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Spinal Cord Injury

Spinal Cord Injury Overview







Population Characteristics:1

  • Prevalence: There is an estimated 270,000 people in the US with a spinal cord injury (SCI) with a range between 236,000-327,000 
  • Incidence: There are 12,000 new cases of SCIs in the US per year (or 40 per 1 million)
  • The average age of injury is 41 years 
  • 80.6% of the SCI population are males
  • In the US, 66% are Caucasian, 26.2% are African American, 8.3% are Hispanic, 2.1% are Asian, and .9% are Native American


  • SCI's are as a result of an acute impact or compression of the spinal cord which prevents the transmission of some or all of the afferent and efferent signals to and from the brain
    • Compression of the cord is caused by a mass or growth (such as a tumor) within the spinal column
  • Of acute impacts/traumatic injuries:
    • 39.2% are due to motor vehicle accidents
    • 28.3% are due to falls
    • 14.6% are from violence (primarily gunshot wounds)
    • 8.2% are due to sports injuries
    • 9.7% are related to "other" or unknown causes

Signs and Symptoms:3

  • The signs and symptoms of a SCI very greatly based upon the level of the injury (higher levels being typically more symptomatic than lower levels of injury) and amount of spinal cord damage/transection. Symptoms typically include:
    • Muscle weakness or paralysis and loss of sensation in the trunk, arms, and/or legs
    • Difficulty breathing
    • Diminished or lack of bowel and bladder control
    • Increased muscle tone and spasticity
    • Sexual organ dysfunction 


Based upon ASIA diagnostic exams, there are four classifications based upon myotome and dermatome (both light touch and pin prick) testing of C2 through S4/S5 bilaterally:

  • ASIA A: Complete - No sensory or motor function below levels S4-S5
  • ASIA B: Sensory Incomplete - Sensory but not motor function is present below the neurological level (the lowest level at which sensory and motor function or normal) and no motor function is present more than three levels below the motor level 
  • ASIA C: Motor Incomplete - Motor function is present below the neurological level and more than half of these muscle grades are less than 3
  • ASIA D: Motor Incomplete - Motor function is present below the neurological level and more than half of these muscle grades are 3 or greater
  • ASIA E: Normal - Sensation and motor function are completely normal following a SCI 


  • The most important prognostic indicator is whether the injury is complete or incomplete 
  • 10-20% of complete SCI's progress to incomplete within the first year
    • The amount of motor recovery following a complete injury is very small or absent
    • 80% of ASIA A patients remain ASIA A if intial examination occurs within 72 hours after the injury. This percentage rises to 97.5% if exam occurs after this 72 hour window.
  • The prognosis for incomplete SCI's is quite variable, as 20 to 75% of individuals regain some portion of ambulation capacity within the first year post-injury
    • ASIA B: Overall ambulation percentage of 33%; direct relationship between pin prick preservation and recovery of function 
    • ASIA C: 76% to 87% chance of ambulating within 1-2 years post-injury
    • ASIA D: 80 to 100% chance of ambulating depending on age 
  • For both complete and incomplete injuries, a majority of the recovery occurs during the first 9 and 12 months and reach a plateau between 12 and 18 months

Physical Therapy Interventions:

  • PT interventions are highly dependent upon the level and completeness of injury 
  • Initially, wheelchair mobility and pressure relief are emphasized followed by bed mobility/transfer/transitional movement training 
  • Sitting and standing balance training as tolerated 
  • Gait training with appropriate assistive device as well as body-weight support treadmill training 
  • Strengthening exercises throughout in order to prevent atrophy, increased bone density, and increase function 
  • Soft tissume mobilization and frequent stretching in order to decrease spasticity and risk of contractures 
  • Functional electrical stimulation as appropriate in order to assist with functional activities (eg ambulation)






1. Spinal cord injury facts and figures at a glance. National Spinal Cord Injury Statistical Center Web site. 2012. Available at: Accessed April 29, 2014. 

2. Kraus KH. The pathophysiology of spinal cord injury and its clinical implications. Semin Vet Med Surg. 1996;11(4): 201-207. 

3. Spinal cord injury. Johns Hopkins Medicine Web site. Available at:,P01180/. Accessed April 29, 2014. 

4. International standards for neurological classification of spinal cord injury. American Spinal Injury Association Web site. Available at: Accessed April 29, 2014. 

5. Burns AS, Marino RJ, Flanders AE, et al. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol. 2012;109: 47-62. 

6. Scivoletto G and Donna VD. Prediction of walking recovery after spinal cord injury. Brain Research Bulletin. 2009;78: 43-51.

7. Scivoletto G, Morganti B, Ditunno P, et al. Effects on age on spinal cord lesion patients' rehabilitaiton. Spinal Cord. 2003;41: 457-464.