 A complete spinal cord lesion is the term used to describe damage to the
spinal cord that is absolute. It causes complete and
permanent loss of ability to send sensory and motor nerve
impulses and, therefore, complete and usually permanent loss of
function below the level of the injury. This will result in
complete paraplegia or tetraplegia. The completeness of
many injuries isn't fully known until 6-8 weeks post injury.
The spinal cord normally goes into what is called spinal shock
after it has been damaged. The swelling and fluid masses
showing on any resultant X-ray, MRI or CT scans, may well
mask the true extent of the underlying injury.
Complete
Paraplegia
Complete paraplegia is a term used to describe complete and
permanent loss of ability to send sensory and motor nerve
impulses to the muscle groups and body functions that are
controlled by nerves leaving the spinal column at T1 level or
below. T1
injuries are the first level with normal hand function. They can
use their arms with all the motor functions of a non-injured person. As thoracic levels proceed
down the spinal column, abdominal musculature recovery is
present, and there is improved respiratory function and trunk
balance (sitting balance) as a result. Sensation below the
level of injury is lost and bladder, bowel and sexual function
will not work normally either (see
Treatment of SCI
for more information)
Some complete
lower injuries have partial trunk movement and may be able to
stand, with long leg braces to support their paralysed legs, and a walker
taking their body weight through their arms, balancing on the
leg braces. They may be able to
walk short distances using this equipment, with assistance. T6-12 patients also have
partial abdominal muscle strength, and may be able to walk
independently for short distances with long leg braces and a
walker or crutches, again taking all their body weight through
their arms, balancing on the leg braces. (The working abdominal muscles are used to
throw the paralysed legs forward whilst the body weight is taken
on a frame or crutches)
Attempting this form of walking is
normally a decision taking in a medical environment. It
takes a lot of determination and strength to achieve
any success with this sort of walking. It isn't for
everyone, indeed many complete paraplegics won't
even want to try it. The usual
mobility solution for a complete paraplegic will be a manual
wheelchair (self-propelled)
Complete
Tetraplegia
Tetraplegia is far more debilitating than paraplegia as the arms
are paralysed too. The descriptions below detail what is
likely to be expected functionally with the different levels of
tetraplegia. It is only intended as a guide and should be
read as such.
 C1-4 Tetraplegia:
Patients with C-1 and C-2 lesions may have functional phrenic
nerves. In these cases, implanted phrenic nerve pacemakers can
be used, and pacing of the diaphragms may be simultaneous or
alternating. If secretions are not a problem, tracheostomies may
be plugged or discontinued. Less equipment may be needed for C-1
and C-2 patients than for C-3 and C-4 patients.
Patients with C-3 lesions have impaired breathing and may be
ventilator-dependent. They can shrug their shoulders and they
have neck motion, which permits the operation of specially
adapted power wheelchairs and equipment, such as tape recorders,
computers, telephones, page turners, automatic door openers, and
other environmental control units with mouth control (sip and
puff), voice activation, chin control, head control, eyebrow
control, or eye blink. Patients with C-4 lesions may be free of
respiratory equipment beyond the initial acute care stage, but
may have the same functional equipment needs as
ventilator-dependent patients.
In addition to powered wheelchairs, C1-4 tetraplegics require
assistance for all personal care, turning, and transfer
functions. Head rests, troughs or a lapboard, for the upper
extremities, and lifts may be necessary. Bed surfaces with two
or more segments that are alternately inflated and deflated may
be indicated for patients who do not have assistance for
turning. Functional electrical stimulation (FES) may restore
elbow flexor function in patients with C-4 lesions. For
patients with lesions at C-5 or higher, power recliners to
achieve pressure relief while sitting are recommended. Patients
with partial C-4 lesions and inadequate elbow flexors and
patients with C-5 lesions may initially require a balanced
forearm orthosis, for enhanced arm placement, or a long opponens
orthosis with utensil slots and pen holders, for wrist
stability, during activities such as feeding, writing, and
typing.
C-5 Tetraplegia: C-5 tetraplegics have functional deltoid and/or biceps
musculature. They can internally rotate and abduct the shoulder,
which causes forearm pronation by gravity. Wrist flexion is
similarly produced. They can externally rotate the shoulder and
cause supination and wrist extension. They can bend the elbow,
but elbow extension can only be produced by gravity, or by
forceful horizontal abduction of the shoulder and inertia or
shoulder external rotation.
C-5 patients require assistance to perform bathing and lower
body dressing functions, for bowel and bladder care, and for
transfers. With the use of balanced forearm orthoses, long
opponens orthoses, or universal cuffs and adaptive equipment,
C-5 patients can feed themselves, perform oral facial hygienic
and upper body dressing activities, operate computers, tape
recorders, telephone, etc. and participate in leisure
activities. They can propel manual wheelchairs short distances
on level surfaces, although the hand-hand rim interface should
be modified with vertical or horizontal lugs (or plastic tubing
can be wrapped around the rims), and gloves should be worn to
protect the hands. Powered wheelchairs, propelled with a hand
control, are needed for community distances and outdoor terrain.
C-6 Tetraplegia: C-6 patients have musculature that permits most shoulder motion,
elbow bending, but not straightening, and active wrist extension
which permits tenodesis, opposition of thumb to index finger,
and finger flexion. Wrist extensor recovery is common in C-6
patients, but its return can be delayed. Tenodesis orthoses
support tenodesis training early in recovery. Wrist-driven
flexor hinge splints permit pinching strength, needed for
catheterization and work skills. Short opponens orthoses with
utensil slots, writing splints, Velcro handles, and cuffs permit
feeding, writing, and oral facial hygiene.
C-6 patients can perform upper body dressing without assistance
and may also perform lower body dressing without assistance.
They can catheterize themselves and perform their bowel program
with assistive devices. They can perform some transfers
independently with a transfer board, turn independently with the
use of side rails, and relieve pressure by leaning forward,
alternating sides, or possibly by push-ups. Water mattresses can
lower pressure sufficiently to eliminate the need for turning
during the night. They can propel a manual wheelchair short
distances on level terrain, operate power wheelchairs, and may
drive with a van and special equipment. They can cook, perform
light housework, and live independently with limited attendant
care.
Upper extremity reconstructive surgery, or functional
neuromuscular stimulation of the upper extremity, or surgery and
stimulation in the same patient can improve function in C-6
patients. Surgery is recommended only for patients who are
neurologically stable and without spasticity. Stimulation can be
provided by external, percutaneous, or implanted electrodes, by
shoulder motion utilizing an external system, or by key and
palmar grip and release, or by a bionic glove, an electrical
stimulator garment that provides controlled grasp and hand
opening.
C7-8 Tetraplegia: C-7 patients have functional triceps, they can bend and
straighten their elbows, and they may also have enhanced finger
extension and wrist flexion. As a result, they have enhanced
grasp strength which permits enhanced transfer, mobility, and
activity skills. They can turn and perform most transfers
independently. They can propel a manual wheelchair on rough
terrain and slopes, and may therefore not need a powered
wheelchair. They may drive with a van and specialized equipment.
They can perform most daily activities, they can cook and do
light housework, and therefore they may live independently. They
may, however, require assistance for bowel care and bathing.
C-8 patients have flexor digitorum profundus function which
permits all arm movement, with some hand weakness. They can
propel a manual wheelchair community distances, including in and
out of a car and over curbs, and may even become wheelchair
independent. They can drive with a van or car and special
equipment. They can perform all personal care and daily
activities, except heavy housework.
Paraplegia -
Complete SCI -
Incomplete SCI -
Treatment -
Complications
-
Causes of SCI -
My Injury
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