2015…this is going to be an incredible year. It’s time to get back to sharing helpful and useful information. When I write these articles, I want to include everyone in the fact finding that I am sharing. These articles are not only for friends in wheelchairs, but also for friends of friends in wheelchairs. Read this information and get to understand more about your buddies in wheelchairs. These articles are written for all and this one deals with the level of functioning following a spinal cord injury.
A question came up recently concerning how that fickle little spinal cord reacts when an injury is inflicted upon it. Fickle and inconsistent…when the delicate spinal cord is injured, it is anyone’s guess as to the level of functioning that will return. You could ask each of us in wheelchairs about our level of functioning and you may hear many different responses. It is not as simple as paraplegic or quadriplegic. I personally feel the easy terminology is “complete” or “incomplete” injury. A “complete” injury means the spinal cord is completely severed. Nothing gets to the brain beyond the point of the injury. This complete level of injury is easiest to define. My injury was a “complete” injury. My back was broken and a tiny piece of the bone completely severed my spinal cord. Nothing is felt or moves (apart from spasms) below the point of injury. A spinal cord injured individual will undergo a series of tests to determine the level of functioning during their hospitalization and rehab. But in my opinion, the real tests come after discharge when the individual is back at home. It is the things we must figure out or learn how to achieve that are not taught in rehab but in our own environments. This is what is termed “independent living.”
“Functioning” means how your body will operate following a spinal cord injury. Does your little toe move independently and not your right index finger? Some people can move their right extremities and not their left. Some can move their lower extremities and not their upper. Personally, I can do everything with my upper extremities but below my level of injury nothing responds to my command. My bodily functions do not respond as they once did prior to my accident because I have a complete severing of the spinal cord. No impulses will travel to my brain because the circuit is broken.
Now, the terminology gets to be a little more difficult to explain, so read closely. “Incomplete” spinal cord injury means the spinal cord was NOT completely severed. So some impulses can make their way through the point of injury and communicate back and forth with the brain. The tricky part is where and how the injury occurred, and how the impulses slip through the injury to the spinal cord. So you may see quadriplegics walking. Or quadriplegics with little upper extremity use, but their lower extremities work well with some rehab. The other little tidbit that makes everything slightly confusing is trunk stability. Upper level injuries make the trunk or abdominal area difficult to stabilize. It’s similar to “Weebles”. Remember those little egg toys from the 70’s and 80’s? “Weebles wobble but they don’t fall down.” Most of us spinal cord injury people know that trunk stability is difficult but we all just make adjustments to make it work.
A while back, a conversation occurred with a few of my differently-abled girls and we were discussing sewing with a sewing machine. I was sharing how much I enjoyed creating Halloween costumes for my children when they were younger, before my accident. But because I could no longer operate the foot pedal of the machine, I gave my sewing machine away. One of my friends shared that she sews using her elbow to operate the foot pedal and another controls the foot pedal by placing it between her chest and the table of the machine. Ingenious girls! I supposed I could have tried to operate my machine but since our sons are grown, I had no reason to try.
If you read my other articles, and I hope you did, you will know that spinal cord injury does not stop us from succeeding at whatever we attempt to do. It may take longer, but we will do it. Never underestimate a spinal cord injured individual, we can be very resourceful.
Researching information on this topic was difficult. I could find but one piece of literature written on the topic of functioning and spinal cord injury. The article was written by my own physician at Virginia Commonwealth University Department of Rehab, Dr. William McKinley. It is a fantastic article and I have included it in my references in case you would like to read it. I hope I have explained the basis of spinal cord injury functioning, but to really understand your own level, it is best to talk with your own physician. There is also other terminology used in spinal cord injury such as “ASIA scores” but that gets confusing and for the purpose of this article, I opted not to go into that. If you have any questions concerning the level of functioning, please forward those to me. If I don’t know the answer, I will certainly locate it. Never fear.
Let’s continue to roll FIT, FABULOUS, and with FUNCTIONING understanding.
Patty Kunze, RNC, BSN
THE ROLLIN RN on FaceBook
Functional outcomes per levels of spinal cord injury. Obtained January 5, 2015 from http://emedicine.medscape.com/article/322604-overview#a
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