SCI RESEARCH PAPER

Spinal cord injury

A spinal cord injury is damage to the spinal cord that results in a loss of functions such as mobility or feeling, usually caused by trauma or disease. I chose this topic for my research paper, because I fight this very battle every single day of my life. I am living with a spinal cord injury and thought that I can provide you with much insight about the injury, statistic wise and what it’s like to live with the injury every day from my perspective. I was injured two years ago on July 26, 2007 in a rollover truck accident, where the cab crushed on my neck and my back, leaving me with a C5-6 spinal cord injury, I also compressed my T1-2 vertebrae in my back and broke my scapula in two places. Luckily for me, I did not sever my spinal cord which would’ve left me with no movement below my level of injury, I just bruised it and cause some trauma to my spinal cord. Just because, people break their neck and their back doesn’t mean it can cause damage to their spinal cord. It’s when you break a vertebrate and it goes into your spinal cord. At the time of injury, I was airlifted on a life flight to the Arrowhead Regional Hospital. I was taken directly into observation where they gave me a cat scan to check for brain injuries which luckily I did not have, then I was taken into MRI where they took pictures of my spine and discovered how severe my spinal cord injury was. Soon after that they put a halo on my head to realign my spine. They do this commonly for neck injuries. They put a 5 pound weight on the back of the halo which is drilled into my skull and winched it, and my spine realigned in 5 minutes. The following day I went into an 8 hour surgery, where they placed four screws and two plates into my neck to stabilize my spine, and they took bone from my spine and fused my C5-6 vertebrae back together. Living with a spinal cord injury has opened my eyes to a whole new world that I didn’t know was out there. It’s taught me how complex or body really is and how our brain and nervous system controls our body and if slightly damaged can cause a loss of function of our limbs and the inability to walk. However, it’s not my approach at this injury.
There are 250,000 Americans that are injured with a spinal cord injury. 52% of these injuries are considered paraplegics and 47% quadriplegic. Paraplegia is where you lose function of two of your limbs, usually your legs. Quadriplegia is where you lose function of all four of your limbs. There are approximately 11,000 new injuries every year. 82% of these injuries are two Males, and 56% of these injuries are between the ages of 16 and 30. The most common way to get a spinal cord injury is an vehicular accident, which accounts for 37% of all accidents. 28% is due to violence, 21% is to falls or diving, 6% is sports related and there’s another 8% for everything else. Motor vehicle accidents is actually decreasing in number and percentage, due to the better safety in cars and trucks. The worst part about this injury, is that most people can’t afford it due to the strenuous costs, which only insurance companies will cover 50 to 55% of the injury. Only 52% of the injured are covered by insurance at the time of injury. Being that I was on the job working for my dad, I was covered by private insurance company called Workman’s Compensation for those who are injured while working. I have been lucky enough to have most of my cost covered by my insurance. This injury can be in upwards of 2.5 million dollars over a lifetime. The average stay in acute care is 15 days, I was in for 8. The average stay in rehab hospital is 44 days, I was in for 63. The average, initial hospitalization costs is a $140,000, mine was close to a million. 63% of individuals are unemployed eight years after a spinal cord injury, yet I refuse to be a part of the statistic, by making strides to get back to working in my dad’s office.

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 waste. A spinal cord carries out, performs and operates the things we do physically throughout the day. There are three parts of the spinal cord that you can damage your proprioception which is knowing where your body is at in space, your feeling sensory, and of course your function sensory, which is being able to move and contract muscles in your body voluntarily. Upper motor neurons are the nerves that lie within the spinal cord that carry out the messages sent back and forth from the brain to the spinal nerves along the spine tract. The nerves that branch out from the spinal cord to other parts of the body are called lower motor neurons. These nerves exit center at each vertebrae and can communicate with specific areas of the body. The sensory parts of the lower motor neurons carryout messages about sensation from the skin and other body parts and organs to the brain. The motor portions of the lower motor neurons send messages from the brain to various body parts to initiate actions such as muscle movement. The spinal cord is a bundle of nerves that carryout nerve impulses to and from the brain and to the rest of the body. The brain and spinal cord constitute the central nervous system. Motor and sensory nerves that are in the Central nervous system are considered apart of the Peripheral nervous system. The Peripheral nervous system controls involuntary functions like blood pressure and temperature regulation of the body. It’s tough for spinal cord injuries to things like blood pressure because of lack of circulation to the lower extremities which usually would push blood backup to our brain and reduce lightheadedness. Doctors say that our thermometer of our body that regulates our body temperature lies within our spinal cord, so when our spinal cord is damaged it damages or thermometer and makes it tough for spinal cord injuries to regulate their body temperature. I have trouble doing this in extreme heat like at the lake, where I’m always running on hot, or extreme cold where it takes 2 hours at night of me laying in bed to get my body temperature back up to normal and be comfortable. One analogy that is typically use to describe a spinal cord, is a telephone cord. On the surface it surrounded by Black Rubber, which can be related to the vertebrae in our back and neck that surround and protect our spinal cord. If you are to take that telephone cord and try and rip it you would fray some of the wires that are inside causing the cord to not carryout specific functions anymore. If you were to try and put the cord back together you would get it all tangled up and not correctly route the wires to where they were before. So what I try and do every day is go to therapy and stimulate my central nervous system to re rout these wires back to normal and regenerate function. The telephone cord has thousands of wires running through the center of it that each carry out a certain function, this can be related to the spinal cord where each cord has a thin sheet that goes around it to protect it and conduct nerve electricity. This sheet we call myelin. A lot of what scientists are doing today with stem cells is trying to find a way to regenerate that myelin sheet and conduct nerve electricity to regain function again. The higher up people damage their spinal cord on the spinal column/vertebrae more dysfunction a personal experience in their upper extremities. The 8 vertebrae in the neck are called the cervical vertebrae which results in quadriplegia. I damaged my C5-6 Cervical vertebrae which is what the C is for which resulted in me loosing function in everything below shrugging my shoulders. The 12 vertebrae in the chest are called the Thoracic vertebrae. The first thoracic vertebrae T1 is the vertebrae were the top rib attaches. Injuries that happen within the thoracic region usually affect the chest and legs resulting in paraplegia, however, most of these injuries people have function of the hip flexors, which is the ability to pull their leg through while walking. Even though it’s not stated that it’s better to be a quadriplegic or paraplegic it takes a harder blow to break a vertebrae in your back then in your neck, which means usually it damages the spinal cord more severely in the back area, which in most cases there are less spasms below the knee level, so people that are paraplegics can’t control their ankle and their planter planterflexion and dorsiflexion. Which results in these people having to wear ankle braces called AFO. Which stands for, ankle foot orthoses. People with the cervical spine injury, generally can get better control of their ankle due to the increase spasms below their knee which keeps those muscles strong. However, each injury is different and some more and less severe than others even at the same vertebra level and every one heels differently, faster and slower so it’s hard to say that two injuries are alike because no one damages exactly the same chords as someone else in their spinal cord. There are three types of spinal cord injuries a complete injury and an incomplete injury and severing your spinal cord. A complete injury means that the person has a 5% chance of regaining function below the level of injury. An incomplete injury, means that the person has a 95% chance of regaining function below the level of injury. This is determined at the time of injury, by a doctor doing what’s called a prin pick tests. He does is by taking a needle and touching the patience butt with it to see if they can feel it. If you can feel it your incomplete, if not your complete. This however an initial diagnosis that can change rapidly because our bodies can heal itself. At the time of my injury I was diagnosed as complete, partly because I had no function below the level of my injury, a year later I was RE diagnose as incomplete because I had regained function below the level of my injury the defied science and what doctors told me that I would never have a chance at walking again. I prove them all wrong and am a testament that miracles can happen for one that I survived a rollover car accident without being dead and no brain injury, but now more importantly I am regaining movement in my legs and trying to put 1 foot in front of the other everyday, stepping towards my goal in life once again. The last type of spinal cord injury, is where you sever your spinal cord, this is a completely lesion through the whole spinal cord, which results in no function ever to be regained below the level of injury. Most people would say this eliminates hope, but in today’s society through the power of medicine, and that a team of doctors at UC IRVINE and the Miami Project through the power of stem cells this can soon be possible that these people will one day walk again as well. The vertebrae in the lower back between the thoracic vertebrae where the ribs attach and the pelvis, are the lumbar vertebrae, this takes a severe blow to damage these vertebrate and spinal cord. There are five lumbar vertebrae. The last vertebrae of the Sacral vertebrae which are but bones, however there’s no spinal cord in our butt so you can damage these vertebrae and not have to worry about your spinal cord. There are five of these vertebrae. This diagram of the spinal cord will further explain what parts your body are damaged depending on where the site of your injury is, and what vertebrae you break. Keep in mind my injury was at this C5-6 level so I lost everything below the use of my deltoids, biceps and triceps.

ON RIGHT SPINAL CORD: Cervical neck injuries usually result in quadriplegia. Injuries
above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often
result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries
generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries
can straighten their arms but still may have dexterity problems with the hand and fingers.
Injuries at the thoracic level and below result in paraplegia, with the hands not affected.
At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result
of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck
control and good abdominal muscle control. Sitting balance is very good. Lumbar and
Sacral injuries yield decreasing control of the hip flexors and legs.
Besides a loss of sensation or motor functioning, individuals with SCI also experience
other changes. For example, they may experience dysfunction of the bowel and bladder,.
Sexual functioning is frequently with SCI may have their fertility affected, while women’s
fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many
involuntary functions including the ability to breathe, necessitating breathing aids such as
mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include
low blood pressure, inability to regulate blood pressure effectively, reduced control of body
temperature,   inability to sweat below the level of injury, and chronic pain.

ON LEFT: This is my x-ray that the doctors took a few hours after my injury.
You can see where my C 5-6 Vertabrae got damaged and went into my
Spinal Cord.

Immediately after a spinal cord injury the victim is rushed to a hospital specialized in trauma to treat the injury. In most regions of the country there are designated hospitals in which are specialized in trauma, and if patients are injured within the region they are to be life-flighted or taken by ambulance to these hospitals. In my case I was injured right outside of Barstow, off of
the interstate 15 heading to Las Vegas, in California. I was airlifted from the scene by a life flight helicopter not knowing whether or not I would live to see the day to say bye to my family and friends and my girlfriend. I was taken to Arrowhead Regional Hospital in Fontana, California which was that trauma hospital for that region. The hospital did pretty much a standard procedure to me, as far as care goes once you reach the hospital. The story goes as by what my parents told me, my helicopter lands on the tarmac and the blades stop spinning and I get wheeled directly into cat scan to check for any brain injuries. Luckily for me I hadn’t suffered any, which is a miracle after seeing the pictures of the crushed vehicle. Immediately after that I was taken into MRI to see how bad I had damaged my spinal cord. After determining the severity of the injury, doctors deemed I would need a halo to be drilled into my head and then tightened and adjusted with weights to realign my neck and my spine. This was some of the most excruciating pain I’ve ever been through. A day later, I was taken into surgery for 8 hours where they put hardware my neck, two plates and four screws and took some of my bone fragment for my spine to fuse back my C5 and 6 vertebrae. Due to the injury, just like many injuries above the C6 level I was intubated through my nose and put on a ventilator to help me breathe because my lungs had collapsed. I also had a feeding tube that went down into my stomach to help me eat. I had to get breathing treatments four times a day while I was in ICU. I also had to get a machine that performed percussion on my chest to loosen up all the mucus that was surrounding my lungs causing them to collapse. These complications are very common for people with my level of injury or higher up the cervical spine. This is due to because people with a T level injury or a back injury maintain muscle strength in their ABS, their core and their diaphragm which is someone’s ability to breathe and maintain their blood pressure. The common length of stay in ICU is 15 days I stayed 8. The stay in a hospital can be quite expensive, insurance companies pay their money’s worth. An average day in a hospital is a $140,000. This can be for expenses like surgeries, potential complications like infections of wounds and the bladder, it can be for I V’s, boots for your feet that prevent pressure sores and many other procedures. My hospital cost in ICU was in upwards of $500,000. These procedures and complications I talked about are common for most spinal cord injuries. There are two types of secondary complication that can happen to the spinal cord. The first is swelling, just like any other injury to our body our muscles get inflamed and we swell. The swelling to our spinal cord occurs that the site of our injury and actually damages the spinal cord further than what was initially damage to it. Scientists and doctors have discovered ways to reduce the swelling and eliminate secondary injury on this part. A great example of this was with football player for the Buffalo Bills, Kevin Everett. He was injured and a football game while I was in the hospital in September of 2007, while making a tackle on kickoff. Immediately paramedics rushed on field identifying that he had a spinal cord injury because he laid limp unable to move his neck. The paramedics injected a saline solution, which is a water and salt solution into the spinal cord at the site of his injury, putting his spinal cord in a hypothermic state to reduce swelling. It’s unknown how severe his injury really was, however he is walking today and regained full function and is considered a miracle by many people. Paramedics are now being taught around the nation to give this injection at the site of the injury, while they’re on scene. The second cause of secondary injury is more due to our bodies way of reacting to it. Scientist have related it to the analogy of this, when we get a cut our body releases two cells, one to heal the inside of our skin and one to heal the outside of it. Within the first 12 hours of a spinal cord injury our immune system also releases cells to try and heal our spinal cord, however not all of them do with they are supposed to. Our body releases a bad cell called a Cytokine which actually goes in and eats away at our spinal cord causing more injury. Dr. Hans Keirstad of the UC Irvine medical group discovered a treatment to eliminate the secondary damage. Hans discovered an injection that spinal cord injuries get within the first 12 hours of the injury, that goes in and eliminates that Cytokine cell and reduces secondary damage by 70%. He discovered this treatment by doing it on rats. It has been proved by the FDA and has went into a clinical human trials for the first time ever in July of this year 2009. This is one of the biggest medical breakthroughs ever and certainly the biggest as far as spinal cord injury goes. This same treatment is able to treat Parkinson’s, Type 1 diabetes and Multiple Sclerosis which will help many individuals throughout the world. Due to the fact that a spinal cord injury is like a cut and develops a scar, Hans created more treatments for spinal cord injuries that are years post injury to get around that scar and regenerate the connection of the myelin sheet in the spinal cord and reroute those wires and get movement back in spinal cord injuries again.

There are many complications that can go on while having a spinal cord injury. A very severe and important thing to know about is Autonomic Dysreflexia also known as AD. This term is also known as hyperreflexia. This is more common for injuries of the T-5 level and above, and less common for injuries between T-6 to T-10, and almost never happens for patients below T-10. The older the injury the less likely as well. Ad can develop suddenly, and is a possible emergency situation. If it’s not treated properly and quickly, it can lead to seizures, stroke and even death. A great way to explain this, is to give the analogy to an able body person. Able bodied people have full sensation and their brain can sense when something is wrong with the body, like something uncomfortable is going on. With a person with a spinal cord injury, they can’t always detect this. For example, for an able body person, if there is a rock or a thorn in an able body persons shoe they can feel it’s uncomfortable and pull it out so it doesn’t hurt anymore. A person with a spinal cord injury if no sensation in their feet, would not be able to feel this rock. So, their body reacts in a weird way to tell them something is wrong. This usually happens, when an irritating stimulus is introduced to the body below the level of the injury. Another example of this is an over full bladder or a full bowel moment, it can also be due to things that are restricting, like socks, boxers or just something overly tight. This stimulus sends a nerve impulses to a spinal cord, where they are shot up to the brain and stopped at the site of the injury due to the lesion. Because, these impulses don’t reach the brain a reflex is activated that increases activity of the sympathetic portion of the Autonomic nervous system. Our bodies way of reacting to this, can be spasms and narrowing of the blood vessels which causes the blood pressure to increase. What a normal body does, is the nerve receptors in the heart and blood vessels detect the rise in blood pressure and send a message to the brain. Then the brain sends a message to the heart, which causes the heartbeat to slow down and the blood vessels above the level of injured a dilate. However, due to the spinal cord lesion and the injury the brain can send the message below the level of injury and the blood pressure can be regulated. In order to treat this, people need to identify the problem immediately and solve it. Whether it be a full bladder that needs to be empty, a bowel movement that needs to be empty, or something restricting that needs to be released. I have experienced this episode one time throughout my injury, and luckily it was in the hospital. I was treated very quickly, and they found that the problem was an over full bladder. Another complication that people can have during spinal cord injury is a bladder infection. These are also called urinary tract infections. Most able bodied people get bladder infections, but they pass them by peeing them out and their immune system fighting off infection. However, spinal cord injuries are more susceptible to this because the lack of function of being able to empty their bladder fully. The urine sits inside the bladder and eats away at the bladder walls causing infection to occur. Spinal cord injuries have to get their urine cultured, to figure out what bacteria is in their bladder, then put on an antibiotic to treat this bacteria. Luckily for me I have only had one bladder infection since my injury, I can empty my bladder pretty well my own. Another major complication that can happen, and is sometimes deadly is pressure sores. Because spinal cord injuries have trouble moving around and adjusting themselves, while they lay in bed they may lay on one side of their body and not know that they are putting too much pressure on their skin while it rubs on their bone, opening up a wound that is susceptible to bacteria. Christopher Reeve’s died of this very reason because his pressure short turned into a staph infection in which it took over his whole body. If a pressure sore does occur it must be treated properly and with much care due to the consequences. I had a pressure sore for eight months, which wasn’t due to sleeping on it, but because the harness I wore for gate training had rubbed my butt raw. My mom and my caregiver had to do wound care on this every day for eight months. The reason it took so long for to go away was because I sit on my butt constantly, throughout the day while in my chair, which kept irritating it. Luckily ever since I haven’t had a problem with it, or any new ones occurring. Quadriplegics suffer from what is called “Quad Belly.” Its called this because, a quads belly looks like a bulge distending from their stomach, almost like a bulge of fat. This is due to the internal lining of their organs/ their abs becoming paralyzed. This inhibits the ability of the abs to hold in the bodies organs in the stomach, causing them to bulge out.

After I got out of ICU I got transferred to rehab hospital called Casa Colina, which is a premier facility in the United States as far as acute rehab goes for spinal cord injury. Which is rehab after your stay in intensive care. The average stay in rehab hospital is 44 days. I was there for 63. Rehab hospital is a lot like the old saying getting your feet back under you. Everyday for 3 hours a day I would work with physical therapists and try and retrain my brain to make certain movements again. We did many things from range of motion to an electronic stimulation bike. Rehab hospital teaches traditional based therapy, which is learning to live and adapt in your chair. This is something that needs to be taught initially to help people become more independent. After rehab hospital, many individuals struggle on what they should do next. Luckily for me I had some guidance on what to do next, with help from my doctors and my family and friends. Casa Colina has a very good outpatient rehab program however, the only teach traditional base therapy and I was looking for something more intense. There are many outpatient facilities that specialize in spinal cord injury recovery however, I heard about a place in Carlsbad California about an hour and half from my house that’s called Project Walk. The name of the facility really does speak for itself and miracles happen there every day. My parents went down there and took the tour of the place and immediately knew it was the place I needed to be. Once my parents had told me about the place, it had seemed great to me however, places like Project Walk that are exercise base facilities aren’t covered by private insurances. So all of it is paid out of your own pocket. Exercise based therapy is therapy that is all done out of a wheelchair. The trainers at Project Walk teach you to live and adapt out of your chair. In other words they work on the body parts that you don’t have the use of instead of the ones that you do, which is what traditional base therapy is. A place like Project Walk is $100 an hour, so quick math will show you that it’s over 40 grand a year. Due to the fact facilities like this and medical supplies are so expensive their foundations that issue grants to people for these very reasons. Fortunately, for me my family is financially stable even after the injury, and it really hurt for me to see people not be able to fulfill their dream of walking again due to the lack of funding. So I turned to my parents and said I wanted to do something to give back, I started a foundation called The Be Perfect Foundation. The idea of the Be Perfect came from my childhood and growing up telling myself to live my life to its fullest, and leave nothing short and be all that I can be. My foundations mission statement is to provide direct financially aid to people with spinal cord injuries in exercise base therapy and to help them with their emotional well being. My foundation has sponsored over 30 people at Project Walk and keep them in exercise based therapy, it has bought ramps for houses for people, it is helped people buy medical supplies, and it has bought wheelchairs for people as well. But most of all my foundation has its name on a new gym that my community, friends and others helped start for spinal cord injury patients, it’s called the Claremont Club SCI Center. This place is like a Project Walk in the sense that it preaches exercise base recovery however, it’s for the patience that live up to my area that can’t make it down to Carlsbad. We have several pieces of equipment in there and have got our trainers certified through Project Walk. My foundation has had two annual events now, that our dinner, dance, silent and live auction nights that have raised with the help of the community, and the donor’s has raised over $250,000 each, Perfect. My foundation I implemented in order to give me a sense that I am giving back in some way to the people that deserve it. The biggest healing part of this injury is how you can deal with it emotionally. This starts with your support structure and attitude. From day one in the hospital I had hundreds of people come visit me, which not only showed me how great of a community I lived in, but more importantly how great my friends really were. This alone I feel is more therapeutic to spinal cord injuries than anything, and the way you can deal with this injury emotionally will get you back up on your feet. I chose to write about spinal cord injury for my research paper not only because it was something I was dealing with every day, but more importantly to spread the word of how many people are needed and that can use help. It’s just a matter of time before we all walk, it’s just about giving us hope. Hope is something that can make or break somebody, so never take away that hope keep spreading the word and we will all walk together someday. Hopefully, with my real life experiences that I talked about, and the factual information I gave you, now you’ll really know what it’s like to have a spinal cord injury if you ever wanted to research it.