Living with a Spinal Cord Injury


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.

The most important – and sometimes frustrating – thing to know is that each person’s recovery from spinal cord injury is different.

All spinal cord injuries are divided into two broad categories: incomplete and complete.

Incomplete spinal cord injuries

With incomplete injuries, the cord is only partially severed, allowing the injured person to retain some function. In these cases, the degree of function depends on the extent of the injuries.

Complete spinal cord injuries

By contrast, complete injuries occur when the spinal cord is fully severed, eliminating function. Though, with treatment and physical therapy, it may be possible to regain some function. 

Incomplete spinal cord injuries are increasingly common, thanks in part to better treatment and increased knowledge about how to respond—and how not to respond—to a suspected spinal cord injury. These injuries now account for more than 60% of spinal cord injuries, which means we're making real progress toward better treatment and better outcomes.



Some of the most common types of incomplete or partial spinal cord injuries include: 

Anterior cord syndrome

This type of injury, to the front of the spinal cord, damages the motor and sensory pathways in the spinal cord. You may retain some sensation, but struggle with movement.

Central cord syndrome

This injury is an injury to the center of the cord, and damages nerves that carry signals from the brain to the spinal cord. Loss of fine motor skills, paralysis of the arms, and partial impairment—usually less pronounced—in the legs are common. Some survivors also suffer a loss of bowel or bladder control, or lose the ability to sexually function.

Brown-Sequard syndrome

This variety of injury is the product of damage to one side of the spinal cord. The injury may be more pronounced on one side of the body; for instance, movement may be impossible on the right side, but may be fully retained on the left. The degree to which Brown-Sequard patients are injured greatly varies from patient to patient.

Knowing the location of your injury and whether or not the injury is complete can help you begin researching your prognosis and asking your doctor intelligent questions. Doctors assign different labels to spinal cord injuries depending upon the nature of those injuries. The most common types of spinal cord injuries include:

Tetraplegia

These injuries, which are the result of damage to the cervical spinal cord, are typically the most severe, producing varying degrees of paralysis of all limbs. Sometimes known as quadriplegia, tetraplegia eliminates your ability to move below the site of the injury, and may produce difficulties with bladder and bowel control, respiration, and other routine functions. The higher up on the cervical spinal cord the injury is, the more severe symptoms will likely be.

Paraplegia

This occurs when sensation and movement are removed from the lower half of the body, including the legs. These injuries are the product of damage to the thoracic spinal cord. As with cervical spinal cord injuries, injuries are typically more severe when they are closer to the top vertebra.

Triplegia

Triplegia causes loss of sensation and movement in one arm and both legs, and is typically the product of an incomplete spinal cord injury.

Injuries below the lumbar spinal cord do not typically produce symptoms of paralysis or loss of sensation. They can, however, produce nerve pain, reduce function in some areas of the body, and necessitate several surgeries to regain function. Injuries to the sacral spinal cord, for instance, can interfere with bowel and bladder function, cause sexual problems, and produce weakness in the hips or legs. In vary rare cases, sacral spinal cord injury survivors suffer temporary or partial paralysis.

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

  • Person can raise his or her arms and bend elbows.
  • Likely to have some or total paralysis of wrists, hands, trunk and legs
  • Can speak and use diaphragm, but breathing will be weakened
  • 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

  • Nerves affect wrist extension.
  • Paralysis in hands, trunk and legs, typically
  • Should be able to bend wrists back
  • Can speak and use diaphragm, but breathing will be weakened
  • Can move in and out of wheelchair and bed with assistive equipment
  • May also be able to drive an adapted vehicle
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C7 injury

  • Nerves control elbow extension and some finger extension.
  • Most can straighten their arm and have normal movement of their shoulders.
  • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
  • May also be able to drive an adapted vehicle
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C8 injury

  • Nerves control some hand movement.
  • Should be able to grasp and release objects
  • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
  • May also be able to drive an adapted vehicle
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

Thoracic Nerves (T1 – T5)

Thoracic vertebrae are located in the mid-back.

  • 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 function in 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

Christopher & Dana Reeves understand how frightening it is to suddenly become paralyzed. Being active one day and immobile the next thrusts you suddenly into an entirely new existence. The changes are enormous and often overwhelming.First, let us assure you that you are not alone. In the United States,there are 1.25 million people living with paralysis caused by spinal cord injury, and hundreds of thousands of others with paralysis caused by other types of trauma or disease. Although it’s a club no one would choose to join, there are people who have gone through similar situations who are eager to help you maximize your health and well-being.

The PRC was created by the Christopher & Dana Reeves Foundation to provide information services and resources on the full range of topics related to paralysis, including specific health and clinical information on the various conditions that cause paralysis,whether by stroke, trauma or disease. We have strong ties with many national organizations to make sure you get the most relevant and reliable information.

DOWNLOAD THE PARALYSIS RESOURCE GUIDE


Follow Recommendations

To ensure that you receive the proper rehabilitation after your spinal cord injury, follow the instructions of your doctor or therapist. This can include attending regularly scheduled medical appointments for continued therapy and follow-up.

Take Steps to Overcome Grief

Seek the professional help of a counselor, psychiatrist, psychologist, social worker, or other mental health provider if you have persistent feelings of anxiety, sad- ness, and anger about your spinal cord injury.

Educate Yourself as much as Possible

Explore the resources that are offered by local groups, state support groups, and nationally recognized spinal cord injury organizations. Be cautious of searching the Internet for topics related to spinal cord injury; instead, rely on websites from reputable organizations that have consolidated information, checklists, and helpful tools.

Communicate Effectively

Keep the lines of communication open among family and friends. Convey how you are feeling and what you are thinking. Your family and friends also may be adjusting to your spinal cord injury.

Never Ignore Pain

If you have pain related to cord injury, speak with your doctor. Complementary therapies such as acupuncture, guided imagery, biofeedback, hypnosis, and yoga can reduce pain. They also may help you cope with stress and improve your emotional and physical well-being.

Make Nutrition a Focal Point

Eating a healthy diet can help you reduce your risk of some complications of spinal cord injury. Good nutrition can help you reach and stay at a healthy weight. Being either underweight or overweight increases your risk of pressure sores.

Continue to Exercise

While in rehab, your rehab team will help you to do various exercises to ensure movement. You may be able to do flexibility exercises on your own or with assistance. Strength exercises with free weights or weight machines also can be beneficial.

Maintain Your Mobility

Mobility is an important part of a spinal cord injury. With the help of mobility devices such as scooters, crutches, walkers, or wheelchairs, you can become independent. These devices may allow you to work, shop, or travel.



Questions and Answers About Medicare for Caregivers 

Challenges, Changes, and Choices: A Brain Injury Guide for Families and Caregivers

Caregiving Tips

  • It is often difficult for an individual with TBI to multitask, so give one instruction at a time. Try using lists and memory notebooks. A calendar is also a helpful tool
  • to organize daily tasks.
  • Be sensitive to the issue of fatigue. If your family member seems tired or overwhelmed, suggest they take a break.
  • Find a case manager to help you navigate your loved one’s needs and become educated on necessary resources.
  • Establish a routine in which your family member pre-plans activities for the day. Scheduling the most important activities for the morning is a good idea, because energy levels tend to decline over the course of the day. Remember that your loved one will have good days and bad days, both emotionally and physically. This is a normal part of recovery.
  • Attend visits to the medical provider with your family member. Ask questions and take notes.
  • Be supportive and patient, but also remember to take care of yourself. If you find yourself completely overwhelmed or you feel yourself “losing it,” take a moment and call someone —
  • a friend, a family member, or support line are all good places to start. Support groups may also be available in your community.
  • Visit your doctor regularly, and get plenty of rest so you can stay strong. Remember, you are doing the best you can and you are making a difference in your loved one's life.

Additional Resources