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ANIMATED SCI LEVELS CHARTMouse over the spinal column to see how the level of injury affects loss of function and control |
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Cervical InjuriesCervical 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, C-8 and T-1 injuries can straighten their arms, but still may have problems with their hands. |
ANIMATED SCI LEVELS CHART
Mouse over the spinal column to see how the level of injury affects loss of function and control
Cervical Injuries
Cervical 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, C-8 and T-1 injuries can straighten their arms, but still may have problems with their hands.
Thoracic Injuries
The first thoracic vertebra, T-1, is located approximately at the same level as the top rib. Injuries to nerves in this region usually affect the chest and the legs, and result in paraplegia. For injuries from T-1 to T-8, there is usually control of the hands but lack of abdominal muscle control. (Individuals with injuries from T-1 to T-6 are also at risk for Autonomic Dysreflexia)
Lumbar Injuries
Injuries to nerves in the area of L-1 to L-5 generally result in some loss of functioning of the hips and legs. Bowel, bladder and sexual function may also be impacted.
Sacral Injuries
The sacrum runs from the pelvis to the end of the spinal column. Injuries to nerves in this area generally result in some loss of functioning of the hips, legs, ankles, and feet. Loss of control of bowel and bladder and sexual functions is also common.
Facing Disability Blog
New Breakthrough: Non-Invasive
Therapy Boosts Spinal Cord Injury Recovery
by Stephanie Lollino
Editor’s Note: Scientists at Shirley Ryan AbilityLab found that a non-invasive electrical stimulation known as Hebbian Stimulation, combined with physical therapy, improved walking and grasping in spinal cord injury patients. Led by Dr. Monica Perez, the research used this technique to enhance connections between spinal and motor neurons. In one study, participants receiving 40 sessions showed significant improvements in walking speed, corticospinal function, grasping, and quality of life. The more sessions, the better the outcomes, with a pronounced improvement in walking speed for those receiving 40 sessions. The study, funded by NIH, VA, and Walkabout Foundation, aims to explore further functional improvements beyond 40 sessions.
In a recent conversation with Dr. Perez, we discussed her research and the implications it could have for SCI treatment.
What exactly is Hebbian stimulation and who is it for?
Dr. Perez: “We are using the protocol for people with spinal cord injury and the procedure aims to enhance recovery. We stimulate nerves and pathways coming from the brain at specific times that allow us to try to improve synaptic connections that are still available.”
Why is Hebbian stimulation so important?
Dr. Perez: “This technique is based on principles of spike-timing dependent plasticity, a process that partially explains the activity-dependent development of the nervous system. We were able to reproduce some of those principles noninvasively in humans and use that to promote recovery.”
Can this therapy be done immediately post injury - or must patients be somewhat stabilized first?
Dr. Perez: “This type of stimulation can be done soon after the injury, but we have mainly focused for now on chronic injuries.”
Can this type of stimulation help patients with quadriplegia?
Dr. Perez: “The beauty of this technique is that we can target different muscle groups that are affected by the injury, which is called multi-site stimulation. So, for example, in people with incomplete quadriplegia, we can target arms and leg muscles simultaneously. This is why we think the concept of the multi-site is extremely important, not only scientifically but functionally, because people with cervical injuries have deficits in upper and lower limb function. So, the idea is to have a therapy that can now address physical issues globally.”
Are there any side effects to this type of therapy?
Dr. Perez: “We have not seen side effects. This is, I think, the most important part of the technique…that it is noninvasive and uses neurostimulation procedures that are widely used in clinical neurophysiology.
How long lasting is this type of therapy for those with SCI?
Dr. Perez: “In our last publication we were able to show that individuals maintain those changes for nine months after the intervention.”
What are the next steps in this type of therapy?
Dr. Perez: We are one of the few groups, if not the only one, who is using multi-site therapy for spinal cord injury recovery. And we are also trying to combine the stimulation with certain types of medication to even further the recovery.
Where is the best place for people to go for this treatment? How can they sign up for it and what is the cost?
Dr. Perez: “After interested patients are screened and tested for their level of connectivity. Then, if you qualify and are part of our research project there is no cost. We don't charge for the protocol because it will help us to better understand the effect of this type of therapy. The enrollment is open now.”
Dr. Monica Perez, is Scientific Chair, Arms + Hands Lab, Shirley Ryan AbilityLab | Professor of Physical Medicine and Rehabilitation, Northwestern University, Research Scientist Edward Hines Jr., VA Hospital [email protected], @MonicaPerezPhD
For information about the trial, contact Sri Vemulakonda ([email protected]). The researchers are creating a registry of people who want to be involved.
For the full study, visit: https://pubmed.ncbi.nlm.nih.gov/36843340/
For a more detailed explanation of the procedure from the Shirley Ryan Ability Lab and its current outcomes click here.
... Read More about Hebbian Stimulation
Facing Disability BlogNew Breakthrough: Non-Invasive |
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FacingDisability presents current information on spinal cord injury which has been developed by working with medical experts at major hospitals universities and rehabilitation institutions. They include: Shirley Ryan AbilityLab, Chicago; Harvard Spaulding Medical Center, Boston; Shepherd Center, Atlanta; Craig Hospital, Denver; Mayo Clinic, Rochester, MN. FacingDisability staff members serve on committees of the Model Systems Knowledge Translation Center (MSKTC) of the National Institutes of Health (NIH) and The National Institute on Disability and Independent Living (NIDLRR). Spinal cord injury medical experts who are interviewed on FacingDisability.com come from: Shirley Ryan AbilityLab, Chicago; Craig Hospital, Denver; Shepherd Center, Atlanta; Magee Rehabilitation Hospital, Philadelphia; Shriners Hospital for Children, Chicago; TIRR Memorial Hermann, Houston; VA Palo Alto Health Care System, CA; Memphis VA Medical Center, TN; University of Michigan, Ann Arbor; MedStar National Rehabilitation Hospital, Washington, D.C.; |
VA Boston Healthcare System; Rehabilitation Institute of Kansas City, Missouri; Case Western University, Cleveland; Clement J. Zablocki VA Medical Center, Milwaukee; Thomas Jefferson University, Philadelphia; Arkansas Spinal Cord Injury Commission, Little Rock; VA Puget Sound Health Care System, Seattle; School of Public Health, Indiana University. Personal interviews of people living with spinal cord injury were recorded by FacingDisability in Chicago, Philadelphia, Atlanta, New Orleans, and California. FacingDisability is regularly invited to make presentations at the national meetings of spinal cord injury associations: Academy of Spinal Cord Injury Professionals (ASCIP), American Spinal Injury Association (ASIA), Rehabilitation Psychology Conference, The International Spinal Cord Injury Society (ISCoS), American Congress of Rehabilitation Medicine (ACRM) and at the Paralyzed Veterans of America Summit (PVA). FacingDisability.com is funded by the Hill Foundation, a 501(c) (3) non-profit. |