Providing bespoke care nationwide for clients with spinal injuries and neurological conditions
Spinal cord injuries describe a wide variety of damage to the spinal column and cord. They have profoundly different effects depending on where in the spine the damage has occurred, and whether the nerve impulses are completely or only partially damaged at the point of the injury.
As there is such variety in problems caused by spinal cord injury, it’s helpful to describe these injuries in terms of where in the body they occur, and from there we can get an idea of what they affect.
Spinal cord injuries can have many causes, and can be acquired or congenital (from birth or very early infancy). In children and adults the main cause of a spinal cord injury is trauma – the most common kind of trauma causing serious back injury is road traffic accidents[i], closely followed by falls.
Apart from accidental injury, spinal cord injury can be caused by some diseases like tumours of the spinal cord or adjacent areas, multiple sclerosis or meningitis[ii].
The backbone, spine, or vertebral column, is the upright, central row of vertebrae – the bones of the spine. Humans usually have thirty-three vertebrae – the upper twenty-four are ‘articulating’, with a cushioning disc in between each one – this means they can move slightly, enabling us to bend, twist, and adjust our posture to help with movement and load-bearing.
When talking about the vertebra, we divide them into regions to help easily understand where in the back they are, and each vertebra in each region is numbered, starting at the top and working downwards. The top 7 vertebrae, just below the skull, are known as the cervical spine – C1 to C7. The next region is the thoracic spine with 12 vertebrae – T1 to T12. Then the lumbar spine – L1 to L5. The next five are fused together to form the sacrum, and finally the coccyx is usually made up of four fused vertebrae.
Each vertebra has a vertebral ‘arch’, effectively a passageway through each spinal bone, towards the back. All the vertebrae line up so this passageway is a smooth, well-lined continuous tube all the way from the C1 vertebra to around L1 or L2. The spinal canal is lined with thick flexible membranes and holds and protects the spinal cord.
The spinal cord and the brain are collectively known as the central nervous system. The spinal cord is made up of nerve tissue, and pairs of nerves extend from it between each vertebrae to form the peripheral nervous system. This is how sensations and commands are relayed between the brain and the rest of the body. Each pair of nerves relates to a different area of the body, and broadly speaking, the further down the spinal cord you get, the further down the body those nerves relate to.
The nerves pass information enabling control over nearly every part of the body. They are responsible for our understanding of the world through touch, taste, smell, sight and hearing, and every other subtle way in which we perceive our bodies and their environment. Our nerves give us control over the use of our bodies. The nervous system even affects those parts of the body which we have no or only partial conscious control of, such as the heart and breathing control.
The higher an injury to the spinal cord is, in general, the more of the body is affected. With a high (C1 to C4/C5) injury, there may be little or no sensation or control of the body below the affected point – the person may lose control over their arms and everything downward. They may also require ongoing assistance with breathing, possibly including mechanical ventilation.
Those with a C6-C8 are more likely to have partial control over their hand and arm movement and sensation, and to have independent breathing control, though they may have trouble with coughing or clearing their chest, especially when if they have respiratory tract infections. People with C-spine injuries who have little or no upper limb control may be referred to as tetraplegic or quadriplegic.
Thoracic spinal cord injuries – T1 and below – with preserved upper limb function may be referred to as paraplegic – having no or little use of their legs, as well as reduced or lack of control over the lower organs; bladder and bowel control, sexual dysfunction and movement of the muscles of the torso (stomach muscles).
In addition to being classified by region, a spinal cord injury may be complete or incomplete. A complete spinal cord injury means profound damage or even severance of the spinal cord resulting in an absolute lack of control from that point downwards.
An incomplete injury means that there is still some useful nerve pathway that has escaped damage, meaning some partial sensation or control below the area of injury. A partial spinal cord injury may mean that one side of the body is affected more than the other. Depending on the part of the spinal cord damaged, it’s possible to retain sensation without movement, or movement without sensation, or areas and functions which are or aren’t affected but which are difficult to predict.
If you or a loved one has sustained a C6 spinal cord injury, you may be wondering what to expect. A C6 spinal cord injury usually means a high degree of effect on the body. Someone with a complete or near-complete C6 injury may have some hand and arm sensation and movement, but it is likely to be quite restricted compared to the average person.
Someone with a profound C6 injury will have a lack of feeling and control over their torso and lower limbs, and may have problems with their breathing and reduced diaphragm control. The most immediate and obvious problem with a complete C6 injury is lack of sensation and motor control, but there are some other health and lifestyle concerns which go along with that:
With any spinal cord injury, it’s essential to have comprehensive and ongoing medical and social input. There are many programmes available to help with continued physiotherapy and rehabilitation, and treatments and management options are improving all the time.
Exciting advances in treatment are already helping improve outcomes for those who’ve suffered spinal cord injury, from stem cell research to nanosurgery. The severity of damage to the spinal cord can make a difference to the amount of recovery possible; some people have made remarkable recoveries in function, but the most severe spinal cord injuries are associated with chronic loss of nerve function[iv].
The lives of people with paralysing spinal cord injuries can be improved by modern medicine and technology, and there are more ways to manage even the most profoundly disabling conditions. The ReWalk robotic exoskeleton can allow those with lower limb disabilities to walk and even climb stairs[v].
Wheelchairs are more sophisticated all the time, and more responsive to commands, even to those with severe loss of nerve function. Modern accessibility requirements and discrimination laws, brought about in part as a response to pressure groups and disability charities, mean that it’s no longer acceptable to exclude people with accessibility needs.
People with a reasonable amount of hand and arm control can drive adapted cars and take part in an impressive amount of sports and physical activities with just a few special adjustments.
The future is bright, with research into chronic neuromotor disorders yielding exciting results[vi], including robotic neuroprosthetics; devices designed to replicate missing function using higher neurological control, and which animal studies have shown can actually help to recover some movement and function.[vii]
Spinal cord injuries of any severity can be disabling, and can require a huge adjustment in the lives of both the person affected and their nearest and dearest. Ongoing support at home can involve the help of a whole team of carers and professionals from a range of disciplines – having specialist advice from physiotherapists, neurologists, specialist nurses and carers who have had training in spinal injuries is the best way to help manage a spinal cord injury.
Support can be on hand for anyone involved in the life and care of someone with a spinal cord injury, from peer support groups, organized, accessible activities, or even just someone at the end of the phone who can give practical advice.
There has never been a better time to find support and care, as the internet is an ideal place for people needing and giving support to come together. Advice can be easily sought, and reviews and recommendations for treatment can be invaluable. The ability to choose the people involved in your care is important; with greater connectivity comes greater choice.
Total Community Care is a unique care provider that focuses on helping give you the greatest amount of independence possible. We offer bespoke spinal cord injury support care packages where you choose the level of care you require, and we take into consideration your home situation and daily needs.
If you or a loved one has suffered a C6 spinal cord injury, you want the best care available. Call Total Community Care on 01858 469790 for a consultation with our experienced, friendly staff and look forward to a more independent life.
[iii] Bonanno, G.A., Kennedy, P., Galatzer-Levy, I.R., Lude, P. and Elfström, M.L., 2012. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation psychology, 57(3), p.236.
[iv] Silva, N.A., Sousa, N., Reis, R.L. and Salgado, A.J., 2014. From basics to clinical: a comprehensive review on spinal cord injury. Progress in neurobiology, 114, pp.25-57.
[v] Esquenazi, A., Talaty, M., Packel, A. and Saulino, M., 2012. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. American journal of physical medicine & rehabilitation, 91(11), pp.911-921.
[vi] DeVivo, M.J., 2012. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal cord, 50(5), pp.365-372.
[vii] Rubia van den Brand, Janine Heutschi, Quentin Barraud, Jack DiGiovanna, Kay Bartholdi, Michèle Huerlimann, Lucia Friedli, Isabel Vollenweider, Eduardo Martin Moraud, Simone Duis, Nadia Dominici, Silvestro Micera, Pavel Musienko, Grégoire Courtine (2012) Restoring Voluntary Control of Locomotion after Paralyzing Spinal Cord Injury. Science 1182-1185