Spinal Cord Injury

By far, spinal cord injury (SCI) is one of the most complex rehabilitation issues -right up there with acquired brain injury – because the spinal cord plays a critical role in making all of our everyday functions possible. Protective bone segments, called the vertebral or spinal column, surround the spinal cord, the largest nerve in the body. The spinal cord is made up of nerves that act as the communication system for the body. The nerve fibers within the spinal cord carry messages to and from the brain to other parts of the body like a fiber-optic cable carrying electrical impulses to areas of the body allowing us to do things like move our arms and legs and experience the sensation of touch or temperature.

When a client experiences a SCI, although muscles may not be damaged, the nerve fibers that send messages to the muscles are often damaged – and no longer able to send the right signals. As a result, due to SCI, a client may experience loss of a variety of functions because the nerve fibers cannot repair themselves. By understanding the interrelation between type of SCI and potential loss of function, a claims handler can more effectively anticipate the types of issues an SCI client may need to address.

Region

The spine is made up of regions with each region responsible for different functions. Accordingly, the type of SCI a client experiences-and in turn, how a client’s functioning is affected-depends on which region of the spine is injured, as well as the severity of the injury.

• Cervical spine: made up of seven cervical bones or vertebrae that are designed to allow flexion, extension, lateral bending and turning of the head. It extends from the base of the skull to shoulder level and also contains the cervical nerves that supply movement and feeling to the arms, neck, and upper trunk.
• Thoracic spine: made up of 12 vertebrae and attaches to the ribs in the chest region. Its main motion is rotation as the ribs prevent bending from side to side, and only allowing a small amount of bending forward and backward. It contains the thoracic nerves that supply movement and feeling to the trunk and abdomen.
• Lumbosacral spine: made up of large, wide, and thick vertebrae and extends from the waistline down the lower back to the base of the spine. Its main motion is bending forward and backward as well as side to side. It contains the lumbar and sacral nerves that supply movement and feeling to the legs, bladder, bowel and sexual organs.

Function

If a client experiences what is known as “complete SCI,” this means damage to the spinal cord, which results in complete and usually permanent loss of function below the level of the injury. By contrast, if a client experiences “incomplete SCI,” this refers to damage to the spinal cord that is partial, so there are still some motor and/or sensory functions. For instance, there may be some ability to feel but an inability to move or, conversely, there may be the ability to move but limited feeling.

The degree of loss in function varies because the amount of damage differs from person to person. A client may not have the ability to move or feel known as paralysis, however, the degree of paralysis depends on where the spinal cord is injured and the severity of the injury. Paralysis can be classified as:

• Paraplegia: the impairment or loss of movement or feeling in the thoracic, lumbar, or sacral (but not cervical) segments of the spinal cord. Depending on the level of injury, the trunk, legs and pelvic organs are affected to varying degrees.
• Tetraplegia also known as quadriplegia: paralysis of the four limbs due to cervical (neck) injuries. Depending on where injured, a client may require a ventilator or electrical implant for breathing, or may have shoulder and bicep control, but no wrist or hand function, or hand function but no wrist control.

Occupational therapist

Developing a solid understanding of the parts of the spine can be helpful in gaining insight into the functional limitations your client may experience, but no one knows the spine better than an occupational therapist (OT). Due to the OT’s focus on assessing and treating a person’s functional abilities and limitations related to completing daily activities, the spine is central to their work in assessing and treating motor vehicle accident clients. After the acute stage of injury when a client has been treated in hospital and is now ready for rehabilitation, the OT assists with a range of activities, everything from organizing discharge planning to attending rehabilitation team meetings to assessing the ability to conduct activities of daily living, as well as return to work options and the need for assistive devices. Understanding the basics about the spine and spinal cord injury provides a good foundation for effective communication as the claims adjuster liaises with the OT to effectively assess and treat SCI clients.

Judy Farrimond is technical advisor catastrophic and legal services and Angela Veri is national director of customer relations at Sibley Inc.