SCI Info.- Frequently Asked SCI Questions:
What is a spinal cord injury? Quadriplegia or Paraplegia?
A spinal cord injury results from paralysis of certain areas of the body along with corresponding loss of sensation or function. “Paraplegia” refers to the paralysis from approximately the waist down and “Quadriplegia” refers to paralysis from approximately the shoulders or chest down. Most spinal cord injuries result in loss of sensation and function below the level of injury including the loss of controlled function including the bladder or bowels.
What is paralysis?
Paralysis is a “partial” or “complete” loss of function especially involving motion or sensation in a part or parts of the body.
How are spinal cord injuries caused?
In 1995, the NSCIA released statistics of the major causes of spinal cord injuries (SCI).
• Motor vehicle or automobile accidents account for 48% of spinal cord injuries;
• Falls account for 21% of spinal cord injuries;
• Sports related injuries account for 14% of spinal cord injuries;
• (Of this 66% are caused in diving accident or swimming pool accidents)
• Violent acts (gun shots and assault) account for 15% of spinal cord injuries; and
• Other causes account for 2 percent.
However, spinal cord injury statistical information after 1995 has acts of violence at 24 percent including gun shot wounds and battery. As such, acts of violence have recently overtaken falls as the second most common source of spinal cord injuries.
Q. What does the spinal cord look like?
The spinal cord in a human looks like television coaxial cable. It is about one-inch in diameter and is a continuation of the brain. It looks like a firm, white fat with a substance similar to abalone. The nerves extend out from the spinal cord to the muscles, skin and bones to control movement, regular body excretions and secretions, and receives sensations. The 31 pairs of spinal nerves divide the spinal cord into segments: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygial.
Q: What exactly is a nerve cell?
Nerve cells have three basic aspects. The nerve cell body, the dendrites, the multiple receiving antenna that are actually the functioning extensions of the nerve body cell that carry impulses towards the body cells, and the axon, the single long “sending” fibers that, in humans, may extend for three feet or more. The axon carries impulses away from the nerve cell body. The dendrites and axons are called “nerve fibers” and can be thought of as long delicate “tentacles” and emanating from the nerve cell. The bodies electrical impulses are conducted along the “outer skin” of the tentacles. This skin is known scientifically as the plasma membrane and is continuous from the dendrites to the cell body. The plasma membrane is made up of precisely arrayed molecules of lipid fats and proteins.
Q: What are nerve impulses?
Nerve impulses are simply electro currents that are carried along with the plasma membrane of the nerve that may start from spontaneous ignition of the nerve body cell, removal of the suppressor impulse, or reception of electro impulse from another nerve cell.
Q: What are synapses?
Synapses are the junctions between the sending fibers of the nerve cell and the receiving fibers of the other nerve cells. The axon “sending fibers” ends in multiple branches each which has a button-like enlargement that nearly touch the receiving fibers of the other nerve cell bodies. As such, nerve cells talk to each other via “synapses”.
Q: What happens to the body when the spinal cord is injured?
An experienced spinal cord injury attorney must know the mechanics of a spinal cord injury. Generally, when a spinal cord is injured, the synaptic connections are interrupted. The impact or force caused by a trauma or accident exceeds the back bones protective design thereby allowing damage the nerve cells and spinal cord. There is then an acute loss of normal blood flow, swelling of the tissue, a breakdown of cell structure and loss of the structure of the myelin sheath. The flow of ionic current is then disrupted when higher concentrated calcium ions on the exterior of the nerve cells breaks through the receptive cell membranes to flood the interior neurons. This process of regaining balance of pressure in the ionic concentration then sets off a series of self-destructive cellular events. Phospholipase enzymes that digest tissue are released from the broken cell membranes. This results in a release of free radicals that satisfy the imbalance by attacking the nearby “good” cells that sets off a process called “lipid peroxidation”. Since the oxygen breakdown of essential cell lipids will lead to more swelling by water entering this tissue from the blood and cerebrospinal fluids, cells breakdown and this accelerates with the release of toxin subjects that affect blood flow. Glutamate, the main exitory transmitter, is an amino acid messenger in normal neuronal communication. But in large doses, glutamate expresses is proxivity by overloading the neuronal circuits. In other words, the neural substances are released such as serotonin, catecholamines, and endorphins. The result is a spinal cord injury.
Q: What is the immediate reaction to transection of the spinal cord?
After the first disruption of the axon (whether by spinal cord transection or contusion) there is an instantaneous escape of axoplasm from both the proximinal and distal ends of the axon. The axon then becomes swollen and axoplasmic which attempts to repair the axons to regenerate. This regeneration is common in the PNS but not the CNS. Other factors influenced by the transection of axons are found in the myelin sheath. As the axoplasmic leakage creates an almost immediate gap in the axoplasmic column within the otherwise intact myelin sheath tube, within just a few hours, the transection of the axonal tips of large fibers are set back from the injury site leaving small fibers at the cut ends. The leakage of axoplasm stops within a few hours of the transection at the axon tip as the axon tip is lined with axolemma and layers of collapsed myelin. The process of “axonal autonomy” begin approximately one day after the transection of the spinal cord and continues for about one week. This is a process where the tips of the axon degenerate by a means of terminal club rupture and then retrograde as much as one centimeter from the point of the original transaction or injury. The terminal club rupture is significant and axoplasmic contents that build up and escape are lysosomes which contain more than 50 enzymes all hydrolythic with acid PH optima. The escaping enzymes could be activated and lead to autolysis of the surrounding spinal cord tissue resulting in the disruption of the smaller intact or good fibers passing near the ruptured terminal clubs. The crucial difference in sheath structure is the presence of the neurilemma basil lamina in the PNS and the absence in the CNS. In the PNS, the basil lamina tube covers the myelin and a node, thus providing a continuous channel for the terminal club to pass through. It may however be possible that the expanding force of the terminal club could be converted by the restraints of the basil lamina into a forward movement. Axonal regeneration could therefore begin.
Q: What is “primary” spinal cord injury?
It is important to segregate primary mechanical disruption of the axons and secondary processes that damages axon further. The reason is that primary spinal cord injury can destroy as much as 90 percent of the axons in the spinal cord and a person may still will recover substantial function. The second spinal cord injury takes on an important role because it may compromise the survival and function of the axons that survive the primary trauma injury. Primary spinal cord injuries are unfortunately not as well understood as they should be. In our experience and our review or spinal cord injury research, one of the best studies on the subject comes from Dr. Andrew Blight who proposed essentially what is called the toothpaste theories of primary axonal injuries in the spinal cord. The toothpaste theory – is where the spinal cord is encased in relatively non-dispensable membrane called a dura. The dura is a very tough and very difficult to cut with a knife. Dura tears are rare in spinal cord injuries. This is the one main reasons why actual full spinal cord “transections” seldom occur. In this case, if you press a non-dispensable tube, there is only two directions that the content of the dura sack can go. In plain language, like rubber bands, they can elongate without breaking if you stretch them slowly, however, if you pull on them quickly they will break. The threshold for breaking is somewhat quick. When the speed of a stretching trauma movement exceeds a certain amount, the axons break. The broken axons then tend to retract. This is called the toothpaste theory because if you press a toothpaste tube, the toothpaste in the middle of the tube comes out first. The paste closer to the tube's surface comes out last. Similarly, the distribution of tissue velocities in the direction concentrates to the most stretching and shearing forces in the central part of the spinal cord therefore leading to central hemorrhage necrosis. The Spinal cord seems to be averted itself during the revolution and recognition of this physical trauma.
Q: At the acute stage, can long-term consequences of spinal cord injuries be reduced?
This must be answered by a medical doctor. However, research shows that the appropriate use of nethylprednisolone represents one of the most significant advances in spinal cord injury treatment. Although it is used or indicated for most acute spinal cord injuries, there appears to be little therapeutic benefits in some cases. The National Acute Spinal Cord Injury Study concluded that high doses of nethylprednisolone administered within eight hours of injury, does improve neurological recovery after acute spinal cord injuries. It is currently the only universally recognized SPINAL CORD INJURY treatment to provide significant neurological improvement in an acute spinal cord injury. Ideally medical treatment would help to reverse the neurological deficit, but acute spinal cord injuries have been extraordinarily resistant to effective treatment. Recent animal models involve spinal cord injuries suggest that drug intervention can improve the neurological outcome. In fact, within the last five years, studies on animal models on spinal cord injuries have shown enhanced neurological recovery utilizing several drug therapies including Gangliosides (please see University of Miami research). The data may apply to humans and pharmacological test may enhance regeneration and recovery.
Q: Can the spinal cord injury individuals get some “return” of function?
Spinal cord injuries are unique and quite different from all others. But there are some generalities that help describe the majority of spinal cord injuries. Our review of research and experience indicates that most spinal cord injury individuals immediately sustain what is referred to as “spinal shock”. The most obvious symptoms is paralysis due to the swelling of the spinal cord. This paralysis can improve if the swelling in the cord subsides or reduces which can begin within three weeks or more after the initial trauma, injury or accident. But then, eventually the improvement most people experience is that their “level” descends at least one level and sometimes two levels below their injury site within a year, especially if they have received nethylprednisolone shortly after the injury.
Q: What are the support groups related to spinal cord paralysis or SCI?
The National Spinal Cord Injury Association
(800) 962-9629
The National Institute of Neurological Disorders and Stroke (NINDS)
(800) 352-9424
(301) 496-5751
Paralyzed Veterans of America
(202) 872-1300
Q: What organizations work with caring for those with SCI
or dealing with paralysis?
The following institutions and organizations include:
American Paralysis Association
(800) 225-0292
(201) 379-2690
Miami Project to Cure Paralysis
(800) 782-6387
http://gsni.com/mia-proj
The Spinal Cord Injury Society
(218)739-5252
New York University
http://www.med.nyu.edu/MASCIS.html
Q: What periodicals, articles and books deal with paralysis, quadriplegia or paraplegia?
The best periodicals include:
New Mobility – a monthly magazine
By Miramar Communications
(800) 543-4116
The Spinal Cord Injury Newsletter
By Dr. Shell M. Chanaud
http://home.aol.com/mednewstub
The Quest for a Cure: Restoring Function after Spinal Cord Injury
By Sam Maddox
(800) 543-4116
Surgery of the Spinal Cord
By Dr. Robert Holtzman and Dr. N. Scott Bennetstein
Published by Springer-Verlag New York, Inc.
Q: Where should a spinal cord injury person go for rehabilitation?
The National Spinal Cord Injury Association (NSCIA (800) 962-9629) maintains a current list of fully accredited rehabilitation programs. In researching a California Spinal Cord Injury Rehabilitation Facility one must carefully examine certain factors. Some factors into choosing a qualified California Spinal Cord Injury Rehabilitation Facility include:
• Reputation/Word of Mouth;
• Proximity to family, home, friends and healthcare;
• Availability of the facility for specific rehabilitation objectives.
Rehabilitation centers throughout California can assist individuals in getting the spinal cord injury person back to a productive lifestyle.
Q: How is sexuality affected by spinal cord injuries?
Sexual function as in all other human bodily functions is controlled by our central nervous system. Any injury to the central nervous system may affect sexual function and the extent of sensation will be affected by the injuries of the various levels degrees and severity of the of spinal cor d injury
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