This article will go over everything you need to know about a C1 spinal cord injury (SCI) including:

• The Anatomy of the Spinal Column
• Diagnosing a C1 Spinal Cord Injury
• Effects of a C1 SCI
• Potential Complications
• Recovery Outlook
• Management Techniques

Anatomy of the Spinal Column

The spinal cord is comprised of nervous tissue extending down the back from the base of the brain. It serves to connect the brain with the rest of the body. As such, the spinal cord is essential for transmitting messages regarding movement and sensation between the brain and the rest of the body. When the spinal cord is damaged, messages regarding movement and sensation may be disrupted, resulting in motor and/or sensory impairments.

The cervical region of the spinal cord, located in the neck area, is encased within the 7 cervical vertebrae at the top of the spinal column. Pairs of spinal nerves branch off of the spinal cord, exiting the spinal column above their corresponding vertebrae.

The C1 and C2 vertebrae are different from other vertebrae in terms of shape and function. Despite being the smallest vertebrae in the entire spinal column, they form the joints responsible for movement of the head.

The C1 vertebra (also known as the atlas) is the uppermost vertebra of the spinal column. It connects to the base of the skull, forming the atlanto-occipital joint. This joint allows the head to nod up and down.

Underneath the atlas lies the C2 vertebra (also known as the axis). The axis has a small, peg-like projection called the dens. The dens points upwards into the ring-shaped atlas to form the atlanto-axial joint, which allows the head to turn side to side. Because the C1 and C2 vertebrae are so closely aligned, injuries to these vertebrae often occur together. The atlas and axis are crucial because they stabilize the skull, enable neck movement, and protect the spinal cord.

The C1 spinal nerves exit the spinal cord just above the atlas. While all other pairs of spinal nerves have a sensory component that transmits sensory information to the brain and a motor component that allows the brain to tell the muscles to move, the C1 spinal nerves typically have only a motor component.

The C1 spinal nerves, as well as the C2 spinal nerves, are responsible for the muscles involved with nodding the head. However, since the C1 nerves do not have a sensory component, there is not a specific area of sensation associated with the C1 spinal nerves.

After a C1 spinal cord injury, information from the C1 spinal nerves can still be transmitted from the brain to the rest of the body. However, the transmission of all sensory and motor messages below this level may be affected, potentially resulting in a loss of movement and sensation in the neck, arms, legs and trunk.

Diagnosing a C1 Spinal Cord Injury

Because C1 is the uppermost level of the spinal cord, a C1 spinal cord injury can affect motor control and sensation throughout the entire body, with the exception of the face.

This occurs because messages between the brain and areas below the level of injury are unable to be transmitted through damaged areas of the spinal cord.

When an individual sustains a spinal cord injury, a physician will test their sensory and motor functions in accordance with the American Spinal Injury Association (ASIA) Exam. This allows them to determine both the level and severity of the injury.

The level of injury refers to the lowest segment of the spinal cord where motor control and sensation remain intact. In the case of a C1 spinal cord injury, functions associated with the C1 spinal nerves are left intact, but all other sensory and motor functions may be impaired. This is because messages between the brain and body cannot pass through damaged areas of the spinal cord.

However, depending on the severity of the injury, a C1 spinal cord injury may not result in a total loss of motor control and sensation throughout the body.

A complete SCI is the most severe type of spinal cord injury, and refers to spinal cord damage that completely severs the spinal cord. When a complete spinal cord injury occurs, all connections between the brain and areas of the body below the level of injury are cut off, resulting in a loss of all movement and sensation below the level of injury.

In contrast, an incomplete SCI refers to when the spinal cord is only partially damaged at the level of injury. Incomplete spinal cord injuries result in spared neural connections, allowing the brain to still send and receive some messages with areas of the body below the level of injury. Thus, individuals with incomplete spinal cord injuries will have some movement and/or sensation below their level of injury.

While the ASIA exam can help to identify the severity of a spinal cord injury, often a CT scan or MRI is used to more conclusively determine whether the injury is complete or incomplete.

Generally, the milder the spinal cord injury, the more spared neural pathways exist, and the greater the recovery outlook.

Effects of a C1 Spinal Cord Injury

Since a C1 spinal cord injury is the highest level spinal cord injury that can occur, it has the possibility to affect the most functions. Although the effects of a C1 spinal cord injury may vary based on severity, many individuals experience the following:

1. Breathing Difficulties

Without immediate medical attention, C1 spinal cord injuries are typically fatal. The C3-C5 spinal nerves connect to the the main muscle involved with breathing, which is called the diaphragm. Because messages from the brain may not be able to get past the C1 level of the spinal cord, individuals may not be able to breathe.

The main priority when treating someone with a C1 SCI is to stabilize their breathing. Individuals generally require ventilator assistance to restore adequate respiration patterns.

Due to breathing difficulties, individuals may also experience difficulties with projecting their voice when communicating.

2. Loss of Movement and Sensation

A C1 spinal cord injury has the potential to affect movement and sensation throughout the entire body, with the exception of the face. This is because facial movement and sensation is controlled by cranial nerves, which bypass the spinal cord and connect directly to the brain.

Since survivors of a C1 spinal cord injury have such significant sensation and motor deficits, they are typically unable to complete their daily activities independently.

3. Lack of Independence with Daily Activities

As a C1 spinal cord injury can cause paralysis of nearly the entire body, survivors require the full-time assistance of a caregiver to perform activities of daily living like bathing, grooming, feeding, and toileting. While a spouse or other family member may be a survivor’s primary caregiver, many choose to hire a caregiver to help with daily tasks.

4. Bladder and Bowel Dysfunction

Bowel and bladder functions are connected to the lowest segments of the spinal cord. When messages to and from the bowel and bladder cannot pass through damaged portions of the spinal cord, survivors may experience changes to their bowel and bladder functions.

As a result, C1 spinal cord injury survivors may not be able to control their bowel or bladder muscles properly or sense when their bladder or bowels are full. This causes survivors to be susceptible to leaking, accidents, and/or constipation.

To prevent bowel and bladder-related accidents from occurring, individuals with C1 SCIs need to follow a bowel and bladder program.

It is essential for C1 spinal cord injury survivors to properly manage these effects to reduce the risk of complications.

Potential Complications of C1 Spinal Cord Injury

Because a C1 spinal cord injury can significantly change an individual’s motor control and sensation throughout the entire body (with the exception of the face), survivors are likely to experience complications. Understanding potential complications that may arise can help survivors be better prepared to manage them.

1. Body Composition Changes

Since spinal cord injuries at the C1 level can result in paralysis of most of the body, individuals often experience physical changes to the body as a result of limited active movement.

Consequences of reduced physical activity include:

• Decreased bone density
• Muscle atrophy (shrinking)
• Circulation problems
• Slower resting metabolic rate

With these potential complications, individuals may lose a substantial amount of weight in the weeks after their injury due to reduced bone density and muscle mass. Alternatively, some individuals gain weight if they continue to eat similar quantities of food as before their injury, since limited movement reduces the number of calories required.

To minimize significant body composition changes, consider working with a dietician to establish a healthy, nutrient-rich diet.

2. Pressure Sores

If individuals lose sensation after a C1 SCI, they likely won’t feel uncomfortable when sitting or lying in the same position for prolonged periods. However, failure to frequently change positions places excessive pressure on certain parts of the skin, usually in bony areas.  This can cut off blood flow and cause the skin to break down. Areas of skin breakdown due to prolonged pressure are known as pressure sores or pressure ulcers.

To prevent pressure sores from developing, change positions every two hours when lying in bed or every half hour when sitting in a wheelchair.

3. Autonomic Dysreflexia

Autonomic dysreflexia is a potentially life-threatening condition characterized by a spike in blood pressure due to stimulation below the level of injury. The most common triggers of autonomic dysreflexia are a full bladder, distended bowels/constipation, tight clothes, skin irritations, and extreme temperatures.

Other symptoms of autonomic dysreflexia include a severe headache, sweating, and shortness of breath.

Limiting exposure to triggers is often the best way to avoid autonomic dysreflexia.

While it is possible to experience serious complications following a C1 spinal cord injury, it is also possible for some to experience great functional improvements through rehabilitation.

C1 Spinal Cord Injury Recovery Outlook

Depending on the severity of one’s C1 spinal cord injury, the recovery outlook will vary.

Since individuals with incomplete spinal cord injuries have some existing neural connections between the brain and the rest of the body, they often have the greatest potential for functional recovery.

This is because the spinal cord is capable of utilizing neuroplasticity, the central nervous system’s ability to rewire itself. Neuroplasticity allows affected sensory and motor functions to be rewired to healthy areas of the spinal cord. Completing targeted, repetitive exercises and activities is the best way to optimize neuroplasticity for recovering functions following an incomplete spinal cord injury.

As individuals with complete spinal cord injuries do not have any neural connections remaining between the brain and the rest of the body at the level of injury, they are unable to utilize neuroplasticity to recover lost functions. However, they can still learn to live fulfilling lives by focusing on compensatory tactics.

Furthermore, new research is being conducted focused on improving functional abilities following high-level spinal cord injuries. This includes studies on stem cell therapy and epidural stimulation, both of which show promising results in promoting functional improvements following a complete spinal cord injury.

Management Techniques After a C1 Spinal Cord Injury

Pursuing rehabilitation is an excellent way to promote recovery after a C1 spinal cord injury. Rehabilitation may include a combination of restorative techniques and compensatory tactics. Restorative techniques focus on improving affected functions, while compensatory tactics focus on optimizing independence with the survivor’s current abilities.

The following are some of the most common types of rehabilitation following a C1 spinal cord injury:

• Physical therapy focuses on maximizing mobility through targeted exercises, manual therapy, and modalities (such as electrical stimulation). Physical therapists can also help survivors and their caregivers learn to safely perform transfers, such as moving from the wheelchair to the bed. If individuals have sustained an incomplete spinal cord injury, physical therapy can help increase movement and strength below the level of injury. Carrying over exercises learned in therapy through a home program is also essential for recovery, as increased repetitions of exercises maximizes neuroplasticity.
• Occupational therapy is centered on optimizing the survivor’s independence and safety with daily tasks. While occupational therapy may include practicing activities of daily living, such as grooming, dressing, and toileting, more often occupational therapists introduce compensatory tactics to help you become as functional as possible. This can involve learning how to use adaptive tools and equipment, such as an eye-gaze controlled power wheelchair. Occupational therapy can also include caregiver training, recommendations on home modifications, and safety education.
• Speech therapy can help you address respiratory and communication difficulties. Speech therapists may use breathing or coughing exercises, voice projection training, or augmentative and alternative communication (AAC) devices to optimize a survivor’s breathing and communication abilities. Depending on the survivor’s abilities and preferences, speech therapists can recommend various types of AAC devices, from a simple paper chart with words and letters to advanced technological software. These devices can allow individuals to communicate through blinking or through their eye gaze if they are unable to communicate vocally.
• Psychotherapy can help survivors and their families cope with the emotional and psychological outcomes of SCI. A psychotherapist can provide helpful insight and resources. Many survivors and their families also choose to join a virtual or in-person support group to share experiences, discuss challenges, and learn from others in similar circumstances.

Pursuing rehabilitation can allow C1 spinal cord injury survivors to optimize and potentially improve their abilities in order to lead fulfilling, engaged lives.

While all C1 spinal cord injury survivors are different, many are able to independently move through their homes and communities using an eye-gaze controlled power wheelchair. Power wheelchairs can be equipped with an attachment for a gaze controlled communication device, allowing survivors to communicate without assistance.

Survivors typically will require full assistance with all daily tasks, including dressing, bathing, toileting, and eating. However, medical equipment providers can help supply individuals with appropriate devices to make all of these tasks doable within one’s own home.

Individuals with C1 spinal cord injuries can also engage in a variety of hobbies, including reading or playing games online with a gaze controlled device, exploring paved paths, or watching sports events. Some survivors may even choose to return to work.

While daily life after a C1 spinal cord injury may look different, survivors can still have an excellent quality of life.

Understanding C1 Spinal Cord Injury

A C1 spinal cord injury can affect functions throughout the entire body, with the exception of the face. However, depending on the severity of injury, motor impairments and loss of sensation will vary.

C1 SCIs are extremely dangerous and often fatal because they can affect one’s ability to breathe. Therefore, it’s essential to seek immediate medical attention.

Life after a C1 spinal cord injury often requires significant lifestyle changes. With the support of your caregivers, rehabilitation specialists, and loved ones, learning to cope and adapt is possible.

The post C1 Spinal Cord Injury: Diagnosis, Effects, & Recovery Process appeared first on Flint Rehab.

This article helps survivors and families understand what to expect after a C2 spinal cord injury, including functions that may affected at this level of cervical spinal cord injury. . It also highlights various rehabilitative interventions that can promote recovery.

Use the links below to jump straight to any section of this article.

• Anatomy of the cervical spinal cord
• Factors affecting spinal cord injury outcomes
• Functions affected
• Treatment options
• Recovery outlook
• A day in the life

Anatomy of the Cervical Spinal Cord

The spinal cord is a bundle of nerves that connects the brain with the rest of the body. The spinal (or vertebral) column protects the cervical spinal cord, consisting of 33 vertebrae that span from the base of the skull to the tip of the tailbone.

As the spinal cord travels through the spinal column, 31 pairs of spinal nerves exit to the right and left sides of the body. These nerves carry messages about the body’s sensation and movement to and from the brain.

Since the spinal cord transmits information between the brain and the rest of the body, it is a vital portion of the nervous system. Damage to the spinal cord can affect sensory and motor functions throughout the rest of the body.

Where is C2 on the Spine?

The spine has five regions. The top region – located in the neck area – known as the cervical spine contains 7 vertebrae and 8 pairs of spinal nerves that exit between the vertebrae.

The first cervical vertebra, called C1 or the atlas, and the second, called C2 or the axis, support the skull and enable head movement. These two vertebrae make up the top of the spinal column. They are essential for supporting the skull, providing neck mobility, and protecting the spinal cord.

The junction where the skull and the C1 vertebra meet forms a joint that allows the head to nod. Conversely, the joint between the C1 and C2 vertebrae allows the head to turn left and right.

The spinal nerves at each level of the spinal cord connect to, or innervate, a specific area of skin for sensation and set of muscles for movement. The C2 nerves carry information regarding sensation of the top and back of the scalp, the ear lobes, and the front of the neck. They also carry messages to the muscles involved with neck flexion (nodding).

Factors Affecting Spinal Cord Injury Outcomes

There are two main factors that influence the effects of a spinal cord injury: the level of injury and its severity.

Level of Injury

The level of injury refers to where the damage to the spinal cord occurred. Each pair of spinal nerves connects to a different area of the body. Generally speaking, higher-level spinal nerves carry information regarding the upper body, and lower-level spinal nerves carry information regarding the lower body.

Because damaged areas of the spinal cord can’t transmit information, the level of injury is defined as the lowest segment of the spinal cord where normal function remains intact.

Survivors of a high-level spinal cord injury may lose sensation and movement of the majority of their body. Those with a lower-level injury may retain control of the upper portion of their body, while experiencing a loss of functions in the lower body.

Severity

The severity of a spinal cord injury depends on how completely the spinal cord is severed.

During a complete injury to the spinal cord, signals from the brain cannot pass through the lesion, meaning that all functions innervated below the level of injury will be interrupted.

On the other hand, during an incomplete spinal cord injury, some connections within the spinal cord remain intact. This allows some sensory and/or motor information to still be transmitted, meaning that not all sensation and/or movement below the level of injury will be affected.

Since there are some existing neural connections in the spinal cord, those with incomplete SCIs have a greater likelihood of recovering lost functions. Functional outcomes can vary significantly depending on the level and severity of the injury.

Functions Affected by a C2 Spinal Cord Injury

Depending on the injury’s severity, C2 spinal cord injury survivors may experience a wide variety of functional outcomes. Here are some of the major functions that can be affected by a C2 SCI.

Breathing and Speaking

Individuals with C2 spinal cord injuries may experience difficulties breathing independently. This is due to impaired function of the diaphragm, the main muscle responsible for respiration. As a result, C2 SCIs are often fatal and require immediate medical attention. Many need the assistance of a ventilator to breathe and may consequently struggle to speak.  

Sensation Below the Neck

Individuals with C2 spinal cord injuries can experience impaired sensation from the neck down.

Sensory information travels from the body through the nerves and up the spinal cord before reaching the brain. Then, the brain processes that information and reacts. For example, when you touch something hot, sensory information travels to the brain and the brain sends a message to muscles, telling them to move your hand.

After a C2 SCI, sensory messages from the neck down may not be able to reach the brain, resulting in loss of sensation throughout the entire body, with the exception of the head. This can be extremely dangerous and requires survivors and their caregivers to be more mindful of potential hazards in the surrounding areas.

Paralysis from the Neck Down

A C2 spinal cord injury may result in quadriplegia (paralysis of the upper and lower limbs). Because a severe C2 spinal cord injury can affect the arms, legs, and trunk, survivors typically need full-time caregiver assistance to perform daily activities like eating, dressing, and repositioning in bed.

Complications that can result from being paralyzed from the neck down including:

• Development of pressure sores. If survivors sit or lie in the same position for extended periods, the prolonged pressure can result in skin irritation and breakdown. Ensuring that the survivor changes position at least every 2 hours can reduce the likelihood of pressure sores developing.
• Changes in body composition. Paralysis from the neck down results in muscle atrophy, which means that the muscles shrink from lack of use. Loss of muscle mass can affect circulation, slow the metabolism, and increase susceptibility to further injuries.
• Bladder and bowel dysfunction. The lowest level spinal nerves connect to the bowel and bladder muscles. Therefore, most spinal cord injuries will result in at least some bladder and bowel problems. As a result, C2 spinal cord injury survivors often need to utilize catheterization and other bladder and bowel management techniques.

While these effects of spinal cord injury can greatly affect one’s life, there are numerous treatment options available to manage the effects of C2 SCI and promote recovery.

C2 Spinal Cord Injury Treatment

Although spinal cord damage can’t be reversed, individuals with C2 spinal cord injuries can still improve their quality of life through rehabilitation and supportive care. They can achieve this by minimizing further damage, maximizing functional abilities, and, for those with incomplete injuries, promoting neuroplasticity.

Immediate treatment for a C2 spinal cord injury generally involves two components:

• Restoring respiratory function. The most urgent priority when treating a C2 spinal cord injury is stabilizing respiratory function. Individuals with complete C2 SCIs have high mortality rates due to impaired diaphragm function. Without immediate medical attention, individuals may be unable to breathe. A ventilator can help restore respiratory function by supporting or replacing the effort to breathe.
• Stabilizing the spinal cord. Depending on the severity of one’s C2 spinal cord injury, decompression surgery may be required to reduce pressure on the spinal cord. Corticosteroids like Methylprednisolone may help reduce inflammation, which can contribute to minimizing the progression of secondary damage.

Once the initial effects of a C2 spinal cord injury have stabilized, survivors are encouraged to begin rehabilitation. Because a C2 spinal cord injury can cause paralysis throughout the body, rehabilitation focuses on identifying preserved functions and maximizing their potential.

Rehabilitation after a C2 SCI can consist of:

Physical Therapy

Physical therapy helps survivors improve their functional mobility through targeted exercises. Especially helpful for those with incomplete spinal cord injuries, physical therapy may include manual techniques, electrical stimulation, and active and passive exercises to maximize mobility and promote recovery.

Occupational Therapy

Occupational therapy teaches survivors and their caregivers how to manage everyday life after SCI. Rehabilitation may include caregiver training to safely and efficiently assist with daily tasks such as transfers, dressing, and managing bowel and bladder care. Rehabilitation may also address safety concerns related to sensation deficits, helping prevent injuries that might go unnoticed due to reduced feeling.

In addition, occupational therapists often recommend adaptive devices and assistive technology, such as voice activated or eye gaze-controlled devices, to optimize independence.

Speech Therapy

Speech therapy can be an essential component of rehabilitation after a C2 spinal cord injury. Therapists may address difficulties with breathing and voice projection through respiratory muscle training. Practicing breathing exercises can help improve lung capacity and residual volume to improve ease and efficiency of breathing. Likewise, coughing exercises may help improve your ability to clear lung secretions. For individuals who are unable to project their voices well enough to be heard, speech therapists may recommend augmentative and alternative communication (AAC) devices, which may rely on eye blinks or gaze to operate.

Psychotherapy

Living with a C2 SCI can be just as much a mental challenge as it is a physical one. Psychotherapy can help you cope with the emotional and psychological effects of SCI. Survivors and their family members can also benefit from participation in a support group for this reason.

Medical Equipment Providers  

Many C2 SCI survivors work with a medical equipment provider to ensure they have the appropriate devices for day-to-day life. Medical equipment providers often work in conjunction with a therapist in order to recommend equipment such as a power wheelchair, pressure-relief mattress, and orthotics. Orthotic devices like braces or splints provide structural support that can help you sit upright, lightly stretch spastic (tight) muscles, and improve alignment.

Each of these areas of rehabilitation can be important components to promoting recovery after a C2 spinal cord injury.

Recovery Outlook Following a C2 Spinal Cord Injury

Many individuals with C2 spinal cord injuries learn to adapt and/or improve their mobility and sensation by participating in a rehabilitation program. Individuals with incomplete spinal cord injuries have a better recovery outlook in terms of recovering affected functions than those with complete spinal cord injuries.

This is because those with incomplete SCIs have some remaining neural connections left intact, allowing some communication between the brain and the rest of the body to occur even below the level of injury. The spinal cord is able to optimize its function through these existing connections through a process called neuroplasticity.

Neuroplasticity refers to the central nervous system’s ability to adapt, rewire and repair itself. In the case of spinal cord injuries, neuroplasticity allows the transmission of information regarding affected functions to be rewired to a healthy area of the spinal cord.

Neuroplasticity is best promoted through repetitive exercises and activities. Therefore, participation in a rehabilitation program, and carrying over exercises using a home exercise program, is a great way to promote recovery.

Although those with complete spinal cord injuries are unable to utilize neuroplasticity, they can learn to adapt using compensatory strategies. While conventional rehabilitation cannot help those with complete spinal cord injuries regain function, many researchers are looking to remedy this.

Methods such as stem cell therapy and epidural stimulation are currently being researched as options to help those with complete spinal cord injuries achieve a better recovery outcome.

A Day in the Life of a C2 Spinal Cord Injury Survivor

It can be hard to picture what the life of a C2 spinal cord injury survivor would look like. Although being paralyzed from the neck down can limit what C2 SCI survivors can complete independently, they can still find ways to live productive, fulfilling lives.

Most individuals with C2 spinal cord injuries require caregiver assistance for getting out of bed, dressing, showering, and managing bowel and bladder needs. If set up appropriately, survivors can drink water or a smoothie independently using a straw. They could choose to chat, look outdoors, or read on a device while eating their breakfast.

After getting ready for the day, many survivors are able to use an eye-gaze controlled power wheelchair to move independently throughout their home and community. They can communicate either verbally or using a communication device.

Typically, survivors have an attachment on their power wheelchair to allow them to see and use their communication device or a gaze-controlled tablet. Throughout the day, survivors are recommended to frequently change position to relieve pressure from the bony parts of their body by utilizing a tilt-in-place function on their wheelchairs.

Some C2 survivors may continue working. Others may pursue therapy or engage in recreational activities, such as online gaming or reading. Still others, especially if they have regained some function, could explore a national park using a rental track chair.

Although a C2 spinal cord injury can drastically change the life of the survivor, there are many ways to continue to engage in and enjoy life.

Christopher Reeve C2 Spinal Cord Injury

For example, Christopher Reeve, an actor best known for his role as Superman, sustained a C2 spinal cord injury at the age of 43. After his injury, he vigorously pursued rehabilitation. He also continued working, directing multiple movies and publishing a few books. However, arguably his most important role after his injury was establishing the Christopher Reeve Foundation, an organization focused on spinal cord injury research, advocacy, and support. 

Although life may be different after a C2 spinal cord injury, there are many ways to adapt and lead an engaging and fulfilling life.

Understanding C2 Spinal Cord Injury

A C2 SCI can affect movement and sensation from the neck down. However, depending on the severity of their injury, survivors may be able to move and feel areas innervated below their level of injury.

After stabilizing the initial injuries, survivors can pursue rehabilitation to manage and improve their functions. Life may look different after a C2 spinal cord injury, but it can still be very fulfilling.

The post C2 Spinal Cord Injury: Understanding the Effects, Treatment, & Recovery Process appeared first on Flint Rehab.

This article will discuss what occurs in the aftermath of a C7 spinal cord injury and how to boost the recovery process. Use the links below to jump straight to any section:

• Effects
• What to Expect
• Incomplete vs. Complete C7 SCI
• How to Regain Movement
• Complications
• Recovery Process

The Potential Effects of a C7 Spinal Cord Injury

Injury to the cervical nerves of the spinal cord often leads to the most severe damage and loss of function because they are closer to the brain. Survivors may experience different outcomes depending on the severity and level of injury. The level of injury refers to the lowest region of the spinal cord where sensation and motor function exist.

Individuals with a C7 spinal cord injury in particular may have limited or absent sensation (feeling) or movement below the shoulders and/or neck. This can make it difficult to move or feel anything in the lower body, trunk, and sometimes even in the hands and fingers.

Spinal cord nerves innervate, or connect to, different parts of the body and can control both sensation and movement. The different areas these nerves innervate are called dermatomes and myotomes, which can be “tested” for function by a doctor or therapist. 

Dermatomes are regions of the skin supplied by sensory neurons from a single spinal nerve. When sensation is not felt at a certain dermatome, it can indicate that sensory information related to that spinal nerve cannot reach the brain. The C7 dermatome can be tested with a pinprick or light touch at the middle finger.

Spinal nerves also innervate different groups of muscles, called myotomes. The muscles innervated by the C7 spinal cord root include the triceps, wrist flexors, and finger extensors. These are essential for certain functions such as straightening the elbows and bending the wrists.

What to Expect After a C7 Spinal Cord Injury

Generally speaking, the lower the level of injury, the higher the possibility of sensation and mobility existing in different areas of the body. Higher-level spinal cord injuries may require regular caregiver assistance. However, survivors with a C7 spinal cord injury often have upper body control and can perform many activities independently.

Studies have shown that individuals with a C7 spinal cord injury can have many upper body functions remain intact. This can include sensation in the head, neck, clavicle, shoulders, outer arms, thumbs, and fingers.

Other functions may include full control of the head, neck, shoulders, elbows, and wrists. Individuals with an injury at the C7 level also have control of actions such as breathing, speaking, and chewing independently, and can even have trunk or postural control.

Because a C7 spinal cord injury allows for use of the triceps and wrist extensors, survivors may also be able to transfer (move from one surface to another) and use a manual wheelchair on their own. However, it’s important to avoid overworking or injuring the arms and shoulders, especially when using a manual wheelchair.

With the help of adaptive equipment such as hand controls, some individuals with a C7 spinal cord injury can even drive a car independently. It can help to talk with your occupational and/or physical therapist to discuss what adaptive equipment or modifications will be best for your specific needs.

Incomplete vs. Complete C7 Spinal Cord Injury

The severity of a C7 spinal cord injury depends on whether the injury was complete or incomplete. A complete spinal cord injury means the spinal cord was fully severed, and there is no movement or sensation below the level of injury. In an incomplete spinal cord injury the spinal cord is only partially severed, with some spared neural pathways for movement and sensation remaining below the level of injury.

Neural pathways may become damaged or destroyed after a C7 spinal cord injury, making it difficult for the brain to communicate with the body via the spinal cord. Fortunately, spared neural pathways can be strengthened and new ones created with the help of neuroplasticity, the nervous system’s ability to rewire itself.

Neuroplasticity helps restore communication between the brain, spinal cord, and muscles to eventually improve function. While a complete injury indicates no movement or sensation below the level of injury, individuals with incomplete injuries have higher chances of regaining function through neuroplasticity.

How to Regain Movement After Spinal Cord Injury

To activate neuroplasticity, the nervous system must be stimulated through high repetition of exercises, or massed practice. The more a function is practiced, the stronger its neural pathways will become. This does not mean, however, that individuals with a complete injury cannot make improvements in strength and function—in fact, just the opposite!

Your therapist can provide you with the therapeutic exercises that are safe and optimal for you. This can include a variety of active exercises and passive range of motion exercises. Passive exercise involves using the assistance of your non-affected limbs or a therapist to help move your affected muscles through their full range of motion.

Performing passive exercises with the help of your therapist or trained caregiver is a great way to promote movement in the affected muscles and stimulate neuroplasticity. This is beneficial to help the nervous system heal, improve blood circulation in the body, and prevent your joints from stiffening.

Every spinal cord injury is different and the rehabilitation process may look different for everyone. Depending on the severity, some may encounter positive results more swiftly than others. To boost your motivation during recovery, it helps to focus on what you can do rather than what you cannot just yet.

Over time, with consistent practice, you can increase the chances of recovery from a C7 spinal cord injury. It is essential to prioritize movement during the recovery journey as this helps lower the risk of further injury or other complications of a spinal cord injury.

Potential Complications of a C7 Spinal Cord Injury

A C7 spinal cord injury results in loss of movement and sensation, which can affect other functions in the body. The more severe an injury, the higher the risk of developing complications such as pressure sores.

Pressure sores typically develop in bony areas such as the elbows, sit bones, tailbone, hip bones, heels, ankles, and knees. Remaining in the same position for prolonged periods of time can cause excess pressure to build up, especially at these bony areas.

This increased pressure can restrict blood flow and cause the skin to break down. If left untreated, this skin breakdown can worsen and even cause damage to underlying bones or joints. Pressure sores can also increase the risk of developing other complications like infection.

To prevent pressure sores from developing, be sure to change positions frequently, such as every two hours when in bed, and every 30 minutes when sitting up in your wheelchair. It’s also important to inspect your skin daily. In the hospital, your doctor or therapist can provide proper care tips to help avoid this complication.

Additionally, immobility can slow down blood circulation throughout the body, decrease heart rate, and even interfere with your metabolism. This can cause blood to pool in the arms and legs, reducing blood supply returned to the heart. Insufficient blood supply can cause dysfunction in your major organs. To lower the risk of complications, it’s important to promote frequent movement of the affected muscles.

Other potential complications of a C7 spinal cord injury can include:

• Bladder and bowel dysfunction: Loss of sensation and motor control can result in the inability to control bladder and bowel reflexes and muscle contractions, making you prone to accidents. To prevent this from happening, a catheter may be necessary to remove urine. Suppositories, medications, and/or other techniques may also help control bowel movements. It is important to establish a good bowel program with the help of your rehab team.
• Reduced bone and muscle mass: Paralysis after a C7 spinal cord injury can make it difficult to move your limbs. Because muscles and bones are being used less, muscle atrophy (shrinking of the muscles) and decreased bone density can occur.
• Disrupted autonomic nervous system functions: The autonomic nervous system (ANS) is responsible for the regulation of involuntary body functions such as temperature, heart rate, blood pressure, and digestion. These functions can be affected by loss of movement and sensation after a C7 spinal cord injury, causing complications such as autonomic dysreflexia.

Survivors may also experience pain and/or spasticity (involuntary muscle contractions) below the level of injury. Although these symptoms may be challenging to overcome, they can sometimes be positive signs of recovery from spinal cord injury because this indicates that there may be connections between your brain, spinal cord, and muscles remaining.

C7 Spinal Cord Injury Recovery Process

To maximize your chances of recovering from a C7 spinal cord injury it’s important to prioritize movement and establish a proper rehabilitation regimen. Rehabilitation can include a combination of physical and occupational therapy exercises that focus on improving mobility, strength, and function after a spinal cord injury.

Physical therapy particularly focuses on improving your gross motor skills involving large muscle groups such as the arms, legs, and torso. This can involve exercises focusing on strength, range of motion, and coordination. 

Occupational therapy focuses on improving your fine motor skills to help you maximize your independence and perform daily activities on your own. This can include activities such as brushing your teeth and getting dressed. Physical and occupational therapists can also help you practice transfers (like moving from your bed to your wheelchair) and suggest home modifications.

Therapists may also recommend using adaptive devices such as a universal cuff to help you eat, brush your teeth, and write independently. While adaptive tools can be helpful for completing daily tasks, it’s important to simultaneously practice therapeutic exercises.

For instance, if you notice your hand function improving, challenge yourself to perform tasks without adaptive tools. This can help you achieve higher repetition of exercises and increase strength and coordination.

Consistent practice of therapeutic exercises helps stimulate the nervous system and activate neuroplasticity, which is essential for C7 spinal cord injury recovery.

Understanding a C7 Spinal Cord Injury

Although a C7 spinal cord injury can impair movement and sensation below the level of injury, upper body functions usually remain intact. The severity depends on whether the injury was complete or incomplete. The more neural pathways remaining after an injury, the higher the chances of stimulating neuroplasticity and regaining function.

While a C7 spinal cord injury can make it challenging to perform daily activities, it’s important to find ways to stay motivated and achieve high repetition of therapeutic exercises. The more a skill is practiced, the more the nervous system will strengthen the neural pathways necessary for that function.

We hope this article helped you understand the effects of a C7 spinal cord injury and how to boost the recovery process.

The post C7 Spinal Cord Injury: What to Expect in the Aftermath & Recovery Process appeared first on Flint Rehab.

Fortunately, by participating in rehabilitative therapies and effectively managing secondary complications, individuals can learn to become as functional as possible and maybe even recover sensory and motor functions.

To help you understand what to expect after a C3 SCI, this article will discuss potential effects and how to manage them. Use the links below to jump directly to any section.

• What is a C3 SCI?
• Diagnosis and classification
• Potential effects
• Recovery process
• Treatment options

What is a C3 Spinal Cord Injury?

The spinal cord is made up of a number of nerves that act as a connection between the brain and the rest of the body. Thirty-one pairs of nerves branch out from the spinal cord, sending motor and sensory messages to and from the body.

A C3 spinal cord injury occurs when damage to the spinal cord damage limits the ability for information to be transmitted past the 3^rd set of cervical nerves. When the spinal cord becomes injured, sensory and motor messages are unable to be transmitted properly, resulting in affected functions below the level of injury.

The uppermost area of the spinal cord, located within the neck, is referred to as the cervical region. The cervical spinal nerves send messages between the brain and body regarding movement and sensation of the head, neck and arms. In survivors of a C3 SCI, the spinal cord is damaged directly below the third pair of cervical spinal nerves.

This means that individuals with C3 injuries only have 3 pairs of spinal nerves that are fully intact. Therefore, depending on the completeness of the injury, all sensory and motor functions related to nerves below the C3 level may be lost.

C3 Spinal Cord Injury Diagnosis and Classification

Doctors may use various tools to diagnose a C3 spinal cord injury. Along with a CT scan and/or MRI, medical professionals typically use physical tests, including an assessment called the ASIA exam. This assessment involves testing sensory and motor functions specific to each level of the spinal cord in order to determine the severity and level of injury.

The severity of a spinal cord injury significantly affects one’s functional outcomes and recovery outlook. A spinal cord injury can be classified as complete or incomplete.

Complete spinal cord injuries are the most severe, resulting in a loss of all sensory and motor functions below the level of injury. In survivors with complete spinal cord injuries, the spinal cord has been fully severed, leaving no spared neural pathways. Since there is no way for messages to be transmitted through the damaged area, no motor control or sensation will exist below the level of injury.  

In contrast, an incomplete spinal cord injury refers to partial spinal cord damage. Some neural pathways are spared and consequently, some motor and/or sensory functions below the level of injury may be unaffected. Incomplete spinal cord injuries may also vary in severity, depending on how many neural pathways are spared.

When individuals sustain a C3 spinal cord injury, the first three pairs of spinal nerves (C1, C2, and C3) are left intact. These nerves are able to transmit sensory and motor information to and from the brain, meaning that sensation and movement functions associated with these nerves remains intact.

The C1 and C2 segments of the spinal cord generally control the muscles that allow you to nod your head up and down as well as sensation at the upper neck and the back portion of the head. The C3 spinal nerves are responsible for sensation in the neck area as well as neck side flexion, which is the ability to tilt your neck to each side.

As a result, individuals with C3 spinal cord injuries should be able to feel and move their head and neck normally. Depending on the severity of the injury, functions below the neck may or may not be affected. Functional outcomes and the onset of secondary complications can vary significantly.

Potential Effects of C3 Spinal Cord Injury

Every C3 spinal cord injury is different. Having an idea of what to expect can help individuals adjust to life after a C3 SCI. Below are 7 of the most common effects that survivors of a C3 spinal cord injury may experience.

1. Breathing Challenges

A C3 spinal cord injury can affect the muscles involved with breathing which, without immediate medical attention, can be fatal. This is because the primary muscle involved in respiration, called the diaphragm, is controlled by the C3-C5 spinal nerves.

Individuals with C3 spinal cord injuries often require the assistance of a ventilator to restore breathing, at least initially. Depending on the severity of the injury and the effectiveness of rehabilitative interventions, it is possible for individuals to strengthen breathing functions and gradually wean off ventilator dependence.

2. Paralysis from the Neck Down

A C3 spinal cord injury results in quadriplegia, which refers to paralysis of the arms, trunk, and legs.

Depending on the severity of your spinal cord injury, some survivors may be able to move and/or feel sensation below your level of injury.

However, in the case of a complete C3 SCI, individuals experience paralysis of the entire body below the neck and require full-time caregiver assistance.

3. Differences in Body Composition

Because spinal cord injuries at the C3 level can significantly affect most body movements, individuals often experience physical changes to the body as a result of limited active movement.

Consequences of reduced physical activity include:

• Reduced bone density
• Muscle atrophy
• Poor circulation
• Lowered resting metabolic rate

Likewise, individuals may initially lose a substantial amount of weight due to decreased bone density and muscle mass. However, they may also gain weight if they continue to consume the same amount of food as they did when they were more physically active.

4. Bowel and Bladder Dysfunction

If information from the bowel and bladder cannot pass through the damage in the spinal cord to reach the brain, then individuals with C3 spinal cord injuries may experience changes to their bowel and bladder functions. As a result, they will not be able to sense when their bladder or bowels are full and are more likely to experience leaking and accidents. Furthermore, if the brain is unable to send messages to the bowel and bladder muscles to contract or relax, eliminating waste at appropriate times becomes challenging.

Complications of bladder and bowel dysfunction include urinary retention, kidney damage, infection, and constipation. To prevent bowel and bladder-related accidents from occurring, it’s essential for individuals with C3 SCIs to follow a bowel and bladder program.

5. Pressure Sores

Since movement of the arms, legs, and trunk is often limited in those with a C3 SCI, individuals are more likely to remain in one position for an extended period. If individuals lose sensation after a C3 spinal cord injury, they likely won’t feel uncomfortable remaining in the same position for a prolonged time.

However, a lack of frequent position adjustments places excess pressure on specific areas of the skin, which can cut off blood flow and cause the skin to break down. When skin integrity is compromised due to prolonged pressure on certain areas of the body, it can result in pressure sores.

Pressure sores most commonly develop in bony areas like the hip bones, heels, knees, tailbone, and elbows.

To reduce the rick of pressure sores, it is essential to change positions every two hours when lying down or every 30 minutes when sitting. Additionally, inspecting the skin daily for any signs of redness or irritation can help identify and treat pressure sores early before they become problematic.

6. Autonomic Dysreflexia

The autonomic nervous system regulates involuntary body functions like body temperature, blood pressure, and heart rate. After a C3 spinal cord injury, individuals may experience autonomic dysreflexia, which occurs when these functions become hyperactive due to the disrupted transmission of messages between the brain and body.

Generally, any stimulation (wearing tight clothing, extreme temperatures, pressure sores, etc.) below the level of injury can trigger autonomic dysreflexia. As a result, individuals may experience a spike in blood pressure, feelings of panic, and flushed skin.

Because signals from the brain may not be able to reach areas below the level of injury, individuals may experience contrasting symptoms above and below their level of injury.

Generally, autonomic dysreflexia can be resolved by identifying what is triggering the episode and removing it. It’s essential for individuals with C3 spinal cord injuries and their caregivers to be alert and mindful of their surroundings.  If symptoms persist, seek immediate medical attention.

7. Spasticity

Following a C3 spinal cord injury, individuals may experience spasticity. Spasticity describes involuntary muscle contractions that can worsen with movement.

Because messages between the brain and areas below the level of injury are disrupted by SCI, spastic muscles are unable to receive signals from the brain to relax and therefore remain tightened. This can cause stiff movements, muscle spasms, and chronic pain.

While the potential effects of a C3 spinal cord injury are significant, there are many ways to effectively manage these effects and pursue recovery.

C3 Spinal Cord Injury Recovery

Every C3 spinal cord injury is unique, and every journey to recovery looks different. Depending on your personal goals and circumstances, treatment may focus on rehabilitative therapy, compensatory tactics, or a combination of both. The goal of rehabilitative therapy is to regain lost functions. On the other hand, a focus on compensatory tactics allows individuals to optimize their independence by finding ways to work around lost functions.

One of the primary factors affecting recovery after a C3 SCI is the severity of the injury. Those with incomplete spinal cord injuries have spared neural pathways, meaning that there are still some connections remaining between the brain and the rest of the body. These spared connections are able to take advantage of the central nervous system’s ability to rewire itself through a process called neuroplasticity. This allows the spinal cord to adapt and reorganize itself so that functions lost or weakened by SCI can be relearned.

Neuroplasticity is activated by repetitive practice of exercises and activities involving affected functions, making rehabilitation essential for recovering sensory and motor functions. The less severe a spinal cord injury is, the more spared neural pathways exist, and the better the recovery outlook.

Conversely, individuals who have sustained a complete injury often focus on compensatory techniques. Although there are some new treatment options currently being studied for those with complete spinal cord injuries, functions often cannot be recovered due to the lack of spared neural connections.

Therapies for C3 Spinal Cord Injury Recovery

Compensatory techniques can allow those with complete SCIs to reframe their definition of recovery, putting a focus on optimizing independence and quality of life, rather than on regaining lost functions.

Therefore, a personalized rehabilitation plan that addresses your specific needs is essential. Rehabilitation for C3 spinal cord injuries can consist of:

• Physical therapy. A physical therapist can assess your functional abilities and guide you through targeted exercises that can help you improve your mobility and strength. They may also use specialized techniques, such as electrical stimulation. Consistently practicing physical therapy exercises, even if only passively, will help promote neuroadaptive changes in the spinal cord. Physical therapists also can provide home exercise programs, which are essential for promoting neuroplasticity for a greater recovery.
• Occupational therapy. Occupational therapists use a combination of rehabilitative therapy and compensatory tactics in order to promote independence in the activities of daily living (personal care tasks such as dressing and bathing) and other daily activities. They may recommend adaptive equipment or assistive technology, such as a voice activated or eye gaze controlled computer or wheelchair. Occupational therapists can also provide caregiver training to facilitate safety in the survivor’s day to day life.
• Speech therapy. Individuals with weakened respiratory functions after a C3 SCI should work with a speech therapist for a voice assessment and related impairments. If needed, speech therapists can recommend alternative forms of communication to allow those with a C3 SCI to communicate effectively.
• Psychotherapy. Adjusting to life after a C3 SCI can be difficult and take a toll on your mental health. Working with a psychotherapist can help you learn effective ways to cope.
• Medications. Medications may be prescribed to help manage secondary complications like pain, spasticity, and depression.
• Orthotics. Orthotic devices like braces and splints will help promote correct musculoskeletal alignment.
• Bowel and bladder programs. Following a bowel and bladder program will help prevent bowel and bladder-related accidents. This can involve following a schedule, catheterization, and using suppositories.
• Dietary changes. Modifying your diet can help prevent excess weight gain, promote bowel and bladder movements, and improve energy levels to participate in rehabilitative therapies.
• New treatments. Researchers are constantly studying new techniques for improving SCI recovery. Studies on epidural stimulation and stem cell therapy are currently underway for those with complete cervical SCIs. This can provide those with a complete C3 spinal cord injury with hope for a more functional recovery in the future.

While adjusting to a C3 spinal cord injury can be challenging, many C3 SCI survivors are able to lead fulfilling lives with appropriate management techniques. Those with complete spinal cord injuries are often able to use alternative controls to operate a power wheelchair independently.

Positioning devices to promote musculoskeletal alignment may also be custom-made to fit the individual’s needs, allowing them to sit up more comfortably. Controls activated though eye-gaze, head movements, or voice commands can also make technology accessible, allowing individuals to communicate through calling or texting, play video games, and surf the internet.

Having full control of the head and neck can increase the ability to engage in different hobbies, such as painting using the mouth to hold the paintbrush. Although those with a complete C3 spinal cord injury will require full-time caregiver assistance, there are still many creative ways to engage in meaningful life activities.

Understanding C3 Spinal Cord Injury

A C3 spinal cord injury can affect movement and sensation below the neck. However, depending on the severity of their injury, individuals may be able to move or feel areas below the level of injury.

By participating in rehabilitative therapies and effectively managing secondary complications, individuals can become as functional as possible and improve their quality of life. Hopefully, this article helped you better understand the effects of a C3 spinal cord injury.

The post C3 Spinal Cord Injury: What to Expect and How to Recover appeared first on Flint Rehab.

A complete spinal cord injury occurs when the spinal cord is completely severed. This results in the loss of all sensation and motor control below your level of injury. Fortunately, there is hope for recovery after a complete SCI.

To help you better understand what to expect following a complete spinal cord injury, this article will discuss:

• Causes
• Can an incomplete SCI be mistaken for a complete one?
• How to exercise
• Recovery

What Causes a Complete Spinal Cord Injury?

A complete spinal cord injury occurs when all neural connections at the site of injury are affected, resulting in no spared pathways. Therefore, complete spinal cord lesions are the most severe form of SCI. They are most commonly caused by car accidents, falls, contact sports, and acts of violence. To understand why this affects movement and sensation, let’s review how the brain, spinal cord, nerves, and muscles communicate.

The spinal cord is the communication pathway that transmits messages between the brain, the peripheral nerves, and the muscles. When an individual has a complete SCI, the damage affects all neural pathways below the level of injury. Because signals are unable to travel past damaged neurons in the spinal cord, the brain cannot receive sensory signals from the body, and the body cannot receive motor signals from the brain.

As a result, only sensation and motor control at and above the level of injury are left unaffected. In contrast, all sensation and motor control below the level of injury is cut off, resulting in paralysis.

Depending on the level of injury, complete spinal cord injuries may result in quadriplegia (loss of use of all four limbs and trunk) or paraplegia (loss of use of the lower half of the body). The higher the level of injury, the more areas of the body are affected.

Can an Incomplete Spinal Cord Injury Be Mistaken for a Complete One?

Not all spinal cord injuries are complete. In fact, the majority of spinal cord injuries are considered incomplete, meaning that there are still some neural pathways left intact below the level of injury. In contrast to those with complete SCIs, individuals with incomplete SCIs retain some motor and/or sensory functions below their level of injury.

Sometimes, a complete spinal cord injury can be misdiagnosed due to spinal shock. Caused by excessive swelling immediately after an SCI, spinal shock describes the complete loss of reflexes, sensation, and muscle tone below one’s level of injury. This can result in an incomplete spinal cord injury being mistaken and misdiagnosed as a complete SCI.

Fortunately, spinal shock is a temporary condition and once inflammation begins to decrease, reflexes may gradually start to return. Spinal shock may be present for several months before it begins to subside.

As spinal shock progresses, individuals will go from experiencing low, flaccid muscle tone to hyperactive reflexes that result in high muscle tone. This drastic change from one extreme to another is generally a good indication that the neurons in the spinal cord are adapting.

Therefore, individuals with SCIs may be happily surprised to discover that their SCI is not as severe as it initially appeared.  

Learn more about spinal shock after SCI »

How to Exercise with a Complete Spinal Cord Injury

Although a complete spinal cord injury results in paralysis below the level of injury, it’s essential to continue to move the entire body.

This involves continuing to exercise unaffected regions of the body and having a trained caregiver or physical/occupational therapist perform passive range of motion exercises on affected regions. Passive range of motion does not require energy exertion by the individual with paralysis. Rather, a caregiver or therapist moves the individual’s body for them.

Exercise will help individuals with complete spinal cord injuries maintain full range of motion in their joints, promote circulation, and prevent secondary complications like pressure sores and edema (swelling) from developing.

Is It Possible to Recover After a Complete Spinal Cord Injury?

While damaged neurons in the central nervous system are not capable of regeneration, there is still hope for recovery after a complete spinal cord injury. Many innovative treatments such as electrical stimulation and stem cell therapy are showing great promise for the future of complete spinal cord injury recovery. However, they still require further research and development before being widely implemented.

Rehabilitation after a complete spinal cord injury will generally focus on maximizing your functional abilities. This means learning how to use functions you do have control over to optimize your ability to care for yourself and protect affected regions of your body from further complications.

Below, we’ll discuss various management techniques for complete SCI.

1. Epidural Electrical Stimulation

Epidural electrical stimulation involves implanting a stimulator over your spine. The stimulator then emits electric currents that mimic brain signals to muscles below the site of injury. Epidural stimulation works around the spinal cord damage to activate the neurons below the level of injury and encourage movement.

For example, this study combined intensive gait training and epidural electrical stimulation on 2 individuals with complete spinal cord injuries. By the end of the 85-week period, both individuals were able to sit, stand, and walk on a treadmill with body-weight support. Although it is still being studied, the initial study results of epidural electrical stimulation are very promising, especially when combined with conventional therapies.

2. Stem Cell Therapy

Stem cells are cells that can divide infinitely and differentiate into a variety of cell types depending on their environment. This makes them ideal for promoting tissue growth and replacing damage caused by SCI.

The type of stem cells most commonly studied for SCI recovery is mesenchymal stem cells, which come from bone marrow.

This case study used a combination of bone marrow nucleated cells and mesenchymal stem cell implantations on a 15-year-old patient with complete SCI. Within 2 years, she developed improved sensations in her lower body and regained bladder, bowel, and trunk control.

While stem cell therapy still requires larger-scale experimentation, this suggests that functional recovery after a complete SCI may be possible in the future.

3. Physical Therapy

Physical therapy plays an essential role in the treatment of complete spinal cord injuries.

At physical therapy, individuals will learn how to exercise areas of the body unaffected by paralysis and how to properly perform passive range of motion exercises on affected areas. They will also learn how to continue with these exercises on their own at home (with a trained caregiver assisting as needed). Exercising will help reintroduce movement to the body to prevent stiffness, promote circulation, and reduce joint pain.

4. Occupational Therapy

Occupational therapy focuses on helping individuals with complete spinal cord injuries learn how to be functional in their day-to-day lives. An occupational therapist will assess the individual’s sensory and motor skills and determine what types of adaptive techniques they can benefit from.

This may involve learning how to use adaptive tools such as a universal cuff to help you hold onto items or a transfer bench to bathe.

5. Psychotherapy

Generally, the more severe a spinal cord injury is, the more challenging it is to cope and adapt. A psychotherapist can help provide the emotional support and guidance you need to get through this difficult time.

6. Caregiver Assistance

A complete spinal cord injury can require you to become more dependent on others. Some people don’t want to burden their loved ones with tasks like using the toilet or bathing. Instead, they find it more comfortable to hire a caregiver.

7. Joining a Support Group

Joining a support group is a great way to connect with others that understand what you’re going through. There, you can share experiences and learn more about potential effects of spinal cord injury,

A support group can also serve as a safe space where you can empower each other with positivity and helpful advice. Family members of those with complete SCIs may also find joining a support group beneficial.

8. Exoskeletons

Exoskeletons are wearable electronic devices that can help individuals with complete spinal cord injuries maximize their mobility. To facilitate movement, individuals simply shift their body weight in the direction they want to go while wearing the robotic exoskeleton.

While exoskeletons are costly and generally not covered by insurance, they enable individuals to perform movements that they otherwise may be unable to as a result of paralysis. This can improve circulation, reduce muscle atrophy, and help individuals maximize their independence.

Complete Spinal Cord Injury: Key Points

Complete spinal cord injury recovery is most effective with the support of rehabilitation specialists and targeted adaptive equipment.

Living with a motor disability may be challenging, but many individuals adapt to live their best life with complete SCI by surrounding themselves with loved ones and focusing on what they can do instead of what they can’t do.

While damage following a complete SCI is irreversible, promising research suggests that recovery may be possible in the future. In the meantime, individuals can learn how to be as functional as possible to optimize their quality of life. We hope this article helped you understand what to expect after a complete spinal cord injury.

The post Complete Spinal Cord Injury: Causes, Recovery Outlook, and Treatment appeared first on Flint Rehab.

This article will help you understand what to expect after a cervical SCI by guiding you through the functions affected at each level of injury. Use the links below to jump straight to any section:

• Overview
• Effects
• Levels
  • C1 spinal cord injury
  • C2 spinal cord injury
  • C3 spinal cord injury
  • C4 spinal cord injury
  • C5 spinal cord injury
  • C6 spinal cord injury
  • C7 spinal cord injury
  • C8 spinal cord injury
• Recovery

Understanding Cervical Spinal Cord Injury

The cervical spinal cord is the uppermost region of the spinal cord that primarily makes up the area along your neck. Because the cervical region bears less weight and has a greater range of motion than lower parts of the spine, it tends to be less stable and more vulnerable to injury. As a result, almost 60% of all spinal cord injuries result in cervical-level injuries.

The cervical region of the spinal cord consists of 8 levels that communicate with different areas of the body. Specifically, each level of the cervical spinal cord sends and receives signals regarding movement and sensation in the neck, arms and hands.

However, after a cervical spinal cord injury, individuals will experience loss of motor control and/or sensation throughout the arms, trunk, and legs. This occurs because signals from the brain cannot pass through damaged areas of the spinal cord.

As a result, sensory and motor functions below the level of injury can also be affected. Since the majority of the body can potentially be affected, the road to recovery is often longer for individuals with cervical spinal cord injuries compared to those with lower level injuries.

Fortunately, there is often hope for individuals to recover affected functions. The severity of a spinal cord injury can play a significant role in determining outcomes. One way to assess the severity of a SCI is to determine whether it is a complete or incomplete injury.

A complete spinal cord injury refers to damage that transects the entire spinal cord. As a result, no connections between the brain and areas below the level of injury exist, resulting in complete loss of functions below the level of injury.

In contrast, an incomplete spinal cord injury only partially transects the spinal cord, leaving some spared or unaffected connections between the brain and areas below the level of injury. As a result, some (but not all) signals can be transmitted past the level of injury and individuals may be able to move or have sensation in areas below their level of injury.

Along with loss of motor control and sensation, individuals may experience additional effects. The following section will discuss various secondary effects of cervical spinal cord injury.

Effects of Cervical Spinal Cord Injury

Depending on the severity and level of your injury, cervical spinal cord injuries can affect a wide variety of functions.

Survivors of cervical spinal cord injury may experience difficulties in following areas:

• Breathing
• Mobility from the neck down
• Sensation from the neck down
• Fine motor skills  
• Balance
• Coordination
• Bladder and bowel control
• Sexual functions
• Gait
• Posture
• Sweating
• Circulation
• Body temperature regulation

Each spinal cord injury is unique and may result in various secondary effects. By taking a personalized approach to treatment and addressing complications individually, individuals can significantly improve their quality of life.

To help you get a better idea of what to expect at each level of injury, the following section will discuss which sensory and motor functions may be affected each level.

What to Expect at Each Level of Cervical Spinal Cord Injury

Each level of cervical spinal cord injury will directly affect a different set of muscles and area of skin. Level of injury is determined by the lowest area where sensory and motor functions are unaffected.

Below, you can find information on your specific level of injury based on the international standards for neurological classification.

C1 Spinal Cord Injury

C1 spinal cord injury is the most serious type of cervical spinal injury. Injury at this level has the potential cause the most widespread loss of function. In fact, C1 SCIs are often fatal because individuals may lose the ability to breathe. Luckily, this level of injury is rare and only makes up only about 1.2% of all SCIs.

After a C1 spinal cord injury, the following may occur:

• Paralysis from the neck down
• Inability to breathe independently (will require ventilator assistance)
• Need full caregiver assistance due to extremely limited mobility
• Communication difficulties (ability to talk can be affected)

Learn more about C1 spinal cord injury »

C2 Spinal Cord Injury

Because the C1 and C2 spinal nerves are closely aligned, C2 spinal cord injuries often result in similar outcomes. Along with the C1 vertebrae, the C2 vertebrae helps support the head and provide the neck with a greater range of motion than the rest of the spine.

After a C2 spinal cord injury, the following can result:

• Paralysis from the neck down
• Inability to breathe independently (will require ventilator assistance)
• Need full assistance of a caregiver
• Limited speaking ability

Read more about C2 spinal cord injury »

C3 Spinal Cord Injury

The C3-C5 spinal nerves connect to the diaphragm, which is the main muscle involved in breathing. Individuals with C3 spinal cord injuries will generally have motor control and sensation in their neck.

The following may occur as a result of a C3 spinal cord injury:

• Improved head and neck control (after spinal cord damage has stabilized)
• Intact neck side flexion (the ability to tilt your head to the side)
• Loss of independent breathing (will require ventilator assistance)
• Paralysis of the arms, legs and trunk

Discover more about C3 spinal cord injury »

C4 Spinal Cord Injury

After a C4 spinal cord injury, individuals may only require temporary ventilator assistance because some parts of the diaphragm are unaffected. With the help of breathing and coughing exercises, many individuals can wean off the ventilator and regain independent breathing.

Other outcomes of C4 spinal cord injury include:

• Full head and neck mobility
• Partial shoulder mobility
• Breathing difficulties/ weakness

Learn more about C4 spinal cord injuries »

C5 Spinal Cord Injury

C5 spinal nerves directly affect sensation around the outer area of the upper arm. Additionally, the C5 spinal nerves connect to the deltoids (which are responsible for shoulder movement), biceps, and brachioradialis (which are responsible for elbow flexion and upward rotation of the forearm).

Individuals with C5 spinal cord injuries may experience the following:

• Normal head, neck, and shoulder movements
• Intact sensation at head, neck, shoulders, and outer upper arms
• Ability to raise the arms and bend the elbows
• Breathing weakness (but usually no need for ventilator assistance)

Read more about C5 spinal cord injuries »

C6 Spinal Cord Injury

After a C6 spinal cord injury, individuals usually retain most arm mobility. With the help of specialized adaptive tools like grip attachments, individuals with a C6 spinal cord injury should be able to perform everyday tasks like eating, grooming, and getting dressed on their own.

Some positive outcomes of C6 spinal cord injury include:

• Preservation of head, neck, and shoulder movements
• Ability to raise the arms, bend the elbows, flip hand palm up and palm down, and extend the wrists
• Normal sensation in the head, neck, shoulders, and outer areas of the arms
• Ability to use tenodesis grasp patterns

Find out more about C6 spinal cord injuries »

C7 Spinal Cord Injury

Due to increased mobility of the upper extremities, individuals with a C7 spinal cord injury generally have a great deal of independence. With a C7 level of injury, individuals retain motor control of their arm and hand but are unable to fully bend the fingers.

A person with a C7 spinal cord injury should be able to:

• feel sensations at the head, neck, shoulder, arms, index fingers, and thumbs
• demonstrate full range of motion in the shoulders and neck
• raise the arms
• bend and straighten the elbows
• bend and straighten the wrists
• extend the fingers

Learn more about C7 spinal cord injuries »

C8 Spinal Cord Injury

Lastly, we’ll discuss what to expect after a C8 spinal cord injury.

Generally, individuals with a C8 SCI can carry out activities of daily living on their own because the majority of their upper body functions are unaffected. After a C8 spinal cord injury, individuals can expect:

• Full range of motion in the wrists, elbows, shoulders, and neck
• Hand weakness
• Normal sensation in the fingers, arms, shoulders, neck, and head

People with a C8 SCI should practice hand exercises to help recover strength and dexterity in their fingers.

Discover more about C8 spinal cord injuries»

Is it Possible to Recover from Cervical Spinal Cord Injury?

For many, there is hope for recovery after cervical spinal cord injury. While damaged regions of the spinal cord are unable to heal themselves, unaffected regions at the level of injury have the potential to utilize neuroplasticity.

Neuroplasticity refers to the central nervous system’s ability to make adaptive changes and reorganize its neural circuitry. It allows for functions affected by cervical spinal cord injuries to be rewired to unaffected regions and relearned through repetitive, task-specific practice. This is why participating in rehabilitative therapies like physical and occupational therapy after SCI is essential.

Every time you perform a movement, it stimulates the spinal cord. Consistent practice helps reinforce demand for that movement and encourages the spinal cord to utilize neuroplasticity to reorganize itself. The more you practice, the stronger the new pathways for that function become.

Unfortunately, only spared neural pathways are capable of utilizing neuroplasticity, which means only individuals with incomplete spinal cord injuries have the potential to recover. However, that does not mean there is no room for improvement for individuals with complete SCIs.

Rehabilitative therapies for complete SCI will focus on maximizing the individual’s functional independence and mobility. This may involve learning alternative ways to perform everyday tasks such as using adaptive tools or using unaffected areas of the body to compensate for paralyzed areas.

While compensatory strategies are the main focus of complete SCI rehabilitation currently, there are promising new treatment options being researched, such as stem cell therapy, to help even those with complete spinal cord injuries regain functions.

Understanding Cervical Spinal Cord Injury

Cervical spinal cord injuries are the most common type of spinal cord injuries.  Depending on the level of injury, cervical SCIs can directly affect mobility in the neck, arms, and fingers. They often can result in trunk and lower body paralysis, depending on the severity of injury.

As you’ve just learned, higher-level cervical SCIs have very different functional and sensory outcomes than lower-level injuries. Additionally, less severe spinal cord lesions will result in fewer impairments. As a result, you may still be able to feel and control areas of your body that are connected below your level of injury.

Individuals with incomplete cervical spinal cord injuries have the potential to recover affected functions and improve their mobility by participating in highly repetitive, targeted exercise. Consistently practicing affected movements helps reinforce demand for those functions and encourage the spinal cord to make adaptive changes.

We hope this article helped you understand what to expect after a cervical spinal cord injury and that there is hope for recovery.

The post Cervical Spinal Cord Injury: What to Expect At Each Level of Injury appeared first on Flint Rehab.

Some individuals may only experience weakness and difficulty with coordinating their leg movements, while others may be paralyzed and lose sensation from the trunk down. 

To understand more about thoracic spinal cord injury, this article will discuss:

• What is a thoracic spinal cord injury?
• Complete vs incomplete SCI
• Functions affected by thoracic spinal cord injury
• Recovery outlook
• Management strategies

What is a Thoracic Spinal Cord Injury?

The spinal cord is a bundle of nervous tissue that runs through the spine, acting as a connecting pathway between the brain and body. Thirty-one pairs of spinal nerves exit the spinal cord between each vertebra.

Each pair of nerves connects to a different set of muscles for movement and area of skin for sensation. There are 12 nerve pairs within the thoracic spinal cord. Injury to this area is referred to as a T1-T12 spinal cord injury, depending on the level of injury.

The thoracic region of the spinal cord connects to and controls the trunk and inner arm muscles, and relays sensations from skin in these areas. The location of the connected muscles and skin at each respective level of the thoracic spinal cord are closely aligned, falling in very similar areas of the body.

The higher the level of your spinal cord injury, the more functions will be affected. This occurs because signals to and from the brain are not able to pass through the area of damage. Thus, the transmission of messages to and from areas below the level of injury may be disrupted.

Because of this, individuals with thoracic spinal cord injuries may also experience paralysis and a lack of sensation in their lower bodies.

Complete vs Incomplete Thoracic Spinal Cord Injury

Spinal cord injuries can be classified as either complete or incomplete based on their severity.

In complete spinal cord injuries, all neural pathways have been severed at the level of injury, eliminating any communication between the brain and body below the level of injury. This results in a complete loss of motor control and sensation below the injury level.

Conversely, when an incomplete spinal cord injury has occurred, some neural pathways are spared. Depending on how many neural pathways are spared during an incomplete spinal cord injury, some sensory and/or motor signals may still be able to be transmitted below the level of injury. This can allow sensory and motor functions to remain intact or be recovered after injury.

Functions Affected by Thoracic Spinal Cord Injury

The level of the spinal cord injury refers to the lowest portion of the spinal cord in which all sensory and motor functions remain intact. Therefore, if an individual sustained a T1 SCI, the functions controlled by the T1 spinal nerves would remain intact, while sensory and motor functions controlled by each of the spinal nerves below that level could be affected.

In the following sections, we’ll describe what may be affected at each level of thoracic spinal cord injury in 2 general sections: T1-T5 SCIs and T6-T12 SCIs.

T1, T2, T3, T4, and T5 Spinal Cord Injuries

T1-T5 thoracic spinal cord injuries primarily affect the muscles in the upper chest, upper back, and inner arms. As a result, individuals with higher-level thoracic injuries may experience difficulties sitting upright due to a lack of trunk stability.

T1 nerve roots affect sensation in your inner forearm and the ability to spread your fingers apart (finger abduction). T2 nerve roots affect sensation around the armpits and upper chest, as well as the upper chest muscles.

T3, T4, and T5 nerve roots affect sensation in the upper back, as well as the upper, mid, and low chest areas, respectively. For example, a T4 spinal cord injury survivor often experiences motor and/or sensory changes from the mid-chest and down.

The intercostal muscles, which lie in between each rib, are also affected by T3-T5 nerve roots. These muscles are vital for breathing, helping the chest to expand and contract during inhalation and exhalation. Therefore, breathing as well as coughing and sneezing may be more challenging at this level of injury or higher.

Additionally, individuals with T6 or higher level injuries are more likely to experience a condition called autonomic dysreflexia which affects involuntary functions like body temperature regulation, heart rate, and blood pressure. Without proper management, autonomic dysreflexia can be life-threatening. Therefore, it is essential for at-risk individuals to be aware of potential triggers and avoid them.

T6, T7, T8, T9, T10, T11, and T12 Spinal Cord Injures

T6-T12 spinal cord injuries affect sensation and motor control around the trunk and abdominal areas. As a result, motor control and sensation in their arms and chest should not be affected.

T6 nerve roots generally affect sensation around the top of the abdomen, and therefore T6 spinal cord injury survivors often experience changes in motor and sensation from the top of the abdomen and down. Each consecutive set of nerve roots connects to a lower portion of the trunk and abdomen.

Individuals with lower-level thoracic spinal cord injuries generally have enough trunk control that they can sit upright and perform transfers independently.

It’s important to remember that while the level of the SCI provides general information regarding functional outcomes, the severity of the spinal cord injury greatly affects the functional abilities retained following the injury. The affected motor control and sensation of someone with any specific level of SCI can vary significantly, resulting in differing functional abilities.

Recovery Outlook for Thoracic Spinal Cord Injury

Life following a thoracic spinal cord injury may look notably different than before. Methods of recovery can vary. For some, recovery entails retraining the brain and body to communicate as they did before the injury in order to recover lost sensory and motor functions.

On the other hand, others pursue recovery by learning adaptive strategies to compensate for their deficits. Many individuals utilize both recovery tactics to become as independent as possible.

When individuals have a complete spinal cord injury, they likely will not be able to recover lost sensory and motor functions. This is because all communication pathways between the brain and body have been severed. Therefore, their recovery will likely focus primarily on learning to compensate for their deficits.

Due to the presence of spared neural pathways, those who have sustained an incomplete spinal cord injury are able to take advantage of neuroplasticity to recover lost functions.

Neuroplasticity is process by which the spinal cord is able to rewire itself. Through the spinal cord’s adaptive changes, functions affected by damage can be relearned. Since only undamaged neural pathways are capable of utilizing neuroplasticity, those with milder SCIs generally have a better recovery prognosis.

The best way to promote neuroplasticity is to consistently practice affected functions. Highly repetitive movements and sensory input help stimulate the spinal cord and reinforce demand for those functions to promote neurological adaptations. Therefore, rehabilitation following thoracic spinal cord injury often focuses on optimizing neuroplasticity.

Thoracic Spinal Cord Injury Management Strategies

Despite having lower body weakness, paralysis, and/or sensation deficits, many individuals with thoracic spinal cord injuries live independent, active lives.

In the following sections, we’ll go over management interventions that can help you manage your secondary effects and pursue recovery after a thoracic spinal cord injury.

Rehabilitative Therapies

Rehabilitative therapies play an essential role in the spinal cord injury recovery process.

Physical therapy uses targeted exercises to improve motor control, promote sitting balance, maintain range of motion, and stimulate the spinal cord through neuroplasticity. 

Occupational therapy empowers individuals to be as functionally independent as possible. This may involve practicing activities of daily living like putting on clothes and performing transfers. Additionally, individuals may learn adaptive techniques to compensate for weakness, paralysis, or lack of sensation of the trunk and/or lower body.

Adaptive Tools and Medical Devices

An occupational therapist may recommend adaptive tools and home modifications to help promote independence after thoracic spinal cord injury. For example, setting up ramps or support bars throughout the house can make it much easier to be independent, especially in a wheelchair. Additionally, those with affected trunk stability following a thoracic SCI may benefit from using a reacher to pick items up without straining or losing their balance.

Other medical devices, such as a customized manual wheelchair, may be recommended by your doctor or therapist.

Learn more about adaptive tools for spinal cord injury »

Mental Health Supports

Following a thoracic spinal cord injury, many individuals may find themselves struggling with their mental health as a result of their circumstances.

Psychotherapy may help individuals learn more effective ways to cope with the changes they are experiencing. Furthermore, many find that joining a spinal cord injury support group is a great way ease the adjustment into life after a spinal cord injury.

Healthy Lifestyles

Pursuing a healthy lifestyle by being physical active, eating a nutritious diet, and keeping a positive mindset can also promote recovery and overall wellness following a thoracic spinal cord injury. Taking steps to manage the secondary effects of your injury can also help to minimize complications and optimize recovery outcomes.

While it is beneficial to participate in rehabilitation early on, focusing on fully engaging in the rehabilitation process is essential for recovery. Consistently practicing exercises during therapy and at home using a home exercise program will help promote adaptive changes in the spinal cord through neuroplasticity to encourage recovery.

Future Treatment Options

New techniques for spinal cord injury recovery are constantly being researched and trialed.

Among the most promising options is a robotic exoskeleton, which would allow even those with high-level complete thoracic spinal cord injuries to walk independently. Although still relatively new, these wearable devices are being used more frequently during rehabilitation with positive results. Furthermore, ways to adapt exoskeletons for personal use at home and in the community are being explored.

Stem cell implantation and electrical stimulation are also being studied as potential techniques to promote recovery.

Understanding Thoracic Spinal Cord Injury

Thoracic spinal cord injuries directly affect movement and sensation in your inner arms, trunk, and abdomen. However, they also affect lower limb functions because messages from the brain cannot always travel past the injury site.

Individuals with thoracic spinal cord injuries are often capable of living independent, fulfilling lives by participating in rehabilitative therapies, maintaining a positive mindset, and making adaptive changes.

We hope this article helped you understand what to expect after a thoracic spinal cord injury.

The post Thoracic Spinal Cord Injury: What to Expect & How to Recover appeared first on Flint Rehab.

To help you understand what to expect after a lumbar spinal cord injury, this article will discuss:

• Definition
• Functions Affected
  • L1 Spinal Cord Injury
  • L2 Spinal Cord Injury
  • L3 Spinal Cord Injury
  • L4 Spinal Cord Injury
  • L5 Spinal Cord Injury
• Complete vs. Incomplete Lumbar SCI
• Potential Complications
• Recovery Methods

What is a Lumbar Spinal Cord Injury?

The lumbar region of the spinal cord consists of 5 segments, based on the five lumbar vertebrae. Each segment connects to  a different area of skin for sensation and muscles for movement. When the spinal cord is partially or completely severed in this area, it is referred to as a lumbar spinal cord injury.

Traumatic lumbar spinal cord injuries are caused by an external force, such as a car accident, fall, or violence. In contrast, non-traumatic causes of lumbar spinal cord injury can vary. These may include tumor/cancer, infection, autoimmune disease, herniated disc/spinal stenosis, or a vascular event such as a spinal stroke.

Damage to the lumbar spinal cord can affect motor and sensory functions at and below the level of injury, while functions above the level of injury remain intact. Therefore, most individuals who have sustained a lumbar spinal cord injury experience sensory and/or motor deficits in their lower body, but can use their upper body and trunk normally.

Functions Affected by Lumbar Spinal Cord Injury

The level of spinal cord injury refers to the lowest level of the spinal cord in which sensory and motor functions remain intact. Medical professionals often use the International Standards for Neurological Classification to determine the level of spinal cord injury. This involves testing sensation and motor functions in various areas of the body.

Since messages between the brain and body cannot pass through spinal cord damage, motor functions and sensation below the level of injury may be impaired.

The following list explains which functions may be affected at each level of lumbar spinal cord injury:

L1 Spinal Cord Injury

L1 spinal nerves affect movement and sensation of the pelvic/hip region. Motor and sensory functions in these areas will remain intact with an L1 spinal cord injury. However, the legs may be completely paralyzed or lack sensation. In addition, bowel and/or bladder function may be affected with L1 SCI.

L2 Spinal Cord Injury

L2 spinal nerves affect sensation in the front portion of the upper thighs. The muscles involved in bending the hips (hip flexors) and bringing the legs together (hip adductors) are also connected to the spinal cord at this level. As a result, individuals with an L2 spinal cord injury will be able to feel their upper thighs and move their hips, but may be unable to move or feel their lower legs.

L3 Spinal Cord Injury

L3 spinal nerves affect sensation at the front portion of the lower thighs and knees. This will also affect the ability to straighten the knees (knee extension) and rotate the hip outward (external rotation). Consequently, individuals with a lumbar spinal cord injury at this level have more hip and knee movement, but may lack sensation and movement in the ankles and lower legs.

L4 Spinal Cord Injury

L4 spinal nerves affect sensation at the front and inner regions of the lower legs. The primary test to determine whether this level of the spinal cord has been injured is the ability to lift the foot upwards (ankle dorsiflexion). However, many other motor functions are also connected at this level.

Hip functions affected by the L4 spinal nerves include:

• The ability to bring the leg back (hip extension), pull the leg outward (hip abduction), and rotate the hip inward (internal rotation).
• Bending of the knee (knee flexion)
• Side to side movement of the ankle (inversion and eversion)
• Straightening of the toes (toe extension)

Following an L4 spinal cord injury, hip, knee and some ankle functions are intact. However, sensation and motor control of the foot may be affected.

L5 Spinal Cord Injury

L5 spinal nerves affect sensation at the outer areas of the lower legs down to the big, second, and middle toes. The ability to bend and straighten the big toe (flexion and extension) and the ability to separate the toes (abduction) are also affected by L5 spinal nerves.

Therefore, individuals with an L5 lumbar spinal cord injury will have feeling and movement in the feet, but lack some ankle movement as well as feeling in the back of the leg.

Complete vs. Incomplete Lumbar Spinal Cord Injury

Even individuals with the same level of injury may experience different secondary effects depending on the severity of injury. While individuals with complete spinal cord injuries lose all motor control and feeling below their level of injury, those with incomplete spinal cord injuries will retain partial motor control and/or sensation below the level of injury.

In a complete spinal cord injury, the spinal cord is completely severed, leaving no spared neural pathways. This eliminates all pathways for communication between the brain and areas below the level of injury.

When the spinal cord is only partially severed, as occurs in an incomplete spinal cord injury, some neural pathways remain undamaged. Therefore, connections between areas below the level of injury and the brain still exist.

These spared neural pathways play an essential role in the recovery of lumbar spinal cord injuries (and all other SCIs). Since damaged neurons (nerve cells) in the spinal cord are not capable of regeneration, only spared neural pathways can be adapted and rewired through a process called neuroplasticity. Neuroplasticity allows spared neural pathways in the spinal cord to compensate for the pathways that were damaged. In turn, this allows individuals to relearn functions after an incomplete spinal cord injury.

There must be spared neural pathways in order for this to occur, so the more spared neural pathways that exist, the higher your potential for recovery.

Potential Complications of Lumbar Spinal Cord Injury

No two spinal cord injuries are alike and individuals can experience a wide range of secondary complications. Generally, more severe spinal cord injuries carry a greater risk of complications.  

Some potential complications following a lumbar spinal cord injury include:

• Spasticity: involuntary muscle contractions that can cause stiff movements, muscle tightening and spasms
• Neurogenic bowel and bladder: loss of control over the bowel and bladder muscles that can increase the risk of leaking, constipation, and urinary retention
• Sexual dysfunction: impaired sexual functions due to the injury impeding the reflexes involved in sexual arousal. Loss of sensation and lack of lower body mobility also play a role in impaired sexual functioning
• Chronic pain: pain can be the result of overdependence on unaffected areas (i.e over-reliance on shoulders for wheelchair mobility), bowel and bladder problems, or nerve damage
• Muscle atrophy: reduced physical activity and limited weight-bearing can cause the leg muscles to weaken and shrink
• Pressure sores: sitting or lying in the same position for prolonged periods places too much pressure on the skin, causing inflammation and breakdown over time

In the following section, we’ll discuss how to manage complications and promote recovery after a lumbar spinal cord injury.

Lumbar Spinal Cord Injury Recovery

Recovery outcomes following a lumbar spinal cord injury vary depending on the level and severity of the injury. With proper treatment and management techniques, many individuals are able to participate in most of their day-to-day activities with minimal or no difficulty.

Unless other medical complications are present, individuals with lumbar spinal cord injuries have normal functioning of their upper bodies. Therefore, many individuals learn to use their upper body to compensate for deficits in sensation and movement of their lower body.

Methods to help you improve and embrace life after lumbar spinal cord injury include:

Rehabilitative Therapies

Physical therapy uses targeted exercises to improve mobility, strength, and flexibility, while occupational therapy focuses on regaining independence in daily activities. Occupational therapists may encourage using adaptive techniques as necessary.

Medical Equipment

Common types of medical equipment for lumbar spinal cord injury include:

• Orthotics: wearable devices to promote musculoskeletal alignment
• Mobility devices: wheelchairs, walkers, canes, etc.
• Adaptive equipment: tools to assist with daily activities, such as a leg lifter
• Other medical equipment: shower chairs, raised toilet seats, etc.
• Car adaptations: such as hand controls or wheelchair locking mechanisms
• Exoskeletons: robotic exoskeletons are currently being studied, but show promising results for allowing individuals with complete lumbar spinal cord injuries to walk again

Talk with your doctor or therapist about what equipment may be beneficial for you.

Emotional Support

The emotional effects of a lumbar spinal cord injury can be as challenging as the physical effects. Joining a SCI support group can help you connect with others who understand what you’re going through. For more individualized care, psychotherapy may be used to help you cope with the secondary effects of your injury.

Medical Intervention

Medications may be prescribed to help manage secondary complications such as pain, constipation, and spasticity. Additionally, surgery may be recommended for some individuals to decompress the spinal cord, stabilize the spinal column, manually lengthen spastic tendons and muscles, and minimize the hyperactivity of spastic muscles.

Lifestyle Adaptations

Creating a routine can encourage consistency with your exercises and medications. It can also help you better predict your bladder and bowel movements. Although improvements are possible, embracing your current abilities and engaging in activities you value is important at all stages of recovery.

Thanks to the Americans with Disabilities Act, most restaurants, stores, and other public places are wheelchair accessible. For those who are used to being more active, many areas have adaptive sports, and rentals for off-roading track chairs are becoming more popular.

By learning how to maximize functional abilities, individuals with lumbar spinal cord injuries can achieve a good quality of life and pursue engaged, active lifestyles.

Understanding Lumbar SCI

Lumbar spinal cord injuries can affect movement and sensation in the lower body. However, because lumbar SCI’s do not affect upper body functions, individuals generally learn to adapt and live independent, fulfilling lives. Hopefully this article helped you understand what to expect following a lumbar spinal cord injury and how to promote recovery.

The post Lumbar Spinal Cord Injury: What to Expect After L1, L2, L3, L4, L5 SCI appeared first on Flint Rehab.

To help you understand each of the spinal cord injury levels, this article will discuss:

• What your level of injury means
• Anatomy of the spinal cord before injury
• Cervical SCI
• Thoracic SCI
• Lumbar SCI
• Sacral SCI
• Coccygeal SCI

How the Level of Spinal Cord Injury Affects Movement and Sensation

The spinal cord is the neural passageway that allows for communication between the brain and body. A spinal cord injury disrupts that connection, preventing areas below the injury from effectively sending or receiving communication from the brain.

The spinal cord in particular is essential for the functions of movement and sensation. As such, common complications of spinal cord injury involve paralysis and/or changes in sensation, such as numbness.

To determine which secondary effects may occur, it is essential to understand your level of spinal cord injury.

When determining your level of injury, a physician will test your sensory and motor functions using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), also called the ASIA exam.

Each level of the spinal cord sends motor signals from the brain to different muscles throughout the body. We call the muscles designated to each level of the spinal cord myotomes.

Additionally, each level of the spinal cord receives sensory information from a different area of skin called a dermatome. This information travels through the spinal cord to the brain for processing and to allow the brain to decide how to appropriately respond.

In the next section, you’ll learn more about how different spinal cord injury levels affect different dermatomes and myotomes and, as a result, affect sensation and movement. Before we get there, let’s discuss the anatomy of the spinal column.

Anatomy of the Spinal Cord Before Injury

The spine, composed of 33 vertebrae, protects the spinal cord. Spinal nerves branch out from the spinal cord and exit above or below their corresponding vertebrae.

For each spinal cord level, there is a pair of spinal nerves (31 pairs in total), with one nerve going to the left side of the body and one going to the right. Furthermore, each spinal nerve contains a sensory nerve root that sends messages from the body to the brain, and a motor nerve root that sends messages from the brain to the corresponding area of the body.

Additionally, we divide the spinal cord into five regions (from top to bottom):

• Cervical
• Thoracic
• Lumbar
• Sacral
• Coccygeal

Motor signals from the brain and sensory signals from the body cannot travel past damaged regions of the spinal cord. As a result, a spinal cord injury may affect all motor functions and sensations innervated below its level, depending on its severity.

If the spinal cord is completely severed, doctors classify it as a complete spinal cord injury. If some connections remain intact, they classify it as an incomplete spinal cord injury. A higher level of injury and a more complete injury affect more functions.

In the next section, we’ll explain what functions each spinal cord injury level affects.

Cervical Level of Spinal Cord Injury

The cervical region of the spinal cord consists of 7 vertebrae and 8 cervical nerve roots in the neck area. Cervical spinal cord injuries are the most prevalent, making up nearly 60% of all SCIs. They also tend to be the most debilitating because the injury can potentially affect the entire body.

Complete cervical spinal cord injuries result in quadriplegia, which describes paralysis in both the upper and lower limbs.

Here are the functions that correspond with each specific level of cervical spinal cord injury.

Cervical Spinal Cord Injury: What Functions are Affected?

• C1 spinal cord injury – can affect most sensory and motor functions throughout the body.
• C2 spinal cord injury – may still have some motion of the neck, while the rest of the body may be paralyzed. Sensation in the back of the head, ears, and upper area of the neck are intact.
• C3 spinal cord injury – can affect your ability to breathe and may require a ventilator, at least initially. This is because the C3-C5 nerve roots innervate the diaphragm, which is essential for breathing. Those with a C3 SCI will be able to move and feel the majority of the neck.
• C4 spinal cord injury – may also affect breathing. However, those with a C4 SCI are able to raise their shoulders and have sensation in the shoulders, upper back, and upper chest.
• C5 spinal cord injury – will have intact sensation at the outer area of the upper arm and the ability to raise the arm to the side (shoulder abduction) and bend the elbows (elbow flexion). However, breathing can still be affected.
• C6 spinal cord injury –sensation at the outer forearms down to the thumbs and part of the index fingers will be intact. Wrist extension will also be intact, allowing grasping to be possible through a technique called tenodesis.  
• C7 spinal cord injury – increasing sensation in the hand, including intact sensation of the middle finger. Those with a C7 SCI will be able to straighten the elbows and bend the wrists.
• C8 spinal cord injury – will be able to bend the fingers and grasp objects. Sensation and most movement in the hand will be intact at this level of injury. It’s worth noting that there is no C8 vertebrae. Thus, the C8 level of spinal cord injury refers to injury at the C8 nerve root.

Learn more about cervical spinal cord injuries »

Thoracic Level of Spinal Cord Injury

Below the cervical region is the thoracic region of the spinal cord. This region of the spinal cord consists of 12 levels.

Thoracic-level spinal cord injuries primarily affect sensation in the trunk and abdomen, as well as the muscles that make up your trunk and chest. As a result, individuals may experience difficulties with balance, posture, breathing, and coughing. Thoracic spinal cord injuries may also affect innervation of important organs, including the lungs, heart, liver, and small intestine.

Because the thoracic region is located below the cervical region, all functions corresponding to the cervical region remain intact. Therefore, individuals with SCIs below the T1 level should be able to use their hands and arms normally.

The lowermost functions left intact at each level of thoracic spinal cord injury include:

• T1 spinal cord injury – intact sensation of the inner forearm and the ability to separate your fingers (finger abduction).
• T2 spinal cord injury – the uppermost chest muscles and sensation near the armpit and upper chest are intact.
• T3, T4 and T5 spinal cord injury – intact sensation at the back, as well as in the upper, mid, and low chest respectively. Intercostal muscles, which are located between the ribs and play a key role in breathing, are often affected during T3-T5 spinal cord injury.
• T6 spinal cord injury through T12 spinal cord injury– can affect the abdominal muscles as well as sensation in the abdomen and low back. A T6 spinal cord injury will leave sensation intact at the top of the abdomen. Lower level thoracic injuries result in sensation deficits in progressively lower areas of the abdomen and low back. For reference, those with a T10 spinal cord injury generally have intact sensation down to the level of the belly button.

Learn more about thoracic spinal cord injuries »

Lumbar Level of Spinal Cord Injury

Following the thoracic region is the lumbar region. This region of the spinal cord consists of 5 levels.

Lumbar spinal cord injuries only affect the lower body, so individuals should have unaffected motor control and sensation in their hands, arms, and trunk. Because individuals with lumbar spinal cord injuries experience weakness or paralysis in their legs, they may struggle with walking and balance.

The lowermost functions left intact at each level of the lumbar spinal cord injury include:

• L1 spinal cord injury – will have sensation at the pelvic region, as well as the ability to flex the trunk. Those with a L1 spinal cord injury will have minimal hip movement. Functions of the legs may still be affected.
• L2 spinal cord injury – will be able to use the hip flexors, which are the muscles near the top of the thighs that allow you to raise your upper legs (such as during walking or marching). Sensation of the upper thighs will also be intact.
• L3 spinal cord injury – will have sensation at the lower thighs and knees and the ability to straighten the knees (knee extension).
• L4 spinal cord injury – will be able to lift the foot upwards (ankle dorsiflexion) as well as feel of the front and inner regions of the lower legs.
• L5 spinal cord injury – will be able to bend and straighten the big toe and have sensation of the front and outer areas of the lower legs down to the big, second, and middle toes.

Learn more about lumbar spinal cord injuries »

Sacral Spinal Cord Injury

The sacral region of the spinal cord consists of 5 levels. Individuals with sacral-level spinal cord injuries have unaffected upper body functions and partial leg functions.

Because bowel and bladder functions are innervated by the bottommost segments of the sacral spinal cord, individuals with nearly any level of spinal cord injury are likely to experience bowel and bladder problems.

The functions left intact at each level of the sacral region of the spinal cord include:

• S1 spinal cord injury – will have sensation at the fourth and pinky toes, heel, and part of the calf. Those with an S1 spinal cord injury can also extend the ankle so that the foot points down (ankle plantarflexion).
• S2 spinal cord injury – will have sensation in most areas of the back of the legs, as well as the ability to bend the knees (knee flexion). The S2, S3, and S4 spinal nerves innervate the pelvic cavity, which is responsible for sexual, bladder, and bowel-related functions. Therefore, these functions may be more or less affected, depending on the level of injury.
• S3 spinal cord injury – will have sensation around the medial buttocks.
• S4 and S5 spinal cord injury – some functions within the perianal area may be left intact.

Coccygeal Level Spinal Cord Injury

At the very end of the spinal cord is a single coccygeal nerve. This nerve innervates the skin around the tailbone. As a result, individuals may experience pain, discomfort, or complete loss of sensation in the tailbone area.

However, because this nerve makes up the lowest level of the spinal cord, individuals should have normal motor control and sensation throughout most of their bodies.

Understanding Spinal Cord Injury Levels and Functions

Functional loss after spinal cord injury depends on the severity and level of injury. The severity of your SCI will determine to what extent functions innervated below your level of injury are affected. Likewise, the level of injury will determine which functions may or may not be affected.

We hope this article helped you better understand spinal cord injury levels and what sensorimotor functions may be impacted.

The post Spinal Cord Injury Levels: A Complete Overview appeared first on Flint Rehab.

Children’s bodies heal faster than adults because they’re still developing. Their bones, muscles, and organs are continuously working towards growing, getting stronger, and functioning more efficiently.

However, their bodies are also more fragile, so a spinal cord injury (SCI) may cause more complications in children than adults.

In this article, we’ll go over what differentiates spinal cord injury in children and the best ways to promote recovery.

How Common is Spinal Cord Injury in Children?

Children make up only a small portion of all reported spinal cord injuries.  

According to the National Spinal Cord Injury Statistical Center’s 2020 Report, less than 1% of 34,733 individuals with SCI were children age 12 or younger. Most injuries in this age group are caused by car accidents and falls.

However, SCIs become more common as children transition into adolescence. From the same report, nearly 8% of individuals with spinal cord injury were 13-17 years old. Teens are more likely to get SCIs from driving cars, playing sports, and engaging in reckless behavior. Younger children are less likely to engage in these activities, thus are less likely to sustain a spinal cord injury.

Children most often sustain higher level SCIs (frequently in the cervical spine, which is the neck region of the spinal column). Additionally, young children are more likely to have complete spinal cord injuries, meaning that there is no communication between the brain and nerves below the level of injury.

While spinal cord injuries are relatively rare in infants and toddlers, many could be prevented by using appropriate car seat safety techniques. The American Academy of Pediatrics changed their guidelines in 2018 to recommend a using a rear-facing car seat for as long as possible, until the child meets the seat’s height or weight specifications (usually around 40 lbs).

Infants and toddlers are more likely to sustain a cervical spinal cord injury during a car accident if they are forward-facing rather than rear-facing. This is because young children have looser ligaments in their spines and relatively large heads in proportion to their bodies. If they are properly buckled into a rear-facing car seat, the neck and spine are more protected during a car accident, reducing the risk of injury.

How Does Spinal Cord Injury Affect Children Differently Than Adults?

Because children are constantly growing and developing, spinal cord injuries will affect their bodies differently than adults.

Specifically, children with SCIs have an increased risk of developing scoliosis and pressure sores.

Scoliosis

Scoliosis occurs when the spine develops a curve to the side.

According to the American Spinal Injury Association, more than 90% of children who sustain a spinal cord injury before puberty develop scoliosis.

Similar to adults, children who have higher level injuries resulting in paralysis of their trunk muscles often struggle to sit upright and may start leaning to the side.

Scoliosis doesn’t develop immediately, but it can be caused by consistently compromised posture. Because children’s bodies and muscles are still growing, they are at higher risk for developing scoliosis than adults with SCI.

Pressure Sores

Children also have much thinner skin than adults. As a result, it is very easy for them to develop pressure sores.

Pressure sores occur when you sit or lay in the same position for too long. The prolonged pressure cuts off blood flow and tissues start to die, which causes skin to break down.

Pressure sores are common after SCI because impaired sensation eliminates feelings of restlessness that urge us to change positions in order to reduce pressure in one spot.

Diagnosing Spinal Cord Injury in Children

It can be difficult to diagnose spinal cord injuries in children. Since children have extremely elastic ligaments, their spine can extend without notable signs of fracture.

A young spinal column can stretch up to 5cm further than the spinal cord. Even though the spinal column may not be affected, the spinal cord can still become damaged. In these cases, SCIs won’t be visible using standard imaging, such as an x-ray or CT scan. This occurs in approximately 20% of all pediatric SCIs, and is called spinal cord injury without radiographic activity (SCIWORA).

Frequently, an MRI may show evidence of an SCI if standard imaging does not. However, an SCI may not be visible even using an MRI in up to 65% of young children displaying symptoms.

The onset of neurological symptoms, such as changes in sensation and paralysis, can take up to four days to occur in children with SCI, further complicating their diagnosis.

Therefore, it’s essential to work with pediatric therapists that understand these challenges and can effectively communicate with your child for optimal recovery.

Recovery for Children with SCI

Recovery from a spinal cord injury (if it is an incomplete injury) is typically quicker for children than it is for adults because they have higher levels of neuroplasticity.

Neuroplasticity is the central nervous system’s ability to rewire itself. By stimulating the spinal cord with repetitive movement, functions weakened by SCI can likely be recovered.

The more repetitions you perform, the more you’ll promote neurological adaptations in the spinal cord. Because children have more neuroplasticity, fewer repetitions are required to recover functions.

Treatments for spinal cord injury in children include:

• Physical therapy. Focuses on increasing mobility and strength through stretching, manual therapy, and exercises.
• Occupational therapy. Addresses difficulties with participating in daily activities through rehabilitation and compensatory strategies.
• Speech therapy. Works on improving breathing, speech, and eating challenges in children with higher level injuries.

Therapists will often use games and fun activities during their treatments to promote optimal engagement. When children are engaged in their recovery, they are often more motivated to complete the repetitions needed for neuroplasticity.

Many therapists will also encourage children to participate in a home exercise program for a faster recovery. Recovery devices that incorporate music and gaming, like MusicGlove, are particularly popular among children because they are both effective and fun to use.

Although children who have sustained a complete spinal cord injury may not recover functions using conventional treatment methods, they can still benefit from therapy. Occupational therapists can teach your child how to compensate for their lost functions using specific strategies and adaptive equipment.

While treatments for spinal cord injury in children are constantly improving, children with SCIs and their families may benefit from joining a support group for emotional support during the recovery process.

Understanding Spinal Cord Injury in Children

Unlike adults, children’s bodies are still developing and an SCI can significantly affect growth and posture.

Luckily, children’s spinal cords are extremely adaptive and can rewire themselves much faster than those of adults through consistent practice, as long as their SCI was an incomplete injury. Hopefully, this article helped you better understand how spinal cord injury affects children and how to best recover affected functions.

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