It has always seemed bizarre to me that Spinal Cord Injury Awareness Day falls in the month of May, when Spinal Cord Injury Awareness Month is represented in September. Nevertheless, May represents various observations for those with disabilities. May is National Mobility Awareness Month, Mental Health Awareness Month, and this week included Global Accessibility Awareness Day. Today specifically marks Spinal Cord Injury Awareness Day (SCIAD). For those of us living with SCI, these overlapping observances are a reminder of the challenges we face, the progress we’ve made, and the work still left to do. As someone living with complete quadriplegia, I see May as a time to talk about the realities of our lives
Understanding Spinal Cord Injury
A spinal cord injury is damage to any part of the spinal cord or nerves at the end of the spinal canal. These injuries often cause permanent changes in strength, sensation, and other body functions below the site of the injury. According to the National Spinal Cord Injury Statistical Center (NSCISC), approximately 17,810 new SCI cases occur each year in the United States, and an estimated 302,000 people are currently living with SCI (NSCISC, 2023). I am one of these numbers.
Injuries are typically categorized by the level and severity of impairment. Two major types of SCI are paraplegia and quadriplegia:
- Paraplegia refers to the loss of motor and/or sensory function in the lower half of the body, usually resulting from injuries to the thoracic, lumbar, or sacral regions of the spinal cord. Individuals with paraplegia retain full use of their upper body but may experience limited or no function in the legs and trunk.
- Quadriplegia, also known as tetraplegia, involves impairment in all four limbs and the torso. This typically results from damage to the cervical region of the spinal cord. People with quadriplegia may have limited or no movement and sensation in both the arms and legs, and in some cases, the respiratory muscles are affected as well.
The impact of SCI extends far beyond physical mobility. I often say that the paralysis is the easy part, managing all of the secondary conditions becomes the challenge. Chronic pain, bowel and bladder dysfunction, skin integrity, and increased risk of mental health conditions. That’s why recognizing both Mobility Awareness Month and Mental Health Awareness Month alongside SCI Awareness Day is so important. We live at the intersection of all these issues every single day.
Complete vs. Incomplete Injuries: Understanding the Spectrum
Spinal cord injuries are classified as either complete or incomplete, depending on the extent of damage to the spinal cord.
- A complete injury means there is a total loss of motor and sensory function below the level of the injury. In this case, the brain is no longer able to send signals past the point of injury. This often results in full paralysis in the affected areas (National Institute of Neurological Disorders and Stroke, 2023).
- An incomplete injury means some motor or sensory function remains below the injury level. The extent of preserved function can vary widely. Some people with incomplete injuries may be able to move one limb more than another or may have more feeling on one side of the body than the other (National Institute of Neurological Disorders and Stroke, 2023).
The severity and classification of a spinal cord injury are determined using a standardized neurological assessment known as the ASIA exam, which was developed by the American Spinal Injury Association. This comprehensive evaluation helps medical professionals determine the level and completeness of the injury by testing motor strength and sensory perception across specific areas of the body. The results are then used to assign a grade on the ASIA Impairment Scale (AIS). This grading system reflects the degree of motor and sensory function that remains below the site of injury (American Spinal Injury Association, 2019).
Image sources: American Spinal Injury Association (ASIA) Impairment Scale, Physiopedia, https://www.physio-pedia.com/American_Spinal_Injury_Association_%28ASIA%29_Impairment_Scale
During the ASIA exam, clinicians assess:
- Sensory function at 28 key dermatomes on both sides of the body
- Motor function in 10 key muscle groups on each side
- Voluntary anal contraction and deep anal pressure, which help determine whether the injury is complete
Based on these assessments, the injury is assigned a grade from A to E:
- AIS A: Complete injury with no motor or sensory function below the injury level
- AIS B to D: Incomplete injury with varying degrees of preserved motor and/or sensory function
- AIS E: Normal motor and sensory function, although the person may still have an SCI diagnosis
This classification system helps medical professionals develop personalized treatment plans, set rehabilitation goals, and estimate recovery outcomes (American Spinal Injury Association, 2019). For those of us living with SCI, the ASIA grade serves as a clinical reference point, not a limit to what is possible in our journey forward.
Raising Awareness
Raising awareness is the first step toward building a world where people with SCI can exist and thrive. SCIAD is more than statistics. It’s about the human experiences behind the numbers. I am one of 17,500 who experienced a spinal cord injury in the United States in 2017, and I have a story to tell. I invite you to listen to our experiences, and share this knowledge.
References
American Spinal Injury Association. (2019). International standards for neurological classification of spinal cord injury (ISNCSCI) worksheet. https://asia-spinalinjury.org/international-standards/
Centers for Disease Control and Prevention. (2023). Spinal cord injury (SCI): Basic facts.https://www.cdc.gov/traumaticbraininjury/scifacts.html
National Institute of Neurological Disorders and Stroke. (2023). Spinal cord injury: Hope through research. https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury
National Spinal Cord Injury Statistical Center. (2023). Facts and figures at a glance. University of Alabama at Birmingham. https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202023.pdf
Physiopedia. (n.d.). American Spinal Injury Association (ASIA) Impairment Scale. Physiopedia. https://www.physio-pedia.com/American_Spinal_Injury_Association_%28ASIA%29_Impairment_Scale
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