through discussion, and in some instances, via consultation with a third author (JT).

First, eligible studies were assessed using a RE-AIM coding system that has been used and modified in previous research (Glasgow, Klesges, Dzewaltowski, Bull, & Estabrooks, 2004; Kessler et al., 2013; Klesges et al., 2005), whereby 31 different items related to the five broad RE-AIM dimensions were considered and assigned a score of 1 (“yes”) or 0 (“no”). The number and percentage of interventions that reported on each of the 31 items were then calculated, as well as the overall mean and standard deviation for items reported per intervention (see Table 1 for the specific items that correspond to each of the five RE-AIM dimensions).

Table 1. Inclusion of RE-AIM and PRECIS-2 Elements Across All Interventions (N = 31).

RE-AIM Dimension and Items% (n)InterventionsPRECIS-2 IndicatorMeanb (SD)
Reach18.5Eligibility criteria
The participants selected for the trial and whether they differ from those in usual care.

Recruitment
How participants are recruited and whether this requires more effort than what is necessary in usual care settings.

3.06 (1.12)

2.48 (1.70)c

1. Exclusion criteria45.2 (14)4 6 8 10 11 13 14 19 21 23 25 27 30 31
2. Participation ratea12.9 (4)2 4 5 27
3. Representativeness12.9 (4)2 10 17 26
4. Use of qualitative methods to understand reach and/or recruitment3.2 (1)31
Effectiveness51.0Primary outcome
The extent to which the primary outcomes are directly relevant to participants.

Primary analysis
The extent to which all data are included in analyses.

2.94 (0.51)

2.28 (1.51)d

5. Measure of primary outcome100.0 (31)1-31
6. Measure of broader outcomes (i.e., QOL, negative outcomes)29.0 (9)1 7 8 11 14 17 19 23 24
7. Measure of robustness across subgroups25.8 (8)2 3 5 6 8 20 22 27
8. Measure of short-term attritiona83.9 (26)1-4 7 8 11-14 16-31
9. Use of qualitative methods/data to understand outcomes16.1 (5)4 6 11 14 28
Adoption-Setting2.4Setting
The setting in which the trial is conducted and the extent to which it differs from usual care settings.
4.47 (0.97)d
10. Setting exclusions3.2 (1)8
11. Setting adoption ratea6.5 (2)8 12
12. Setting representativeness0.0 (0)--
13. Use of qualitative methods to understand adoption at setting level0.0 (0)--
Adoption-Staff1.6Organization
The resources/expertise/organization of care required to deliver the intervention and whether they differ from those available in usual care.
2.26 (1.46)
14. Staff exclusions3.2 (1)8
15. Staff participation ratea3.2 (1)8
16. Staff representativeness0.0 (0)--
17. Use of qualitative methods to understand staff participation0.0 (0)--
Implementation14.2Flexibility (delivery)
How the intervention should be delivered and whether flexibility in delivery differs from that expected in usual care.

Flexibility (adherence)
The strategies used to enhance participant adherence, and whether flexibility in how strategies are used differs from that in usual care.

1.80 (1.00)e

2.52 (1.34)

18. Delivered as intended16.1 (5)10 12 14 16 26
19. Adaptations to intervention16.1 (5)2 12 13 16 26
20. Cost of intervention (time or money)6.5 (2)8 25
21. Consistency of implementation across staff/time/settings subgroups3.2 (1)10
22. Use of qualitative methods to understand implementation29.0 (9)6 11 13-16 21 26 28
Maintenance-Individual9.0Follow-up
How often participants are followed up and the extent to which this differs from usual care follow-up.
2.44 (1.55)
23. Measure of primary outcome at ≥6 month follow-up16.1 (5)6 8 10 18 19
24. Measure of broader outcomes (i.e., quality of life, negative outcomes) at follow-up6.5 (2)8 19
25. Measure of long-term robustness across subgroups6.5 (2)6 8
26. Measure of long-term attritiona12.9 (4)8 10 18 19
27. Use of qualitative methods to understand long-term effects3.2 (1)6
Maintenance-Setting4.8
28. Program ongoing (&gt; 6 month post-study funding)6.5 (2)2 6
29. Long-term program adaptations6.5 (2)2 6
30. Some discussion of sustainability of business model6.5 (2)2 6
31. Use of qualitative methods to understand setting-level institutionalization0.0 (0)--
Overall RE-AIM15.5%

Notes. RE-AIM = Reach, Effectiveness, Adoption, Implementation, Maintenance (Glasgow et al., 1999); PRECIS-2 = PRagmatic– Explanatory Continuum Indicator Summary-2 (Loudon et al., 2015); SD = standard deviation.

Interventions: 1 = Arbour-Nicitopoulos, Martin Ginis, Latimer, Martin Ginis, &amp; Latimer, 2009, 2 = Arbour-Nicitopoulos et al., 2014, 3 = Arbour-Nicitopoulos et al., 2017, 4 = Bassett-Gunter et al., 2013, 5 = Bassett &amp; Martin Ginis, 2011, 6 = Block et al., 2010, 7 = Brawley et al., 2013, 8 = de Oliveira et al., 2016, 9 = Foulon &amp; Martin Ginis, 2013, 10 = Froehlich-Grobe et al., 2012, 2014; 11 = Froehlich-Grobe &amp; White, 2004, 12 = Gainforth, Latimer-Cheung, Athanasopoulos, &amp; Martin Ginis, 2013, 13 = Kosma, Cardinal, &amp; McCubbin, 2005, 14 = Lai, Rimmer, Barstow, Jovanov, &amp; Bickel, 2016, 15 = Latimer-Cheung et al., 2013, 16 = Latimer-Cheung et al., 2013; 17 = Latimer et al., 2006, 18 = Myers, Gopalan, Shahoumian, &amp; Kiratli, 2012, 19 = Nooijen et al., 2016, 2017; 20 = Pelletier, Latimer-Cheung, Warburton, &amp; Hicks, 2014, 21 = Piatt, Compton, Sara Wells, &amp; Bennett, 2012, 22 = Radomski et al., 2011, 23 = Rimmer, Wang, Pellegrini, Lullo, &amp; Gerber, 2013, 24 = Sheehy, 2013, 25 = Thomas et al., 2011; Wise et al., 2009, 26 = Tomasone, Arbour-Nicitopoulos, Latimer-Cheung, &amp; Martin Ginis, 2018, 27 = van der Ploeg et al., 2007, 28 = Warms, Belza, Whitney, Mitchell, &amp; Stiens, 2004, 29 = Wickham et al., 2000, 30 = Zahl, Compton, Kim, &amp; Rosenbluth, 2008, 31 = Zemper et al., 2003.

Second, eligible studies were assessed for each of the PRECIS-2 domains using the adapted extraction tool. The nine PRECIS-2 categories, a brief description of each, and their mapping alongside the related RE-AIM dimensions are presented in Table 1. A 5-point Likert scale was used to assign a score for each intervention on all nine PRECIS-2 domains, whereby 1 was “very explanatory”, 2 was “rather explanatory”, 3 was “equally pragmatic and explanatory”, 4 was “rather pragmatic”, and 5 was “very pragmatic” (Loudon et al., 2015); these scale descriptors are used throughout the current review. We have also referred to the PRECIS-2 domains as primarily explanatory (i.e., scores of 1 or 2) or primarily pragmatic (i.e., scores of 4 or 5) to enhance reporting and ease of understanding regarding the location of intervention components on the respective ends of the continuum. In addition to individual intervention scores, the overall means and standard deviations of PRECIS-2 scores for each domain, across all 31 interventions, were calculated (see Table 1). When interpreting the mean scores for each of the PRECIS-2 domains, values > 3.50 were also deemed to be primarily pragmatic, values between 2.50 and 3.50 were deemed to be equally pragmatic and explanatory, and values < 2.50 were described as primarily explanatory.

A PRECIS-2 “wheel”, a key component of both PRECIS (Thorpe et al., 2009) and PRECIS-2 (Loudon et al., 2015), was also generated for each study to visually display the results of the PRECIS-2 scoring. Within the wheel, each domain is represented by a line and arranged around a central point (resembling a ‘web’), with the explanatory pole (1) placed proximally (i.e., close to the center of the wheel) and the pragmatic pole (5) placed distally (i.e., farthest from the center of the wheel). As such, based on the scores assigned to each study using PRECIS-2, a tighter web indicates that an intervention is more explanatory, and a wider web indicates that it is more pragmatic (Loudon et al., 2015; Thorpe et al., 2009).

When coding, and to assist with achieving consensus when necessary, the two reviewers regularly consulted the PRECIS-2 definitions outlined by Loudon et al. (2015). It should be noted that there was some initial confusion regarding the definition of “usual care” in the context of LTPA self-management interventions for adults with SCI. To address this confusion and to minimize the potential for errors and discrepancies, a preliminary evidence- and expert-informed definition of usual care was developed by the authors prior to scoring.1

Discussions also took place with regard to the primary outcomes of interest used in the Tomasone et al. (2018) review, as the relevance of such outcomes to participants constitutes the primary outcome domain of PRECIS-2. For the purpose of the present review, consensus was achieved and LTPA was assigned a score of 4 (i.e., rather pragmatic), as it was assumed to be important and relevant for some individuals but not necessarily all adults with SCI. LTPA antecedents, on the other hand, were assigned a score of 2 (i.e., rather explanatory), given that it was assumed that such variables may have less known relevance for (or be “less recognizably important”; Loudon et al., 2015, p. 9) to most adults with SCI.

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Pathophysiology, mechanisms and applications of mesenchymal stem cells for the treatment of spinal cord injury

Pravin Shende, Muna Subedi, in , 2017

1 Introduction

Spinal cord injury (SCI) is well-defined as an injury or lesion that results due to the dysfunction imposed on the spinal cord thereby compromising the major functions of spinal cord viz; sensory, motor, autonomic, and reflex, either completely or partially due to trauma or disease or degeneration (non-trauma) [1,2]. Global incidence for SCI is estimated to be in 40–80 persons in a million population. Amongst these, 90% occurs due to trauma but the occurrence appears to be growing recently for the non-traumatic SCI [3]. The incidence of SCI level is shown in Fig. 1. Cervical region accounts for about 55% of acute SCI, and the rest three regions i.e. thoracic, thoracolumbar and lumbosacral, each report for about 15% of SCI [4].

(Video) 203. The Role of Exercise and Rehabilitation in Non-Traumatic Spinal Cord Injury

Non-Traumatic Spinal Cord Injury - an overview (2)

Fig. 1. Level of Injury in Adult SCI.

The prevalence of SCI is about 54 cases per million population, as per census data in USA, thereby indicating about 17,000 new cases being re-counted each year. Male accounts for 80% of these incidences. When compared to cases of 1970s, the age for incidence has increased from then 29years to 42years now, however, the length of stay in hospital has decreased from 24days to 11days. When neurological category at the time of discharge of SCI patients is taken into consideration since 2010, 45% accounts for incomplete tetraplegia followed by 21.3%, 20% and 13.3% accounting for incomplete paraplegia, complete paraplegia and incomplete paraplegia respectively. Only 0.4% of SCI cases experience complete recovery on discharge from hospital [5].

SCI is the most serious complication that usually lead to neuronal death and axonal damage resulting in dyskinesia or somatosensory loss [6]. SCI interrupts the nerve connections between the brain and the body, and results in paralysis. The pathology of SCI is determined by both the primary mechanical injury and the secondary processes that prevails around hours and days after injury, includes ischemia, anoxia, inflammation, cavity and glial scar formations [7]. Spontaneous regeneration of neural tissue and the efficacy of therapies used for regeneration of axons is also compromised during secondary tissue damages of SCI [8].

Usually, the spinal cord axonal regeneration is subsidized by various factors, some of which includes diminution on inherent growth potential of CNS neurons, damaged CNS myelin that generate inhibitory signals, local astrocytes in reaction to the external stimuli forming glial scars and the absence of nerve growth factors and neurotrophic factors [9]. SCI is a serious damaging condition where patient experience significant sensory and functional loss, along with financial, social and emotional problems. SCI patients are at bigger risk of cardiovascular complexities, deep venous thrombosis, bed sores, osteoporosis, neuropathic pain and autonomic dysreflexia. SCI involves various complexities involved in its mechanism along with the failure on repairment and regeneration of neurons in the human body that limits the treatment of SCI and thus, makes it a multi-fronted challenge [10].

In this paper, we are presenting our recent understandings on SCI, pathophysiology associated to it and the applications of mesenchymal stem cells (MSCs) therapy in the treatment of SCI. Basic and clinical researchers associated in academics, business and various regulatory organizations who are interested or involved in stem cell research could be benefitted from this review paper.

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https://www.sciencedirect.com/science/article/pii/S0753332217310302

Inconclusive efficacy of intervention on upper-limb function after tetraplegia: A systematic review and meta-analysis

Sébastien Mateo, ... Gilles Rode, in Annals of Physical and Rehabilitation Medicine, 2020

3.2 Study characteristics

Among the 29 studies included, 5 used a cross-over design [19,39,53,58,60]. All but one was a single-centre study; the only multicentre involved 7 centres [44]. The studies included a total of 647 individuals with tetraplegia: SCI etiology was exclusively traumatic in 11 studies [28,39,43,45,50,55–57,59,61,62] or mainly traumatic with some participants with non-traumatic SCI in 4 studies [17,41,47,58], and etiology was not reported in 14 studies [9,16,18,19,40,42,46,48,49,51,53,54,60,63]. SCI level ranged from C2 to C7 and AIS grade from A to D. Only 2 studies restricted the inclusion to individuals with motor-complete SCI (AIS grade A and/or B) [17,50], with no information provided by 3 other studies [40,42,58]. Mean time since injury was 49 (SD 42) months (i.e., mean 4 [SD 3.5] years) at study inclusion. For all but 3 studies [46,49,63], the mean total duration of the intervention was 1591 (SD 1516) min (i.e., mean 26.5 [SD 25] hr) and ranged from 66 to 40,320min delivered over a mean of 8 (SD 7) weeks (range 1 to 36 weeks). The characteristics of the participants and interventions are in Table 1.

A total of 5 studies were retained for the intensive versus less intensive intervention analysis because of a greater number of movements practiced [45–47] or longer duration of the experimental than control intervention representing a difference of 450min (i.e., 7.5 hr over a 5-week period [17]) or 2370min (i.e., 39.5 hr over an 8-week period [44]). For the experimental group of these studies, daily practice was increased by 18min [17] or by 59min [44]. The 5 studies included a total of 150 participants (mean age 37 [SD 5] years) with an SCI level that ranged from C2 to T1 and a mean time since injury at study inclusion of 29 (SD 31) months. Participants had complete or incomplete lesions [17,44,46] or only incomplete lesions [45,47]. Interventions lasted for a mean of 1653 (SD 878) min (i.e., mean 28 [SD 15] hr) over a mean of 5.4 (SD 2.5) weeks.

A total of 5 studies were retained for the neuromodulation versus sham meta-analysis [16,18,19,48,60]. Neuromodulation consisted of functional electrical stimulation of forearm muscles triggered by brain activity measured during motor imagery using a brain–computer interface [16], tDCS combined with upper-limb training [18,48] or rTMS combined with upper-limb training [19,60]. These studies included a total of 56 participants (mean [SD] age 49 [6] years) with an SCI level that ranged from C2 to C8 and a mean (SD) time of 99 (21) months since injury at study inclusion. Participants had complete or incomplete lesions [60] or only incomplete lesions [16,18,19,48]. Interventions lasted a mean (SD) of 548 (597) min (i.e., mean [SD] 9 [10] hr) over a mean (SD) of 1.75 (0.5) weeks.

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https://www.sciencedirect.com/science/article/pii/S1877065719300764

Cancer Rehabilitation

Vishwa S. Raj MD, ... Natalie S. Garces BSN, RN, in Seminars in Oncology Nursing, 2020

Post-Acute Care

PAC is the primary setting for care delivery within the US for all rehabilitation-appropriate diagnoses, including cancer. As defined by the CMS, PAC consists of inpatient rehabilitation facilities (IRF), skilled nursing facilities (SNF), HH care agencies, and long-term care hospitals (LTCH). PAC has been identified as a primary focus for cost containment with CMS.88 However, PAC rehabilitation services are critical for improving patient function and QOL.89 To help reduce Medicare expenditures, a negative potential consequence is decreased access to PAC for all patients, including cancer survivors.

IRFs are the treatment setting of choice for conditions that require intensive rehabilitation with consistent medical supervision. Individuals must be able to tolerate therapy for several hours per day, have face-to-face contact with a rehabilitation physician, and show measurable benefit from the rehabilitation program (ie, show how intensive therapy and medical supervision successfully address parameters of care). For services to be covered by Medicare, they must also: be considered both reasonable and necessary; require close medical and nursing supervision throughout the entire inpatient stay; integrate multidisciplinary therapy intervention of at least two modalities, including PT or OT, for at least 3 hours per day for 5 days per week; and involve social services. An additional consideration is that, for IRFs that participate in the Medicare program, 60% of admissions have a primary diagnosis or comorbidity of at least one of 13 specified conditions. Although cancer is not specifically identified as one of these diagnoses, they can be coded in a manner consistent with Medicare compliance. For example, brain tumors maybe considered non-traumatic brain injuries, spinal cord metastases could be coded as non-traumatic spinal cord injuries, and resection of sarcoma may be identified as amputations. Analysis of the Uniform Data System for Medical Rehabilitation database from 2010 to 2012 shows 2.4% of all IRF admissions constituted cancer patients, and 72% of these patients were discharged to a community setting.90 Although a valuable resource, IRF may be underutilized because of lack of awareness by providers and referral sources and concerns about the delivery of oncology care while in the rehabilitation setting. However, IRF can be a valuable resource for patients who require medical supervision and who would benefit from extensive therapy services to improve performance status or address pertinent functional issues affecting QOL. With the appropriate coordination, it may also allow for the concurrent delivery of oncological services.

SNFs provide short-term skilled nursing and rehabilitation services to beneficiaries after a stay in acute care. Medicare can authorize a stay of up to 100 days after a medically necessary inpatient hospital stay. At day 21, patients with Medicare are responsible for copayments, which in 2019 averaged $170.50 US per day. The utilization of SNF for rehabilitation cases increased significantly between 2002 and 2017, from 78% to 95%, respectively. In SNFs, therapy intervention can range from 45 minutes per day for a minimum of 3 days to 720 minutes per week requiring two disciplines, one of which is involved for at least 5 days. Total spending in 2017 was $28.4 billion US, with a median payment per day of $480 US and median payment per stay of $18,121 US.91 In 2019, changes in the Medicare reimbursement structure may cause a change of focus from volume of services provided to value. Clinically relevant factors will be emphasized and includes a combined limit on group and concurrent therapy of 25%, with payment adjustments for non-therapy ancillaries92 This may negatively impact the total amount of therapy services offered in the future. However, it may allow SNF to provide higher-complexity medical care, which had been a primary barrier for patient access. More sophisticated analyses of outcomes in context of complexity of diagnoses may be possible as CMS develops new approaches to SNF level of care. Individuals who may most benefit would be those who require less medical supervision than the IRF setting with less intensive therapy needs, but who also would benefit from 24-hour nursing support before transition to the community.

HH services consist of skilled nursing, PT, OT, SLP, aide services, and medical social work meant to provide care in the home setting. CMS requires that patients receive benefits for fewer than 8 hours per day, or that they cannot leave their homes without considerable effort. As opposed to SNF, a previous hospital stay is not necessary for coverage. Physician certification for eligibility must occur 90 days preceding or 30 days after initiation of HH. Episodes are for 60 days, but at the completion additional episodes can be initiated for continued need. As a substitute for step-down inpatient units, HH may help keep beneficiaries in their homes and reduce Medicare expenditures. From 2002 to 2016, the number of episodes per user increased from 1.6 to 1.9. The number of episodes that did not involve prior hospitalization rose from one half to two thirds of all cases.93 HH can commonly be applied to cancer populations, especially in situations where access to outpatient services may be difficult. However, the level of medical supervision is far less significant compared with IRF and SNF levels of care. Nursing and therapy services can be provided, although they are typically no more frequent than 3 times per week for an hour at a time. Patients who would most benefit from this level of care are individuals whose performance status is generally higher, and who do not require frequent medical interventions in an outpatient setting.

LTCH provides hospital intensive care for relatively extended periods of time. LTCH typically has an average length of stay greater than 25 days. In 2017, Medicare spent $4.5 billion US, for 103,000 beneficiaries and 116,000 admissions. Typical cases have chronic critical illness, and exhibit metabolic, endocrine, physiologic, and immunologic abnormalities that result in profound debilitation and commonly ongoing respiratory failure. Sixty percent of Medicare beneficiaries requiring a tracheostomy, who also experienced more than 96 hours of ventilator support, were discharged to LTCH. Patients with septicemia or respiratory failure requiring mechanical ventilation for more than 96 hours also utilized these services.94 Typical individuals receiving LTCH care have significant co-morbidities, similar to that requiring acute care hospitalization. The medical care is usually prioritized over therapy services because multiple and frequent interventions may limit the ability of individuals to participate in rehabilitation. However, it remains a valuable resource for individuals with the highest level of medical complexity. For cancer patients with significant medical co-morbidities but who cannot remain in an acute care setting, LTCH may be the appropriate disposition. However, the amount of therapy may be limited because of time needed to provide medical care.

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FAQs

What is considered a non-traumatic spinal cord injury? ›

Non trauma spinal cord injury can be what is termed 'complete' or 'incomplete'. Refers to injuries where there is no muscle function or sensation below the level of injury. This affects both sides of the body to the same degree. Complete injury does not necessarily mean the spinal cord has been severed.

What is the difference between traumatic and non-traumatic spinal cord injury? ›

' Traumatic injuries are caused by an abrupt traumatic hit to the spine which results in damage to one or more of the vertebrae, or a severing of the spinal cord. Non-traumatic injuries are the result of slow internal damage to the spinal cord region.

What are the three types of spinal cord injuries? ›

There are three types of complete spinal cord injuries: Tetraplegia. Paraplegia. Triplegia.

What are 3 complications that a spinal cord injury patient of any level of injury are at risk for? ›

A spinal cord injury can cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes can also increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.

What is non traumatic? ›

non-traumatic (not comparable) not caused by, or not causing, trauma or emotional distress.

How does a spinal cord injury affect the brain? ›

Spinal cord injuries can cause widespread and sustained brain inflammation that leads to progressive loss of nerve cells, with associated cognitive problems and depression, researchers have found for the first time.

Can a spinal cord injury go unnoticed? ›

Traumatic cervical spinal cord injury secondary to low-impact trauma may go unnoticed in patients with CA.

Is a spinal injury a trauma? ›

The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body for movement and sensation. Acute spinal cord injury (SCI) is due to a traumatic injury that bruises, partially tears, or completely tears the spinal cord.

Can a complete spinal cord injury become incomplete? ›

Particularly in the first weeks after an injury, swelling may interfere with function. When swelling goes down, an injury that appeared to be a complete spinal cord injury might turn out to be incomplete.

What is the most commonly injured spinal cord level? ›

SCI typically affects the cervical level of the spinal cord (50%) with the single most common level affected being C5 (1). Other injuries include the thoracic level (35%) and lumbar region (11%).

Which site is most common in spinal injuries? ›

The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.

What organs are affected by spinal cord injury? ›

Short- and long-term complications following SCI can occur in the nervous system (such as neurogenic pain and depression), lungs (such as pulmonary edema and respiratory failure), cardiovascular system (such as orthostatic hypotension and autonomic dysreflexia), spleen (such as splenic atrophy and leukopenia), urinary ...

What is the best treatment for spinal cord injury? ›

Options include soft neck collars and various braces. Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery might also be needed to stabilize the spine to prevent future pain or deformity.

What is the most common complication of spinal cord injury? ›

Pressure ulcers are a common complication following SCI. Good prevention requires identifying the individuals at risk for developing pressure ulcers[49]. Pressure ulcer is the most common long term complication in SCI.

What does the term trauma mean? ›

Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.

Why are safety protocols necessary to prevent brain injuries? ›

Because the brain controls almost everything you do, it is important to protect it and prevent it from being injured. Injury prevention is important, because traumatic brain injuries can result in long-term negative effects when they are not diagnosed and treated properly.

Which of the following describes shock following a spinal injury? ›

Neurogenic shock is a condition in which you have trouble keeping your heart rate, blood pressure and temperature stable because of damage to your nervous system after a spinal cord injury. Like other types of shock, this is a serious condition that can be fatal because your blood flow is too low.

What are the chances of walking again after a spinal cord injury? ›

Approximately 80% of patients with incomplete spinal cord injury (SCI) can regain ambulatory ability after participation in a rehabilitation program. However, most of them can walk non-functionally and require a walking device.

Can spinal cord injury cause neurological problems? ›

Spinal cord injury causes inflammation which can affect the whole nervous system – this includes the brain, and the brain can be very sensitive to inflammation and pressure.

How does spinal cord injury affect breathing? ›

Cervical SCI often leads to an interruption of the descending bulbospinal respiratory pathways, resulting in respiratory muscle paresis and/or paralysis; the more rostral the level of the injury, the greater the likelihood that a major respiratory impairment will occur.

How long does it take for nerves to heal after spinal cord injury? ›

Spontaneous recovery typically plateaus at 12-18 months. However, neuroplasticity never completely goes away, and spared neural pathways are always capable of adapting, even years after SCI. The intensity that you approach your rehabilitation with also plays a crucial role in your recovery.

Can a spinal cord injury get worse over time? ›

The longer a spinal cord injury goes undiagnosed and untreated, the worse the injury may become. Paralysis does not always occur the instant a spinal cord injury happens. Symptoms may slowly manifest as the damaged area of the spinal cord bleeds and swells.

Can spinal cord injury be cured? ›

In very rare cases, people with spinal cord injury will regain some functioning years after the injury. However, only a small fraction of individuals sustaining a spinal cord injury recover all function.

What is the most common cause of spinal cord injury? ›

The leading causes of spinal cord injury are road traffic crashes, falls and violence (including attempted suicide). A significant proportion of traumatic spinal cord injury is due to work or sports-related injuries.

How long can you live with a spinal cord injury? ›

Life expectancy depends on the severity of the injury, where on the spine the injury occurs and age. Life expectancy after injury ranges from 1.5 years for a ventilator-dependent patient older than 60 to 52.6 years for a 20-year-old patient with preserved motor function.

What causes spinal injury? ›

SCIs result from damage to the vertebrae, ligaments, or disks of the spinal column or to the spinal cord itself. A traumatic SCI may stem from a sudden blow to the spine that fractures, dislocates, crushes, or compresses one or more vertebrae. Car crashes are the leading cause of SCI among people younger than 65.

How do you know if a spinal cord injury is complete or incomplete? ›

People with complete spinal cord injuries will have a loss of muscle function and sensation on both sides of the body. People with incomplete spinal cord injuries may retain varying degrees of muscle movement and sensation. A person with an incomplete injury may be able to move one arm or leg more than the other.

Which part of the spine is most vulnerable to injury? ›

The cervical spine encompasses seven vertebrae and serves as a protection to the spinal cord. The segment of the spine most susceptible to injury is the cervical spine based on its anatomy and flexibility.

What are the two types of spinal cord injuries? ›

Most cases can be divided into two types of spinal cord injury – complete spinal cord injury vs. incomplete: A complete spinal cord injury causes permanent damage to the area of the spinal cord that is affected. Paraplegia or tetraplegia are results of complete spinal cord injuries.

What are the 2 main commonly injured areas of the spine? ›

SCI results in a decrease or loss of movement, feeling, and organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas.

Why are spinal cord injuries permanent? ›

Spinal cord injuries are permanent because it's direct damage to the nerves that send signals to the brain that controls many of our functions. While modern medicine can help partially heal some of those wounds and allow some with spinal injuries to lead independent lives, there are some injuries that are permanent.

What are the signs your spine injury is serious? ›

Signs of Spine Injury

You have severe back pain that gets worse when you move. You're experiencing numbness, tingling, or weakness in your back, buttocks, and legs. You experienced a trauma and lost consciousness as a result. You're also feeling pain and stiffness in your neck and the surrounding area.

Why can't the spinal cord heal itself? ›

Damage to the spinal cord rarely heals because the injured nerve cells fail to regenerate. The regrowth of their long nerve fibers is hindered by scar tissue and molecular processes inside the nerves.

How is a spinal cord injury diagnosed? ›

Diagnostic tests for spinal cord injuries may include a CT scan, MRI or X-ray These tests will help the doctors get a better look at abnormalities within the spinal cord. Your doctor will be able to see exactly where the spinal cord injury has occurred.

What are the 2 types of spinal cord injuries? ›

What are the types of spinal cord injuries?
  • Complete: A complete injury causes total paralysis (loss of function) below the level of the injury. It affects both sides of the body. ...
  • Incomplete: After an incomplete injury, some function remains on one or both sides of the body.
1 Dec 2020

What is an example of a spinal cord injury? ›

A spinal cord injury (SCI) is damage to the spinal cord that results in a loss of function, such as mobility and/or feeling. Frequent causes of spinal cord injuries are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida, Friedreich's ataxia, etc.).

What is the most common complication of spinal cord injury? ›

Pressure ulcers are a common complication following SCI. Good prevention requires identifying the individuals at risk for developing pressure ulcers[49]. Pressure ulcer is the most common long term complication in SCI.

What are the stages of spinal cord injury? ›

Acute injury phase (less than 48 hours after the traumatic event) Subacute injury phase (48 hours to 14 days after) Intermediate injury phase (14 days to 6 months after) Chronic injury phase (6 months after and beyond)

What is the best treatment for spinal cord injury? ›

Options include soft neck collars and various braces. Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery might also be needed to stabilize the spine to prevent future pain or deformity.

Which medicine is best for spinal cord? ›

Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), gabapentin (Neurontin), muscle relaxants, anti-depressants, and painkillers. Depression is common, but there are many medications that are used to treat this disorder.

Which part of the spine is most vulnerable to injury? ›

The cervical spine encompasses seven vertebrae and serves as a protection to the spinal cord. The segment of the spine most susceptible to injury is the cervical spine based on its anatomy and flexibility.

What is the most common cause of spinal cord injury? ›

The leading causes of spinal cord injury are road traffic crashes, falls and violence (including attempted suicide). A significant proportion of traumatic spinal cord injury is due to work or sports-related injuries.

How long can you live with a spinal cord injury? ›

Life expectancy depends on the severity of the injury, where on the spine the injury occurs and age. Life expectancy after injury ranges from 1.5 years for a ventilator-dependent patient older than 60 to 52.6 years for a 20-year-old patient with preserved motor function.

What is the most common type of spinal cord syndrome? ›

Central cord syndrome is the most common form of incomplete spinal cord injury characterized by impairment in the arms and hands and to a lesser extent in the legs.

How long does it take to walk after spinal cord injury? ›

The time period a patient needs to rehabilitate depends on the patient's injury and ability to heal. Some patients can take a few weeks to regain the ability to walk, while others take several months or longer.

Why can't the spinal cord heal itself? ›

Damage to the spinal cord rarely heals because the injured nerve cells fail to regenerate. The regrowth of their long nerve fibers is hindered by scar tissue and molecular processes inside the nerves.

Can a spinal injury cause weight gain? ›

While many individuals with spinal cord injuries initially experience weight loss, many are also susceptible to weight gain later on in their recovery. This occurs because individuals continue to eat the same amount of food that they did when they were more physically active.

What part of the spine can paralyze you? ›

A person with a complete C4 level of injury is paralyzed from the shoulders down. A person with a complete T12 level of injury is paralyzed from the waist down.

How does spinal cord injury affect breathing? ›

Cervical SCI often leads to an interruption of the descending bulbospinal respiratory pathways, resulting in respiratory muscle paresis and/or paralysis; the more rostral the level of the injury, the greater the likelihood that a major respiratory impairment will occur.

Why are spinal cord injuries permanent? ›

Spinal cord injuries are permanent because it's direct damage to the nerves that send signals to the brain that controls many of our functions. While modern medicine can help partially heal some of those wounds and allow some with spinal injuries to lead independent lives, there are some injuries that are permanent.

Videos

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