Providing bespoke care nationwide for clients with spinal injuries and neurological conditions
No two spinal cord injuries are exactly alike. The amount of feeling and function a person retains after a spinal cord injury (SCI) depends on the nature and extent of the injury.
The spinal cord is a bundle of nerves extending from the brain down the backbone. Pairs of nerves branch off from the spinal cord at each vertebra. These nerves are the control and sensation pathways from the body to the brain.
The nerves correspond to areas of the body and, broadly, the higher pairs of nerves service the higher parts of the body, and the lower nerves lead to the lower parts.
The nerves accountable for sensation are quite complicated; different nerves are responsible for different types of physical sense. A person with an incomplete spinal cord injury may lose their ability to detect changes in temperature, but may retain the ability to feel pressure.
Being able to feel vibration is a specific sense that can be lost. People with certain spinal cord injuries may also experience ‘phantom’ pains or sensations, such as pins and needles even where no functional sensation pathway exists.
Another sense that can be impaired by an SCI is proprioception – the body’s innate sense of the position of every part of itself – the sense that means we know where each part of our body is in relation to the rest. If you close your eyes and extend your arm then try to touch the tip of your nose, you’re using proprioception.
Damage to the spinal cord affects the nerves from that point down, not just the nerves at the point of injury. It can affect sensation, coordination, movement and motor ability. Depending on its level and severity, spinal cord injury in most situations causes continence and sexual function issues.
Severe spinal cord injuries can make people more likely to be affected by other conditions. A person who cannot clear their own chest secretions by coughing is at risk of chest infections, and a person who has reduced sensation can be at risk of skin and tissue damage from pressure or moisture.
The term ‘spinal cord injury’ describes a spectrum of effects, but people with significant impairment from spinal cord injuries will need specialist support for many activities of daily living.
A complete spinal cord injury means that the spinal cord is damaged at one or more points along its length, and the damage is severe enough that it doesn’t allow any nerve impulses at all to pass that point.
How ‘complete’ an injury is depends on the amount of function lost and doesn’t refer to the specific nature of the injury. In general, though, a complete spinal cord injury is one where the spinal cord is severed, compressed, or otherwise damaged enough to have total loss of function below that point.
At the initial, acute stage of spinal injury it is not always clear how much function can be recovered, but a complete spinal cord injury means life-long and total loss of function below the level of injury.
The effect of a spinal cord injury depends not just on the level of the injury, but on the amount of damage to the spinal cord at that point. The spinal cord is a bundle of nerves and the damage may only affect some of them. The area of damage, i.e. the front or rear, left or right sides of the spinal cord nerve bundle, determines the kind of function that is retained.
An incomplete spinal cord injury can have a huge variety of functional impacts, and so the phrase can be used to describe people who have the most minimum of symptoms – from the slightest changes in sensation – to very profound and debilitating injuries.
A person with an incomplete spinal cord injury may need assistance with every activity in their daily lives, or they may live completely independent and barely affected lives – or anything in between. Incomplete spinal cord injuries are a complex spectrum.
If we were to look at a cross section of the spinal cord, we could point out which area of the nerves relate to which function.
This means that the type of incomplete spinal cord injury can give us a clue as to which functions and areas are likely to be affected; we describe categories of incomplete spinal cord injuries by the area of the cross section of spinal cord that is affected. People with incomplete spinal cord injury very often have good recovery of many of the functions lost to them in the acute stages of the injury.
The type of function lost or preserved depends on the specific areas of nerves within the spinal cord bundle that are affected. The spinal cord is simply an extension of the central nervous system that starts at the brain, and like the brain the spinal cord has a left and right half, and different functions at the front (anterior) and rear (posterior) aspects. The nerves that make up the central cord also have their own distinct functions. Types of incomplete SCI include:
The American Spinal Injury Association (ASIA) developed a comprehensive physical and functional examination known as the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) used to assess function across multiple key sites of the body and grade the severity of injury. The ASIA grades are known as ASIA Impairment Scale (AIS) grades A to E:
Incomplete SCI is more likely to respond to rehabilitation, and lots of function can be recovered by intense and tailored physiotherapy and management, including repetitive passive or active motion. The amount of improvement depends on many factors, including the level and extent of the injury, any other health conditions, and the amount and type of support the affected person is able to get in the early stages.
Rehabilitation programmes for people with SCI focus on practical functional skills; improving gait and balance is one of the most significant rehab goals in terms of subjective social and lifestyle improvement after SCI. People with complete SCI usually have a more predictable pattern of rehabilitation, as the ability to recover from a complete spinal cord injury after the acute phase is very limited.
People with an incomplete spinal cord injury do not always have a predictable pattern of recovery. The rehabilitation process can take weeks, months, even years, with improvements in functional ability continuing long into the recovery process.
Research into management of neurological injury is always ongoing and new techniques are being developed all the time. As a consequence, the outcomes for people with incomplete SCI are improving all the time.
One of the reasons that it can be hard to predict how much of their ability someone will recover after a spinal cord injury is that they can suffer ‘spinal shock’ in the very first stages.
Spinal shock is the body’s response to an acute spinal cord injury; it occurs in the first few hours or days after the initial injury. The body’s natural response to any injury is to reduce blood supply and begin the clotting process, and areas of damage are prone to becoming swollen or inflamed.
These natural processes actually make a spinal cord injury worse, with inflammation causing pressure on already vulnerable parts of the spinal cord and a reduced blood supply meaning less oxygen supply to those parts of the body that are trying to heal.
Spinal shock can be recognised and managed in hospital and can have good outcomes. The condition can make it difficult, however, to predict how much functional improvement there will be after the acute phases of an SCI. When the inflammation settles down and blood supply improves, sensory and motor functions can improve as well, and good levels of rehabilitation may be possible.
The severity, level and area of an injury to the spinal cord can vary widely. Anybody with ongoing care or social support needs after an SCI should be assessed throughout a rehabilitation process. The purpose of rehabilitation is to get you as well and functional as possible, and then help you structure the best plan of care to meet your ongoing needs.
Rehabilitation can be a lengthy process and doesn’t necessarily stop when someone is discharged from their rehab facility – having physiotherapists and occupational therapists as well as specialist carers and nurses as part of your home care team means attaining and maintaining the best possible functional ability and overall health after your injury.
Total Community Care work with the multidisciplinary teams involved in our clients’ rehab programmes and beyond. This means we can participate early in the process of planning for discharge home or can take over a care package with a thorough understanding of the needs of our clients.
Our clients are at the centre of everything we do. We believe that the best package of care starts with the client and is created in collaboration with the most important people in our clients’ lives. No two people are alike, and we help support the lives and lifestyles of people across the wide spectrum of extra care needs.
Our aim is to empower people to choose their own care team, plan their own package of care, and to prioritise the things in life that are most important – family, work, home life, leisure time and holidays away – we can provide tailored, specialised support throughout.
At Total Community Care we pride ourselves on providing the complete package to support our clients and their loved ones to continue the kind of lives they want to lead.