Providing bespoke care nationwide for clients with spinal injuries and neurological conditions
The physical impact of a spinal cord injury depends largely on the area of the spine where the damage occurs. As the spinal cord progresses from the brain down the backbone, pairs of nerves extend between each vertebra to different areas of the body. This means that the nerve signals at and below the area of injury are those affected – so the higher up the injury, the more of the body is affected.
As the nerves that branch off into the limbs arise from different points in the spinal cord, injuries above the level of the nerves of the arms will cause a person to lose the use of all four limbs – this is known as tetraplegia or quadriplegia. Injuries below the level of the nerves that branch into the arms but above those that communicate with the legs will cause loss of use of the lower limbs, but with preserved function of the upper limbs – this is often known as paraplegia.
Damage to the spinal cord may be caused by a traumatic injury including fractures of the vertebrae and cord compression, or may have causes from within the body such as tumours or infection.
A spinal cord injury may be total – where there is no useful communication between the brain and the nerves below the point of injury. The injury may be partial, where there is damage to part of the nerve bundle, and so there may be preserved function in certain areas, for example on one side of the body but not the other.
The spine is largely divided into four areas – the cervical spine makes up the bones of the neck, the thoracic spine is the part of the backbone supporting the upper torso and ribcage, the lumbar spine is the lower back and the sacral spine is the very bottom of the back.
The cervical spine or C-spine is the name for the top seven vertebrae of the backbone. These are the bones of the neck. Injuries at the level of one of the cervical vertebrae will be a numbered C1 to C8 – C1 refers to the pair of nerves at the very top of the spine, and C8 is the lowest pair of nerves. The lowest cervical vertebra is C7 – it has a protrusion which makes it easy to feel – it’s the ‘knobbly’ part of the backbone at the base of the neck.
Total injuries to any part of the cervical spine will mean loss of sensation and motor function from that point downward; this includes continence and sexual function, and issues with joints and muscles resulting from lack of use and movement. People with C-spine injuries will nearly always need 24-hour support.
C1 and C2 injuries, as the highest parts of the spinal cord, are the most total. People with very high total spinal cord injuries may have no communication between the brain and anything below the top of the neck, and so may be totally paralysed, and dependent on mechanical ventilation. People with high c-spine injuries will be dependent for all personal care including positional changes for comfort and preventing pressure damage. High cervical spine injuries will affect a person’s ability to clear their lungs, and possibly to clear saliva from their mouths and may affect speech and swallow.
C3, C4, and C5 injuries may require the use of a ventilator, particularly those at C3 level, while C4 and C5 may have some breathing control but some lack of diaphragm control meaning that they may not require a permanent mechanical ventilator, but may need cough assist devices and periodic ventilation. People with injuries at C5 and lower should retain their ability to speak, and may have some control and sensation to their upper arms and elbows, but without control or sensation to their hands.
C6, C7, and C8 injuries are below the level of some of the nerves which communicate with the hands and arms. People with injuries at these levels generally have some motor control over the hands and arms, but may lack fine coordination, and can have altered sensation. This may take the form of referred pain, odd tingling or pins and needles in the hands. The lower the injury, the more upper limb function is retained.
The middle 12 vertebrae of the spine are known as the thoracic spine, or T-spine vertebrae. They are the vertebrae with ribs attached. Like all spinal cord injuries, the lower down the spine the damage occurs, the less effect there is on normal function. People with T-spine injuries usually have good upper limb control – this means that they may be able to drive a car adapted for hand controls.
Total T-spine injuries will always affect lower limb, continence and sexual function, and control and sensation to the torso.
T1 and T2 injuries still have some impact on the arms, and may particularly affect flexion of the wrist and the muscles to the back of the upper arms. Nonetheless, people with high T-spine injuries can usually retain or regain good use of their arms.
T3 to T8 injuries affect the muscles of the trunk – the back and stomach muscles will be affected to a degree depending on the height of the injury. The lower the injury, the more scope there is for good rehabilitation, muscle strengthening and control.
T9 to T12 injuries, if total, will mean the loss of nerve communication with the muscles and organs of the lowest parts of the abdomen, and the legs. However, upper limbs, breathing, and upper torso muscles should be unaffected, meaning good sitting control, ability to drive a modified car, transfer themselves bed to chair, wheelchair to car and so on. Good control of the muscles of the upper body means more independence in both manual or electric wheelchairs, and some people use standing frames for mobility, exercise and therapeutic use.
Injuries to the lumbar vertebrae, the five bones of the lower back and the spinal cord nerves there, affect the body from below that point, so largely affect the legs, bladder, bowels and sexual function.
L1 and L2 are the last bones of the spine to contain the spinal cord within them, and the nerve roots that correspond to the lower vertebrae branch off from this point. Total cord injuries at the level of L1 and L2 will mean loss of the use of legs and control of the lower organs and muscles.
L3, L4 and L5 injuries, where the nerves of the spinal column are not held together in a single spinal cord, can have variable effects, which can differ from total loss of control and sensation of the legs and lower organs, to numbness or mildly reduced control of range of motion. People with L-spine injuries can expect a good level of independence and rehabilitation.
The sacral spine – S-spine – comprises the lowest part of the backbone leading into the coccyx, or tailbone. There are five vertebrae that make up the sacral spine. The spinal cord does not reach into this point – L2 is the lowest vertebra containing spinal cord, but the spinal column is still the central hub for the nerves that branch off to the lower extremities. This means that injuries to this lowest part of the body have less effect than any higher injuries, but can still have some serious repercussions in life. In general, someone with an S-spine injury can expect normal levels of independence, but may have problems with bladder or bowel sensation and control.
S-spine injuries may lead to sexual dysfunction, particularly in men, but should not affect primary fertility. A common symptom after sacral spinal injury is lower back or leg pain, and reduced sensation around the groin is often an issue.
There is such a range in effect from different levels of spinal cord injury, and any one injury can affect the entire spinal cord at that point or only one side, front or back of the nerve bundle. This means that there is huge variation in the changes someone with a spinal cord injury will experience. Generally, anyone with any degree of serious spinal cord and nerve damage can expect to encounter big changes in their life and lifestyle.
Assistance with the physical side of life can take many forms and can range from total dependence on ventilators and carers for all activities of daily living, to perhaps, problems with continence or lower movement and sensation which can be managed independently. Professional rehabilitation after a spinal cord injury is designed to help you achieve the optimum functional level for you as an individual and to plan for any ongoing support you need.
Getting the right kind of care and support is essential for maintaining quality of life, and for preventing problems associated with spinal cord injury. People with spinal cord injuries are at risk of pressure sores, skin and tissue damage associated with incontinence, muscle wastage, and joint problems. Ongoing care should include regular physiotherapy as well as personal care, and with a dedicated care team, a physiotherapy regime can be well maintained. Carers with a special interest and background in spinal cord injury and clients with extensive care needs can make all the difference to life after a spinal cord injury.
The emotional and mental health impact of a spinal cord injury cannot be understated; any event that has a significant effect on the way you live and function is bound to cause changes in your outlook, both short- and long-term. Having new health needs and an increased reliance on other people can be very difficult. Remember that you still deserve to have control over your life, to feel useful and seek enjoyment. There are lots of ways to get support through these times, from professional help, peer support groups, online, locally, nationally and worldwide.
At Total Community Care we believe that you should have the ultimate choice over the people who help you day-to-day, and our job is to enable you to assemble a team of specialist carers and healthcare professionals who can enable you to live the life you want. Consequently, you are involved from the outset in the selection of your care team. With your input we create recruitment adverts that are bespoke to your needs and carer interviews are held with you, a family member and or your case manager. This approach keeps you in control of choosing the right care team for you.
We provide 24 hour care in your own home, and your regular team members can accompany you as you continue your journey throughout changes in your functional ability and healthcare needs. We can accompany you on holidays, enable you to work, socialise and just continue to enjoy your life.
No one spinal cord injury is the same as any other, just as no two people are the same. Aside from the variation in effect and function after a spinal cord injury, there is infinite variety in the way people respond to injury and rehabilitation, both physically and emotionally. Rehabilitation and care planning after a spinal cord injury must be based on holistic assessment – consideration of the person as a whole – with a full appreciation of their lifestyle, desires and place in their family, work and friendship circles as well as physical and functional needs.
A care team will incorporate day-to-day personal assistants for everyday physical and emotional support and personal care. A really comprehensive care package should also incorporate or have links to healthcare professionals from associated backgrounds like neuro rehab, physiotherapy, speech and language therapy, and clinical psychology. With expert input, a good care team can become a great care team. A dedicated care team will provide continuity of care, growing to learn the best way to look after you, and to help you look after yourself and your loved ones.
That’s why it’s so important to choose a care provider who will support you in making decisions about your own needs based on the things that are important to you – the individual – and the people you care about.