Spinal Cord Injuries
Spinal cord injuries involve damage that leads to impairment or complete loss of function below the level of the injury. The spinal cord is the body’s main communication pathway between the brain and the rest of the body. It begins at the brainstem and extends down to the L1–L2 region of the spine. It contains multiple spinal tracts that either descend from the brain to control movement or ascend from the body to relay sensory information such as touch, pain, temperature, and proprioception.
These injuries may result from traumatic events, such as falls or road traffic accidents, or from non‑traumatic causes including tumours, infections, or degenerative spinal conditions. In addition to motor and sensory deficits, spinal cord injuries can also affect reflexes and autonomic functions, leading to changes in bladder and bowel control, sexual function, and temperature regulation.
The most common grading scale for spinal cord injuries is the ASIA grading scale which grades the level of injury from A-E:
- A- Complete: No motor or sensory function, poor prognosis for recovery.
- B- Sensory incomplete: Sensation preserved below the level of injury but no motor function.
- C- Motor incomplete: Motor function preserved below the level of injury but 50% of muscle groups have a strength <3/5.
- D- Motor incomplete: Motor function preserved and >50% of key muscle groups have a strength >3/5.
- E- Normal: Motor and sensory function are normal.
In the acute phase of an injury, if the injury is thought to be severe, it is very important to urgently assess respiratory function. This is because the spinal pathways in your neck C3-5 are essential for respiratory function. If someone were to have a complete injury at these levels, they may be unable to breath and need putting on a ventilator to save their life. A lot of these patients will need to have respiratory support for the rest of their life.
Physio rehab will largely depend upon the level of injury and the ASIA grading. For example, with a complete injury, the rehab potential is very poor so the aim of physio will be almost purely compensatory and looking at preventing secondary complications. If it is a lower grade of injury, there will likely be more rehab potential to improve with strengthening work, the use of orthotics and specialist equipment. As well as the grade of injury, the level is very important as it will indicate the impairments you will expect them to have. If the injury is in the upper spine (cervical), you will likely have weakness in all 4 limbs and potential respiratory impairment. If the injury is in the mid back (thoracic) you will expect lower limb weakness and the potential for trunk weakness. If the injury is in the lower back (lumbar) then trunk should be preserved but they are likely to have lower limb weakness with some preservation in hip function.