What is a spinal cord injury?
A spinal cord injury refers to damage to any part of the spinal cord. The messages being sent along the nerves are disrupted past the point of injury leading to a loss of sensation and/or function below the level of injury. Sensation and function loss varies greatly among people with spinal cord injuries due to differences in the extent of damage to the spinal cord. The level along the spinal cord can impact how much of the body is not receiving signals from the brain.
Further, the severity of the damage at the level of injury may be ‘complete’, referring to no signals traveling past the injury, or ‘incomplete’ referring to only some signals not being able to pass the site of injury. For example, an individual with an injury at the spinal cord level C6 may experience impaired strength from some of the muscles in their arms and down their body. The extent of this person’s physical impairments depends on the type and severity of the damage to the spinal cord.
What is the physical impact of a spinal cord injury?
As spinal cord injuries impair the body’s feeling and muscle function, people living with spinal cord injuries may face challenges in their daily lives such as difficulty sitting up in bed, standing from a chair, walking short distances, reaching to pick up an object, etc.
Each experiences different challenges depending on their level of function. Often these difficult daily tasks become goals to work towards and to regain independence.
Why is exercise important for spinal cord injury?
After a spinal cord injury, there is an increased risk of other health conditions such as heart, bone, or joint diseases, largely due to a decrease in physical activity level.
Exercise is highly recommended to maintain a healthy heart, lungs, blood vessels, bones, and joints. With the right guidance, exercise is a safe and effective treatment to many conditions associated with spinal cord injuries and to improve functional ability.
Spinal Cord Injury Specialists
We, as exercise physiologists, are trained to provide a safe and effective exercise program for people living with a spinal cord injury to ultimately make life easier!
Many allied health professionals (Exercise Physiologists, Occupational therapists, Physiotherapists, Dietitians) can assist a person with a spinal cord injury towards their goals through different types of treatment. Accredited Exercise Physiologists (AEPs) are the highest qualified exercise professionals who prescribe exercise to improve the body’s functional ability and maintain a healthy body. With the guidance of an AEP, many people with spinal cord injuries can build on their ability by learning new ways to move and by increasing the strength and endurance of their muscles. AEPs are trained to provide safe and effective exercise programs for people living with disabilities such as spinal cord injury.
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Summary of new information
A spinal cord injury (SCI) disrupts the site for reflex integration between body sensors and motor and autonomic effectors, leading to a range of physical, social, and psychological changes. Habitual exercise can be instrumental in reducing fatigue, pain, weakness, joint deterioration, and incipient neurological deficits commonly experienced after SCI. However, exercise options for individuals with SCI are limited compared to those without physical impairments.
In SCI, the spinal cord typically remains anatomically intact but suffers contusion, infarction, or mechanical deformation, interrupting its local or relay circuitry. The ASIA scale defines the type of impairment closely following injury, distinguishing between upper motor neuron injury (above T10) and lower motor neuron injury (below T10). Muscle atrophy is greater in cases of flaccid paralysis.
Tetraplegia results from cervical segment injury, while paraplegia stems from thoracic, lumbar, or sacral segment injury. “Spinal Shock,” a state of areflexia following SCI, may occur due to hyperpolarization of cord neurons. Approximately one year post-injury is typically when researchers classify neurological stability for research inclusion.
SCI syndromes include anterior cord syndrome, central cord syndrome, Brown-Sequard syndrome, and conus medullaris syndrome, each characterized by specific motor and sensory impairments.
People with SCI experience accelerated pathological states associated with premature aging and deconditioning, such as dyslipidemia, heart disease, circulatory insufficiency, and bone/joint injuries. Many body organs and tissues acutely respond to exercise despite their decentralised or denervated states.
Following SCI, affected body systems undergo significant changes, including muscle inefficiency and weakness, bone demineralization, deterioration of the cardiovascular system, and dysfunction of the autonomic nervous system. Peak exercise capacity diminishes due to blunting of physiological responses depending on the level of injury (LOI).
Endurance training, matched with guidelines for individuals without SCI, improves VO2 peak, with the magnitude inversely proportional to the LOI. Circuit resistance training interspersed with endurance activities is considered the most optimal training procedure. Carefully prescribed exercise has demonstrated the ability to enhance activity, life satisfaction, and health in individuals with Spinal Cord Injury, underscoring its importance in rehabilitation and overall well-being.
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