What can I expect after spinal cord injury?

Level of Injury

The level of injury refers to the lowest point on the spinal cord below which there is a decrease or absence of feeling and/or movement. The higher the spinal cord injury is on the vertebral column, or the closer it is to the brain, the more extensive the injury's effect will be on the body's ability to move and feel. A lower level of injury will mean more movement, feeling and voluntary control of the body's systems. For example, a person with a C-5 level of injury has a decrease or loss of feeling and movement below the base of the neck. An injury at the L-1 level means the individual has a decrease or loss of feeling and movement below the first lumbar spinal cord segment, in the low back. A person whose injury was at L-1 would have more feeling and movement than someone with a C-5 level of injury.

Tetraplegia refers to the condition of a person with a spinal cord injury that is at a level from C1 to T1. In tetraplegia, formerly called quadriplegia, the person sustains a loss of feeling and/or movement in their head, neck, shoulder, arms and/or upper chest.

Paraplegia is the general term for the loss of feeling and/or movement in the lower parts of the body. The body parts that may be affected are the chest, stomach, hips, legs and feet. An injury anywhere from T2 down to S5 results in paraplegia.

Levels of injury and affected areas

Neck: Cervical (neck) injuries usually result in quadriplegia.

C-1 to C-4: These very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe. A person with an injury at this level will require a mechanical ventilators or diaphragmatic pacemakers.

C-5: C-5 injuries often result in loss of control at the wrist or hand; shoulder and biceps control are not affected.

C-6: C-6 injuries generally leave a person with wrist control, but no hand function.

C-7 and T-1: Individuals with C-7 and T-1 injuries can straighten their arms but may have dexterity problems with the hand and fingers.

T-1 to T-8: Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control.

T-9-T12: Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and sacral injuries yield decreasing control of the hip flexors and legs.

Complete or incomplete injury

The amount of feeling and movement that an individual retains also depends on whether the injury is complete or incomplete. A complete injury, usually caused by a complete severing of the spinal cord means there is no motor or sensory function in the S4 or S5 area, or anal area. If there is evidence of any motor or sensory function in this area, one of three classifications is given.

Some people with an incomplete injury may have feeling, but little or no ability to move. Others may have movement and little or no feeling. Every incomplete spinal injury is unique because the amount of damage to each person's nerve fibers is different. Because of these individual variations it is impossible to accurately predict how much of an individual's sensory and motor function will return. An individual whose injury is incomplete generally stands a greater chance of recovering of some or all his/her motor and sensory function.

The level and location of injury is instructive in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses.

Changes after the initial damage

Sometimes the initial injury only bruises the spinal cord, or causes it to swell. As the swelling goes down and the pressure on the nerves is relieved, the nerves may begin to work again. There are no tests to predict whether any nerves, or how many, will begin to work again or when this will occur. This makes it impossible for medical staff to guarantee how much or when function may return.

Some individuals have involuntary movements, such as twitching or shaking. These movements are called spasms. Spasms are not a sign of recovery. A spasm occurs when a wrong message from the nerve causes the muscle to move. The individual often can not control this movement.

In addition to movement and feeling, a spinal cord injury affects how other systems of the body work. An individual with SCI learns new ways to manage his/her bladder and bowel. His/her skin and lungs often need special care and attention to stay healthy. There may also be changes in sexual function.

Functional goals after spinal cord injury

Functional goals are a list of realistic expectations for activities that a person with a particular level of spinal cord injury eventually can look forward to performing. Functional goals are developed in the course of rehabilitation, and are shaped by individual considerations such as the person’s body type, general health, fitness level and any other health concerns. These goals are set during rehabilitation with the medical team. Having functional goals helps a person in rehab focus on what he or she can realistically achieve, develop new ways to manage his/her daily activities and stay healthy, and achieve maximum independence.

The Spinal Cord Injury Information Network based at the University of Alabama School of Medicine has developed a chart, Functional Goals for Specific Levels of Complete Injury, that outlines the expected functional goals for a person with a complete injury (i.e. no movement, no sensation) at each vertebral level. The entire chart can be seen at http://www.spinalcord.uab.edu/show.asp?durki=30166. In general the higher up the spinal column the injury is, the more limited the person’s functional goals will be.