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Recent Questions
What is the spinal cord?
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This may seem to be silly question but, until people get spinal cord
injury or know somebody who is, most pay little attention to their
spinal cords. Most people don’t know the different parts of the
spinal cord, what each part does, and how the spinal cord transmits
sensory and motor information. Many think that the spinal cord conducts
information like a telephone wire and the spinal cord can be fixed by
reconnecting it. Some people mistakenly believe that the spinal cord is
the vertebral column. While almost everybody knows that spinal cord
injury causes paralysis, many are not aware that the spinal cord also
controls the bladder and bowel, sexual function, blood pressure, skin
blood flow, sweating, and temperature regulation.
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What are the effects of SCI?
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The effects of SCI depend on the type of
injury and the level of the injury. SCI can be divided into two types
of injury - complete and incomplete. A complete injury means that there
is no function below the level of the injury; no sensation and no
voluntary movement. Both sides of the body are equally affected. An
incomplete injury means that there is some functioning below the
primary level of the injury. A person with an incomplete injury may be
able to move one limb more than another, may be able to feel parts of
the body that cannot be moved, or may have more functioning on one side
of the body than the other. With the advances in acute treatment of
SCI, incomplete injuries are becoming more common.
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What is Spinal Cord Injury?
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Spinal Cord Injury (SCI) is damage to the spinal
cord that results in a loss of function such as mobility or feeling.
Frequent causes of damage are trauma (car accident, gunshot,
falls, etc.) or disease (polio, spina bifida, Friedreich's Ataxia,
etc.). The spinal cord does not have to be severed in order for a loss
of functioning to occur. In fact, in most people with SCI, the spinal
cord is intact, but the damage to it results in loss of functioning.
SCI is very different from back injuries such as ruptured disks, spinal
stenosis or pinched nerves.
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What is the spinal cord and the vertebra?
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The spinal cord is about 18 inches long and
extends from the base of the brain, down the middle of the back, to
about the waist. The nerves that lie within the spinal cord are upper
motor neurons (UMNs) and their function is to carry the messages back
and forth from the brain to the spinal nerves along the spinal tract.
The spinal nerves that branch out from the spinal cord to the other
parts of the body are called lower motor neurons (LMNs). These spinal
nerves exit and enter at each vertebral level and communicate with
specific areas of the body. The sensory portions of the LMN carry
messages about sensation from the skin and other body parts and organs
to the brain. The motor portions of the LMN send messages from the
brain to the various body parts to initiate actions such as muscle
movement.
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Why is my spinal cord important?
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Your Spinal Cord is important because without a spinal cord your brain and your body couldn't communicate with each other.
The spinal cord is the pathway for impulses
from the body to the brain, and from the brain
to the body. These impulses are different signals our brain sends and receives from our bodies.
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I need help in getting something so I can use my computer. Can you help me?
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I have a spinal cord injury and have no mobility from the neck down. I need some help in getting something so I can use my computer. Can you help me?
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What's the difference between a paraplegic and a quadriplegic?
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Spinal cord injuries occur when there's damage to the spinal cord.
The result is loss of function, usually in mobility or feeling. Severe
injuries that occur in the neck usually result in quadriplegia, which
is paralysis from about the shoulders down. Typically, the higher the
neck injury, the more disability there is.
More than 54 percent of spinal cord injuries are the result of
vehicular collisions. More than a quarter result from other medical
conditions and sports injuries. Falls make up about 18 percent.
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What is a disability trial work period?
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The trial work period (TWP) allows disability beneficiaries to test
their ability to work for at least nine months. During the TWP, Social
Security beneficiaries may earn any amount and receive full Social
Security Disability benefits. Effective Jan. 1, 2001, earnings of $530
per month count as a trial work month. After completion of nine trial
work months, the substantial gainful activity (SGA) level is used to
determine whether earnings are substantial or not. If earnings fall
below the SGA level, full benefits generally continue. If earnings are
higher than the SGA level, cash benefits are normally suspended while
medical benefits continue. Beginning Jan. 1, 2001, a Social Security
Disability SGA level is $740 a month, or $1,240for a person who is
blind. This amount will be automatically adjusted annually based on
increases in the national average wage index.
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What is Paraplegia and Quadriplegia?
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Paraplegia is the loss of sensation and movement in legs and in part or
all of the trunk, usually resulting from an injury to the spinal cord
below the neck. Quadriplegia (also Tetraplegia) is paralysis of all
four limbs (from the neck down) resulting from injury to the neck.
Fractures or compression of the vertebrae, which cause permanent damage
to the spinal cord may lead to loss of sensation, movement, pain
management, bladder and bowel control, as well as affecting sexual
function.
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What is spinal cord injury?
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Many misconceptions abound concerning spinal cord injury. For example,
many people believe that the spinal cord below the injury site dies
after injury. Others think that the injured spinal cord is like a cut
telephone wire and can be fixed by reconnecting the cut ends. Some
people think that the vertebral column is the spinal cord. Even doctors
have misleading and inaccurate ideas about spinal cord injury. For
example, many doctors casually use the word “transection”
to refer to severely injured spinal cords. The word should only be
applied to the extremely rare situation when the spinal cord has been
cut and the cut ends are separated.
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What is autonomic dysreflexia?
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The autonomic nervous system often becomes hyperactive in people with
spinal cord injury. Autonomic dysreflexia manifests in large increases
in blood pressure (hypertension) with systolic pressures exceeding 200
mm Hg, slow (bradycardia) or fast heart rate (tachycardia), headaches,
facial flushing, exuberant sweating, hyperthermia, stuffy nose, goose
pimples, nausea, and other signs of autonomic hyperactivity. Called
autonomic dysreflexia, these episodes may be spontaneously or may be
instigated by infection, pain, or other conditions that stimulate the
autonomic nervous system. Severe autonomic dysreflexia may be
life-threatening.
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What is meant by the terms "complete" and "incomplete" injuries?
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Complete injuries result in total loss of sensation and function below
the injury level. Incomplete injuries result in partial loss.
"Complete" does not necessarily mean the cord has been severed. Each of
the above categories can occur in paraplegia and quadriplegia.
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Has the incidence of SCI changed in recent years?
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We don't know, because there haven't been any national studies of
incidence in the past 15 years. The statewide registries will
eventually be able to answer this question after they have been in
existence a while longer.
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How does spinal cord injury affect the skin?
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Spinal cord injury reduces or eliminates skin sensation in dermatomes
below the injury site. Because people cannot feel or move, they may sit
or lie for long times on certain parts of their body. Pressure impedes
blood flow in the skin. Due to muscle atrophy, the normal tissue
padding that cushions the butt may be reduced. Absence of sensation,
loss of muscle padding, and long periods of pressure can lead to skin
breakdown and development of pressure sores or decubiti. Decubiti are
potentially life threatening but preventable.
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What happens to the bladder, bowel, and sexual function?
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The spinal cord also carries “autonomic” signals that
control blood pressure, blood flow, breathing, sweating, bowel,
bladder, sexual, and other autonomic functions.
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Is there a time limit on Social Security disability benefits?
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No. You will continue to receive a disability benefit as long as your
condition keeps you from working. Your case will be reviewed
periodically to see if there has been any improvement in your condition
and whether you are still eligible for benefits. If you are still
eligible when you reach 65, your disability benefit will be
automatically converted to retirement benefits.
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Has the spinal cord been decompressed?
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The spinal cord injury usually results from fracture of vertebral bones
that compress the spinal cord. Continued spinal cord compression
increases tissue damage and reduces functional recovery. If the neck or
cervical segments are fractured, traction may straighten out and
decompress the vertebral column. Chest or thoracic fractures cannot be
decompressed by traction. Surgery may be necessary to decompress and
stabilize the spinal cord.
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How is spinal cord injury classified?
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In 1990, the American Spinal Cord Injury Association (ASIA) proposed a
uniform classification system that had five categories, defined in
Table 1. Motor level is defined as the level at which the key muscle
innervated by the segment has at least 3/5 of its normal strength.
Sensory level is defined as the lowest spinal cord level that still has
normal pinprick and touch sensation. If there is a spinal cord level
below which there is no voluntary motor or conscious sensory function,
the person is called a “complete” spinal cord injury. Since
the S5 is the lowest spinal cord level that innervates the anal
sphincter, a person that has no voluntary anal sphincter control or
sensation is defined as a “complete” spinal cord injury.
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When the cord is bruised, are the A- cells killed B- cells demylinated C- axons destroyed D- combinations/ all three or does it depend on the injury.
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All three can occur. Cells and axons are stretched and sheared when
compression displaces the spinal cord. At the compression site, there
are axons, neurons, astrocytes, and oligodendroglial cells. Depending
on the velocity and extent of the stretching and shearing, cellular
damage occurs to these cells. If the injury causes bleeding, the blood
is toxic to cells and contributes to the injury. Finally, the injured
tissues release a variety of chemicals that causes further tissue
damage. These include free radicals, inflammatory cytokines, neurotoxic
neurotransmitters, and other chemicals.
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How many spinal cord injuries occur in the U.S. each year?
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Studies suggest the incidence rate of SCI is about 40 cases per million
population, excluding those who die at the scene of the accident. Given
a current United States population of approximately 281.4 million
persons, this means that over 11,000 new cases occur each year.
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How disability is determined
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Social Security uses a step-by-step process involving five questions:
Are you working? If you are and your earnings average more than $700 a
month, you generally cannot be considered disabled. Is your condition
severe?
Your impairments must
interfere with basic work-related activities for your claim to be
considered. Is your condition found in the list of disabling
impairments? Social Security maintains a list of impairments for each
of the major body systems that are so severe they automatically mean
you are disabled. If your condition is not on the list, it has to
decide if it is of equal severity to an impairment on the list. If it
is, your claim is approved. If it is not, go to the next step. Can you
do the work you did previously? If your condition is severe, but not at
the same or equal severity as an impairment on the list, then Social
Security must determine if it interferes with your ability to do the
work you did in the last 15 years.
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Whats leading cause of death?
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In years past, the leading cause of death among persons with SCI was
renal failure. Today, however, significant advances in urologic
management have resulted in dramatic shifts in the leading causes of
death. Persons enrolled in the National SCI Database since its
inception in 1973 have now been followed for 27 years after injury.
During that time, the causes of death that appear to have the greatest
impact on reduced life expectancy for this population are pneumonia,
pulmonary emboli and septicemia.
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What is a Stem Cell?
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All mammals begin as two cells -- sperm and egg -- that combine into a
single cell. This single cell will divide exponentially into
specialized cells making up various organs and systems -- all the
tissues of a new organism. Simply put, a stem cell is an immature cell
that can become a different cell, or perhaps become one of many
different cells. Most stem cells also can renew themselves -- divide --
indefinitely. These two characteristics are what present a new pathway
to repairing damage to the human body caused by trauma, degeneration
and disease.
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Causes of Spinal Cord Injury
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The most common causes of spinal cord injury are car and other motor
vehicle collisions (54.7%), falls (17.7%), and other medical conditions
and sports injuries (27.6%). The injury is usually caused by sudden
impact, which crushes the spine and cord.
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How Much Can I Earn Before I Lose All My Benefits?
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If you have no other income besides earnings, you may earn up to
$1,189 a month in 2003 before losing your entire federal SSI payment.
But if you live in a state that adds money to your federal SSI payment,
you may earn more. If you have other income, such as Social Security
benefits, the amount you can earn before losing any payment may be
lower. However, when you apply for SSI disability payments, we consider
earnings of $800 or more an indication that you are able to do
"substantial work" and you would not qualify for SSI on the basis of
disability.
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What happens when nerve fibers regrow?
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The nerve cell body remains intact, and only the "sending" or
"receiving" fibers have to regrow as longer extensions from the nerve
cell body. The peripheral nerves, outside the brain and spinal cord can
do this quite easily. But within the brain and spinal cord there is
much impediment to such regrowth.
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What is the phrenic nerve and where is it situated?
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The phrenic nerve goes from the spinal cord to the diaphragm, a large
muscle at the bottom of your chest that mediates breathing activity.
Axons of the phrenic nerve come from the phrenic nucleus situated at
spinal cervical segments C3, C4, and C5. Most of the axons About 75% of
people have an accessory phrenic branch that comes from C5 and even C6.
The sternocleidomastoid muscle is the long muscle that goes from the
angle of your jaw to the head of clavicle, the long horizontal bone
that goes from your shoulder to the front base of your neck. Various
branches of the phrenic nerve head down behind the sternocleidomastoid,
joining together at the subclavian vein (a vein that is under the
clavicle) and descending downward into the chest.
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What Gender?
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Overall, 81.6% of all persons in the national database are male.
Although this four-to-one male to female ratio has varied little
throughout the 25 years of the Model Systems data collection, since
1990, the percentage of males has decreased to 80.5% (from 81.8% in the
1970's).
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Does everyone who sustains a spinal cord injury use a wheelchair?
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No. Wheelchairs are tools for mobility. High C-level injuries usually
require that the individual use a power wheelchair. Low C-level
injuries and below usually allow the person to use a manual chair.
Advantages of manual chairs are that they cost less, weigh less,
disassemble into smaller pieces, and are more agile.
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I understand that to get Social Security disability benefits, your disability must be expected to last at least a year. Does this mean that you must wait a year after being disabled before you can get benefits?
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You do not have to wait a year after the onset of the disability before
you can get benefits. You should file as soon as you can after becoming
disabled and benefits begin after a five-month waiting period. The
waiting period begins with the month Social Security decides your
disability began.
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Applying for SSI
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If you are applying for Supplemental Security Income benefits you also
need the following: information about the home where you live, such as
your mortgage or lease and landlord's name; payroll slips, bank books,
insurance policies, car registration, burial fund records and other
information about your income and the things you own.
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How Long Will Social Security Continue While I Work?
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Generally, you’ll receive your full monthly Social Security
benefit for a year after you return to work. If you continue to work
beyond that while still disabled, your eligibility for monthly cash
benefits will continue for at least another 36 months. Here’s how
it works:
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How Do I Get Started On A PASS?
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Anyone can help you with a PASS, including your vocational
rehabilitation worker, employer or the Social Security office. In
general, the following rules apply:
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Whats the age SCI happen?
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SCI primarily affects young adults. Fifty-five percent of SCIs occur
among persons in the 16 to 30 year age group, and the average age at
injury is 32.1 years. Since 1973 there has been an increase in the mean
age at time of injury. Those who were injured before 1979 had a mean
age of 28.6 while those injured after 1990 had a mean age of 35.3
years. Another trend is an increase in the proportion of those who were
at least 61 years of age at injury. In the 1970's persons older than 60
years of age at injury comprised 4.7% of the database. Since 1990 this
has increased to 10%. This trend is not surprising since the median age
of the general population has increased from 27.9 years to 35.3 years
during the same time period.
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Do people with SCI have jobs?
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People with SCI have the same desires as other people. That includes a
desire to work and be productive. The Americans with Disabilities Act
(ADA) promotes the inclusion of people with SCI in the mainstream
society. Of course, people with disabilities may need some changes to
make their workplace more accessible, but surveys indicate that the
cost of making accommodations to the workplace in 70% of cases is $500
or less.
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How Do Earnings Reduce My Payments?
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If your only income besides SSI is the money you make from your
job, then we don’t count the first $85 in earnings you get each
month. One-half of what you earn over $85 is deducted from your SSI
check.
If you have other income besides earnings (such as a
Social Security check), then we don’t count the first $65 in
earnings you get each month. One-half of what you make over $65 is
deducted from your SSI payments. But, $20 of your other income, such as
your Social Security check, is not counted either.
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How long will recovery take?
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Recovery takes a long time. Most recovery occur within 6 months but
many people continue to recover function for a year or more. A recent
poll of the CareCure Community suggests that 61% recovered function
more than one year after injury. In another poll, 16-18% of people who
are “complete” spinal cord injury recovered additional
function 3 or more years after injury. A recent study detailed how
Christopher Reeve recover function over 7 years after his injury. So,
recovery frequently continues for years after injury.
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What is the difference between Social Security disability and SSI?
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This is confusing to a lot of people because both programs are
administered by the Social Security Administration. Social Security
Disability Insurance (SSDI) is a program that workers, employers and
the self-employed pay for with their Social Security taxes. You qualify
for these benefits based on your work history and the amount of your
benefit is based on your earnings. Supplemental Security Income (SSI)
is a program financed through general tax revenues -- not through
Social Security trust funds. SSI disability benefits are paid to people
who have a disability and who don't own much or have a lot of income.
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Was methylprednisolone given?
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This is the high-dose steroid (30 mg/kg intravenous bolus followed by
5.4 mg/kg/hour for 23 hours if it is started within 3 hours and for 47
hours if between 3 to 8 hours after injury). It should not be started
more than 8 hours after injury. Clinical trials have shown that this
treatment improves recovery by about 20% when given within 8 hours
after injury but does not help when started more than 8 hours after
injury. While methylprednisolone is not a cure, every little bit helps.
Complications are minimal.
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Where should spinal-cord-injured persons go for rehabilitation?
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The National Spinal Cord Injury Association (NSCIA at 1-800-962-9629)
maintains a current list of all accredited programs... over 50 in all.
Some factors to consider in choosing a facility:
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How does a child qualify for disability benefits?
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Children who have severe disabilities may be eligible for monthly
benefits under one or more of the programs Social Security administers.
The Social Security program pays benefits to disabled or retired
workers and their families and to the families of deceased workers.
Child's benefits generally may be paid to a dependent unmarried child
under age 18, to a child age 18 or older who became disabled before age
22, and to a full-time elementary or secondary school student under age
19. If the parent is alive, he or she must be entitled to retirement or
disability benefits.
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What is the ASIA Classification System?
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After injury, many people are frequently told that they have been
classified as ASIA A, B, C, or D. What is the meaning of this
classification. ASIA stands for the American Spinal Injury Association.
The members of this association encompasses physicians who take care of
approximately 70% of people with spinal cord injury in the United
States and Canada. About a decade ago, they defined a standardized
classification of spinal cord injury severity and level, including how
to document severity and level by motor and sensory examination of
people with spinal cord. The ASIA classification system has been
endorsed and accepted by the IMSOP (International Medical Society of
Paraplegia) who represent a large number of spinal cord injury
physicians world-wide. For this reason, the system is frequently called
the International Spinal Cord Classification System. Download available!
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Does demylination STOP conduction or SLOW DOWN conduction?
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Axons that are demyelinated cannot conduct as well. Cells called
oligodendroglial cells form myelin around segments of axons. Each
segment may be as long as several millimeters in length. Also, the
axons are usually partially remyelinated after injury. The conduction
deficit depends on the extent of demyelination and remyelination.
Demyelination may stop or slow down conduction. More important, it may
prevent the conduction of a train of impulses. Axonal information is
often coded in bursts of action potentials. Demyelinated axons may be
able to support one impulse but not a rapid train of impulses.
Demyelination can also reduce the safety factor of conduction. In other
words, an impulse has a smaller chance of getting through a
demyelinated zone. Demyelination or abnormal myelination reduces the
amount of information that an axon can pass through.
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How Can SSI Help Me With My Work Expenses?
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The rules work the same as if you were receiving Social Security
benefits. Work expenses that are related to your disability are
deducted from your earnings when we figure if they are high enough to
affect your benefits. These expenses may include work equipment, such
as a special typewriter or desk, or modifications to your car or home
to help you get to and from work. This means you can earn well over the
SSI income limits and still continue to get payments.
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How many people are alive today in the U.S. with SCI?
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Estimates vary, but the generally accepted range is between 183,000 and 230,000 persons are alive today in the U.S. with SCI.
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What ethnic groups have SCI?
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A significant trend over time has been observed in the racial
distribution of persons in the Model System database. Among persons
injured between 1973 and 1978, 77.5% of persons in the database were
Caucasian, 13.5% were African-American, 5.7% were Hispanic, 2% were
American Indian and 0.8% were Asian. However, among those injured since
1990 only 59.1% were Caucasian, while 27.6% were African-American, 7.7%
were Hispanic, 0.4% were American Indian, 2.1% were Asian (and 0.5%
were unknown and 2.5% were unclassified).
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Do therapies have to be applied shortly after injury?
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Several experimental therapies are aimed at restoring function in
chronic spinal cord injury, when recovery has stabilized a year or more
after injury. These include 4-aminopyridine (a drug that increases
excitability of demyelinated axons), porcine fetal stem cell
transplants (stem cells from pigs), and olfactory ensheathing glial
transplants (cells from the nasal mucosa or from olfactory bulbs).
Other experimental therapies are being planned, including drugs and
chemicals that block growth inhibitors. Thus, there will be many
opportunities to participate in clinical trials.
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What are the levels of Spinal Cord Injury?
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There are seven cervical, twelve thoracic, five lumbar, and one sacral
vertebrae that make up the spine. The bones get progressively thicker
moving down the spinal cord. The level of injury references Spinal Cord
Injuries. Cervical Injuries are the highest these injuries are referred
to as C2 being the highest level of injury and C8 being the lowest
level of injury with the most function. Individuals with Cervical
injuries are most often referred to as Quadraplegics because all four
limbs are affected.
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What is the nerve center at L1? Why can't anyone with an injury below that have function below injury, or respond to FES?
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The part of the spinal cord that is situated at the bony segmental
level of L1 contains most of the spinal cord that represent the L1-S4
spinal segments. These segments innervate the pelvic area and the legs.
Collections of neurons in these segments control a variety of
functions. These include walking (locomotion), the series of reflexes
leading to urination (micturation), sexual function, etc. The neurons
of course also mediate the reflexes that control and coordinate
movements in the legs. Finally, many of the neurons that innervate the
muscles of the pelvic area and legs are situated in these segments. If
these motoneurons are killed, the muscles that they innervate will
undergo atrophy. Electrical stimulation may not be able to activate
atrophied muscles.
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What are the leading causes of SCI?
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Motor vehicle crashes rank 1st at 38.5% followed by acts of
violence at 24.5%; falls at 21.8%; sports at 7.2% and all others at
7.9%. These figures are for all injuries reported to the National
Database since 1990. The percentage of cases due to acts of violence
and falls have increased steadily since 1973. The percentage of cases
due to motor vehicle crashes and sports has been falling.
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