spinal cord injury awareness week 15 - 21 November 2004
ParaQuad is greatly concerned about the number of people who sustain spinal cord injuries, resulting from road accidents, water related accidents, accidents in the home or in the workplace and from sporting and recreational activities. Spinal Cord Injury Awareness Week is an opportunity to raise awareness in the community to the causes of spinal cord injury and appropriate preventative measures. For further information click here.
spinal cord injury information
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TOPICS COVERED BELOW
PARAPLEGIC OR QUADRIPLEGIC?
The human spine consists of the bony outer casing made up of segments of bone called vertebrae. They protect the spinal cord which runs the inner length of the spine. The spinal cord is like a mass of intertwined telegraph wires which transmit nerve messages from the brain to various parts of the body. They provide the initial stimulus from the brain for sensation and movement.
In spinal cord injury, the spine is normally damaged somewhere along its length. Thus it is said that you have broken your back or neck. The bone in the spine will mend as will other bones in the body when they are broken. However, the nerve tissue in the spinal cord which is also damaged when the spine is broken, will not mend. It is this nerve damage which causes the permanent loss of function and results in the conditions known as paraplegia or quadriplegia. These conditions may also result from medical conditions, such as a tumour or abscess which result in spinal damage.
This damage can cause permanent loss of feeling and movement in the legs, arms and trunk. It can also mean the loss of bowel, bladder and local sexual function.
Paraplegia involves a loss of sensation and movement in the legs and in part or all of the trunk. This varies according to the level of the injury. Generally, the lower the injury, the less the loss of movement and sensation. Paraplegia usually results from an injury to the spinal cord in the mid and lower back.
Quadriplegia normally means a loss of sensation and movement in all four limbs and the trunk. This generally results from a spinal cord injury to the neck. However, the loss of sensation and movement may not be complete with some sensation and movement being retained in parts of the arms and legs.
WHAT IS THE SPINAL CORD?
The spinal cord, located within the vertebral column, is a soft cylindrical structure made up of highly organised nervous tissue. Extending downward, as a continuation of the brain, the spinal cord is the main pathway of communication between the brain and the rest of the body. It is a delicate structure protected by the vertebrae and their associated ligaments and muscles, the spinal meninges and the cerebrospinal fluid (CSF). In adults the spinal cord is approximately 42-45cm in length and extends from the foramen magnum in the occipital bone to the second lumbar vertebral level (L2). However, the tapering end of the cord may terminate as high as the 12th thoracic vertebral level (T12) or as low as the third lumbar vertebral level (L3).
Thirty-one (31) pairs of spinal nerves enter and exit from the spinal cord throughout its length passing through small openings between each vertebra. There are eight (8) pairs of cervical nerves, twelve (12) pairs of thoracic nerves, five (5) pairs of lumbar nerves, five (5) pairs of sacral nerves and one (1) pair of coccygeal nerves. Nerves of the spinal cord are grouped or bundled so that related types of nerve fibre run together. Motor nerves, nerves that transmit information to muscles and stimulate movement, are anatomically positioned toward the front of the body. Sensory nerves, nerves that transmit information to the brain about sensations such as touch, position, pain, heat and cold are located toward the rear or posterior of the body.
WHAT IS THE VERTEBRAL COLUMN?
The vertebral column in an adult typically consists of thirty-three vertebrae arranged in five regions: Seven (7) cervical vertebra, twelve (12) thoracic vertebra, five (5) lumbar vertebra, five (5) fused sacral vertebrae and four (4) fused coccyx vertebrae. In adults the vertebral column is approximately 72-75cm in length and serves to:
- Protect the spinal cord and spinal nerves
- Support the weight of the body
- Provides a partly rigid and flexible axis for the body and a pivot point for the head
- Play an important role in posture and motion (movement from one place to another)
WHAT IS SPINAL CORD INJURY?
Spinal Cord Injury (SCI) involves damage to the spinal cord that results in a loss of function such as mobility or feeling. In order for the loss of function to occur, the spinal cord does not have to be completely severed. In most individuals with SCI, the spinal cord is intact, but it is the damage to it that results in the loss of functioning. Also, a person can break their back or neck yet not endure a SCI if only the bones around the spinal cord (the vertebrae) are damaged, not the actual spinal cord. In these cases, the bones usually heal and the person does not experience paralysis.
FREQUENT CAUSES OF SPINAL CORD INJURY
The most common causes of damage to the spinal cord are trauma's such as motor vehicle accidents, motor bike accidents, falls, sports injuries (particularly diving into shallow waters), gunshot wounds, assault and other injuries; and disease such as Polio and Spina Bifida.
Direct injury such as cuts can occur to the spinal cord, particularly if the bones (vertebrae) are damaged. Fragments of bone or fragments of metal (for example from a car accident) can cut or damage the spinal cord causing injury. If the head, neck or back are twisted abnormally, the spinal cord can be pulled, compressed or pressed sideways, also possibly causing direct damage. The accumulation of blood or fluid can cause swelling within the spine or spinal cord causing compression of, and damage to the spinal cord, resulting in an SCI.
WHO IS AFFECTED BY SPINAL CORD INJURY?
Anyone can be affected by spinal cord injury. The majority of SCI accidents involve young people aged between 17 and 30 years, with 28% of spinal cord injuries occurring in the 15-24 year old age group in 1996/97. Out of the approximate 300 Australians who acquired a spinal cord injury in 1997, males made up roughly 80%.
WHAT ARE THE EFFECTS OF SPINAL CORD INJURY?
The effects of Spinal Cord Injury vary depending on the type and level of injury sustained. We can divide SCI into two categories - complete and incomplete. A complete injury means that there is no function below the level of the injury (no sensation and no voluntary movement) and both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. One limb may be able to be moved more than the other, the person may be able to feel parts of the body that cannot be moved and there may be more functioning on one side of the body than the other.
Neck (cervical) injuries usually result in quadriplegia. People with injuries to the C1 - C4 level often require a ventilator to breathe. Shoulder and biceps control can remain with C5 injuries, however wrist and hand movements do not. C6 injuries can give wrist control but no hand function while at C7 and T1 individuals can straighten their arms but may have dexterity problems with their hands and fingers. Spinal cord injuries to the thoracic level and below result in paraplegia, where the hands are not affected. At T1 through to T8 there may be poor trunk control as a result of the lack of abdominal muscle control. Lower injuries of T9 to T12 allow for good sitting balance from abdominal muscle and trunk control while injuries to the Lumbar and Sacral regions mean a decrease in control of the hip flexors and legs.
Along with the loss of sensation and motor functioning, people with spinal cord injuries experience other changes. A loss of bowel and bladder control may occur and sexual functioning is commonly affected. Other effects of spinal cord injury may include low blood pressure, reduced control of body temperature, inability to sweat below the level of injury and chronic pain.
HOW CAN YOU PREVENT SPINAL CORD INJURY?
Many spinal cord injuries can be prevented by using safe practices at work and at play.
- Follow correct safety procedures and use protective equipment in the workplace.
- Regular exercise, good posture and lifting heavy objects in the right way (letting your leg muscles do most of the work) all help prevent spinal injuries.
- In recreation, warm up thoroughly and use appropriate techniques and equipment when playing sports.
- Check the depth of water before diving in, and examine the general area for any obstacles before diving and skiing.
- When on the roads, practice defensive driving and always wear a seatbelt. Never drink alcohol or take drugs and drive and don't travel in a vehicle that is being driven by a person under the influence of drugs or alcohol.
- Remember to wear an approved helmet when bike riding, skateboarding, roller-blading and motorbike or trailbike riding.
- Don't take unnecessary risks when horse riding, snow or water skiing, rock climbing, hang-gliding or trampolining.
THERE IS NO CURE FOR SPINAL CORD INJURY - THERE IS PREVENTION.
Sixteen year old Alice was the front seat passenger with her young, inexperienced boyfriend John at the wheel. They were on their way home from a friend's party where John had had a few drinks. Just a few streets from home, he lost control of the car coming round a corner and skidded into a power pole. Alice's head was whipped back and forth, damaging her spinal cord and leaving her a quadriplegic. She copes, but would give anything not to have accepted that lift.
Rupert was just twenty years old when he was driving to work one wet, winters day. Ten minutes late, he was driving faster than he knew he should have been on the slippery roads, when he skidded out of control. Without a seatbelt, Rupert was thrown through the windscreen and landed heavily on his back. He spent the next seven months in hospital adjusting to life as a paraplegic, but is certain that had he been wearing a seatbelt, he would be walking today.
Thirteen-year-old Mark was having fun with friends at the lake on his Uncle's farm. After walking along the banks from their usual swimming spot, he came across a small mound of rocks about a metre off the ground. Ready for another swim, Mark climbed up and dived into the water landing on some hidden rocks. He was dragged from the water and awoke in the Austin Hospital Spinal Unit to the shattering news that he was a quadriplegic.
HOW TO HELP - RESCUE TECHNIQUES
In all first aid care, the carer must take the following steps immediately:
If there is a threat to the patient's life, treat the dangers, Airway, Breathing and Circulation first.
- DANGER: If present, remove the danger or remove the patient from the dangerous environment.
- RESPONSE: Check the patient's conscious state.
- AIRWAY: Ensure the patient's airway is clear - remove vomit, blood, dentures, etc.
- BREATHING: Ensure the patient is breathing.
- CIRCULATION: Ensure that the patient's heart is beating and if there is major external bleeding, control the bleeding by direct pressure.
REMEMBER: Following an accident, prevent secondary spinal injury by NOT MOVING THE PATIENT if spinal injuries are suspected UNLESS there is a life threatening reason to do so (see above). Life threat takes precedence over possible spinal injuries.
- DO NOT MOVE THE PATIENT
- ADVISE OTHERS NOT TO MOVE THE PATIENT
- SEND SOMEONE TO CALL 000 AND ASK FOR AN AMBULANCE TO ATTEND
- REASSURE THE PATIENT
- TRY AND FIND OUT THE PATIENTS NAME AND ADDRESS
- WAIT WITH THE PATIENT FOR THE ARRIVAL OF THE AMBULANCE OFFICERS
It is more common for spinal injuries to occur without life threat.
POSSIBLE SPINAL INJURY SHOULD BE ASSUMED IN THE FOLLOWING CASES:
- Any car accident at greater than 75kph.
- Any pedestrian hit by a car at greater than 30kph.
- Any car accident where there is a car rollover or where a passenger has been thrown from the vehicle.
- Any significant fall, including falls in the elderly.
- Any shallow water diving or surfing accident.
- Following helmet damage from a motorcycle accident.
- Any unconscious trauma patient or significant neck or head injury.
- Any penetrating injuries e.g. Gunshot wound to the spinal region.
- Any trauma to the neck and back if associated with past spinal disease.
- Any physical signs and symptoms associated with the spine e.g. the position the patient was found in, pain or tenderness around the spinal area.