Spinal cord injury can occur as a result of trauma following a road or workplace accident or as a result of tumours or infarcts (lack of blood supply) to the spinal cord. Injury is named by the lowest level that has full normal function. For example, when someone is considered a C5 quadriplegia, it means that the lowest level with full feeling and movement corresponds to the patch of skin and key muscle group associated with that level of nerve supply. In this case it is the bicep muscle and feeling on the outside of the elbow. The American Spinal Injury Association (ASIA) uses a detailed and standardised scale to determine this, and it helps us predict functional outcome.
Spinal cord injury can be classified as complete or incomplete. Complete injuries result in completed paralysis below their level of injury, without sparing at the end of the cord (sacral sparing), also known as ASIA A. Some people have partial paralysis either in the form of preserved sensation or movement in their lower parts of their body. This means that they can be classified as an ASIA B, C or D which are all forms of incomplete injury.
Sometimes partial paralysis follows a set of patterns, known as a syndrome:
Anterior cord syndrome means that there has been damage to the front part of the spinal cord, usually disruption in the anterior spinal artery, the main blood supply to the spinal cord. The result of this that the tracts that lie in the front of the spinal cord become injured, resulting in a loss of movement and feeling of temperature and pain. However, the tracts that transmit information about our body position (proprioception) and light touch are preserved.
The most common of spinal syndromes, central cord syndrome refers to injury to the inner part of the spinal cord, most frequently as a result of hyperextension injury of the neck especially in older people. The result is such that the arms are disproportionately affected by paralysis, whereas the lower trunk and legs progressively are spared. This is due to the anatomical organisation of the spinal tracts.
This syndrome related to the loss of movement and sensation on one side of the body, due to the injury affecting one side of the spinal cord. It is almost like getting a stroke on one side of the spinal cord, except that on the other side there is also a loss of pain, crude touch and temperature sensation as well, usually 2-3 levels further down. This is because the tracts that transmit pain, crude touch and temperature cross at the spinal cord level.
Neurological physiotherapists are physiotherapists with additional training and expertise in treating problems related to the brain, spinal cord, inner ear and nerves. Neurological physiotherapists apply their neuroscience knowledge to predict the likelihood of recovery given the type of injury and the distribution of symptoms. From here we can provide a framework to commence rehabilitation and therapy for maximising function at a given level of injury and severity.
Many spinal cord injured individuals desire the ability to walk again, but lack the postural control to do so. This directly impacts on the spinal cord’s ability to access any preserved reflexive patterns and rhythm to walking (central pattern generators) and can have a profound effect on the recovery process. Therefore it is important that postural control is heightened for control and development of movement. Our neurological physiotherapists apply the principles of sensory feedback, postural adjustments to help individuals with spinal cord injury control their tone and regain as much motor control as possible. This may be in the form of intensive therapy.