In Canada, there are approximately 4,300 new spinal cord injuries each year. In 2010, an estimated 86,000 Canadians were living with the effects of a spinal cord injury.1 This number is expected to climb to 121,000 by 2030 as Canada’s population ages and the number of new injuries increases each year.2
Spinal cord injuries impact the individual, their family, and community, as well as society as a whole. In 2013, the estimated annual costs associated with traumatic spinal cord injuries in Canada were $2.67 billion and the estimated lifetime costs for an individual were between $1.47 million to $3.03 million.3 These estimates include both direct costs for health care provided in hospital, other care environments, or at home as well as the indirect costs such as lost or changed work-related income.
The personal physical, social and economic cost to an individual with a spinal cord injury cannot be tallied in dollars alone and is specific to each individual and situation.
What is a spinal cord injury (SCI)?
SCI occurs when there is damage to the spinal cord from an injury or a disease process. The spinal cord is a bundle of nerves that runs from the base of the brain down the back. It is protected by vertebrae (bones that make up the spine) and is the body’s communication superhighway. It sends messages back and forth from the brain to control movement, provide nerve supply to internal organs and feel sensation in the rest of the body.
SCI may be classified as a complete or incomplete injury. When the SCI is complete, messages can no longer get through, resulting in loss of feeling and loss of movement (paralysis) below the injured part of the spinal cord. With an incomplete injury, the amount of function remaining will vary depending on the nerves that have been damaged and the muscles, organs or area of sensation that they supply. SCI can also affect other functions such as breathing, bowel and bladder control and sexual functions.
SCIs are classified as quadriplegic (tetraplegic) if the injury is in the neck causing loss or impaired function in the arms, trunk and legs. If the injury is in the middle or low back, the SCI is identified as paraplegic, meaning there is lost or impaired function in the legs and possibly in the trunk, depending on the level of injury.
Causes of spinal cord injury
There are two common causes of SCI.
The first is identified as a traumatic SCI (tSCI). This means the injury has occurred because of an external impact or injury damaging the spinal cord. The most common causes of tSCI are motor vehicle accidents, falls, accidents from sport or recreational activities such as diving into shallow water, or from a violent attack.1 Traumatic SCI injuries affect men more than women at a rate of 2:1 and occur more frequently in the younger population.4
The second cause of SCI is non-traumatic SCI (ntSCI) and occurs when a disease process, infection or tumor damages or presses on the spinal cord causing the loss of function.
How physiotherapists help
Regardless of the cause or level of the SCI, there may be changes in how the injured person is able to look after themselves, move around the home or community and participate in work, sport, or leisure activities. A physiotherapist can help at every stage from immediately after injury or the onset of symptoms; through rehabilitation and managing long-term concerns related to living with a SCI. A physiotherapist will provide education, exercises, equipment, and strategies to manage functional activities. This may include teaching techniques to family or other individuals to provide support as needed.
During the early, acute stage, the physiotherapist will be focused on current functional abilities and basic needs. If the SCI was a traumatic one, the physiotherapist will also treat any other injuries or medical concerns that may have occurred. Other key goals of treatment include prevention of secondary problems such as bed sores and lung problems, preventing any further injury to the cord itself, and helping adjust to a new normal.
As treatment progresses, the focus of treatment will switch to working towards returning home, and achieving identified goals. The goals for each individual will be different. Some people want to be as independent in their personal care as possible, while others may want to return to work, or sport and prioritize this over independence in other areas. A physiotherapist will help to identify specific, individual goals and then develop plans to achieve these goals.
Physiotherapists will assess how the injury has affected the ability to move and implement strategies to help optimize movement and function. Treatment will vary depending on the injury, but can include:
Helping to regain or maximize the ability to use affected limbs and to maintain strength in unaffected limbs.
Teaching new ways to move, transfer and care for oneself.
Teaching friends and family how to help with daily activities, community mobility, and other activities.
Teaching long-term movement skills like walking with mobility aids or wheelchair skill training.
Providing education and exercises to prevent future mobility problems or issues related to decreased mobility such as respiratory illness, pressure sores and limited joint movement.
Working with other team members to identify and obtain any equipment necessary to support functional abilities.
A physiotherapist can help individuals who have suffered a SCI reach their maximum physical potential. Goals and priorities may well change throughout the journey. During rehabilitation, a physiotherapist will monitor treatment progress and help reach or modify recovery goals. Once the initial rehabilitation is completed, it may be helpful to seek follow-up treatment with a physiotherapist in the community to maintain or continue to improve function, independence and community participation.
By working on specific body impairments, a physiotherapist will help improve the ability to perform activities with as little assistance as possible or finding different ways to do things. As limitations are reduced or strategies are developed to manage them, a physiotherapist will address the ultimate aims of rehabilitation: increasing participation and overall satisfaction with life.5
If you or a family member have experienced a spinal cord injury, an excellent resource is Spinal Cord Injury Alberta. You can access this organization at: http://www.sci-ab.ca/
Farry A, Baxter D. (2010) The Incidence and prevalence of spinal cord injury in Canada. Joint publication of: Rick Hansen Institute and Urban Futures. Available at: http://fecst.inesss.qc.ca/fileadmin/documents/photos/LincidenceetlaprevalencedestraumamedullaireauCanada.pdf
Noonan VK, Fingas M, Farry A, Baxter D, Singh A, Fehlings MG, Dvorak MF. Incidence and prevalence of spinal cord injury in Canada: a national perspective. Neuroepidemiology. [Internet] 2012 [cited 2018 April 24]:38(4):219-26. Available from: doi: 10.1159/000336014. Epub 2012 Apr 27.
Krueger H, Noonan VK, Trenaman LM, Joshi P, Rivers CS. (2013) The economic burden of traumatic spinal cord injury in Canada. Available at: https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/publicat/hpcdp-pspmc/33-3/assets/pdf/CDIC_MCC_Vol33_3_1_Krueger_E.pdf
Shroff G, Thakur D, Dhingra,V, Baroli,DS, Khatri D, Gautam R D. (2016). Role of physiotherapy in the mobilization of patients with spinal cord injury undergoing human embryonic stem cells transplantation. Clin Transl Med, 5, 41. Available at: http://doi.org/10.1186/s40169-016-0122-5
Gómara-Toldrà N, Sliwinski M, Dijkers M P. (2014). Physical therapy after spinal cord injury: A systematic review of treatments focused on participation. J Spinal Cord Med: 37(4), 371–379. Available at: http://doi.org/10.1179/2045772314Y.0000000194
Born to Move
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.