Shriners Hospitals for Children® are pioneers in pediatric spinal cord injury (SCI). Children’s bodies are quite different from adults, and while they are often more easily able to adapt to change, they must also face different challenges as they grow physically and developmentally following an SCI injury.
Receiving treatment from a facility that specializes in pediatric SCI care can make a tremendous difference in the child’s rehabilitation and ultimate quality of life well into adulthood. Here are a few reasons why children should receive pediatric-focused care.
- Children’s skulls are thinner and may be fused.
- Their head size is proportionally larger.
- They are skeletally immature and have an increased risk of developing secondary skeletal conditions.
- Their injury may not be seen with standard x-rays so a CT scan or MRI may be needed to properly diagnose the injury.
- Crying may mask respiratory failure.
- Irritability may disguise autonomic dysreflexia, an over-activity of the autonomic nervous system that can cause an abrupt onset of extremely high blood pressure, leading to seizures stroke and, in the most severe cases, death.
Diagnosing Spinal Cord Injuries:
Children who are patients at Shriners Hospitals for Children® have already been stabilized in an acute care or trauma hospital and the degree of their SCI has likely already been determined. However your child’s doctor will perform an ASIA (American Spinal Injury Association) examination to describe or classify your child’s injury. This test will be repeated frequently, including when your child is admitted, when he or she begins physical therapy and prior to discharge.
Based on the ASIA testing results your child’s injury will be classified according to a scale that uses a letter and a number that describe where the nerve and spinal cord damage is located.
- There are 8 cervical nerves (C1-C8), but only 7 cervical vertebrae.
- There are 12 thoracic nerves (T1-T12) and vertebrae.
- There are 5 lumbar nerves and (L1-L5) vertebrae.
- There are 5 sacral nerves and (S1-S5) vertebrae.
- The cervical vertebrae start at the top of your spine, in your neck. Thoracic vertebrae come next, followed by the lumbar and then the sacral vertebrae, which are at the bottom of your spine in your lower back.
- Each vertebra is given a number corresponding to its order in line.
- A cervical level injury is the highest injury level and causes the most loss of function. A cervical injury causes loss of function in your arms and legs.
- A sacral injury is the lowest level of injury and causes loss of function below your waistline.
Cervical SCI
A cervical injury is known as tetraplegia, but you may hear the older term “quadriplegia.”
- If your injury is from C1-C3, you will have limited movement of your head and neck
- You will need a breathing machine to help you breathe. You may have trouble speaking and may need to communicate with others.
- You will need a motorized wheelchair that can be driven by controls you operate with your head, chin, or mouth.
- You will need a breathing machine to help you breathe. You may have trouble speaking and may need to communicate with others.
- You will need a motorized wheelchair that can be driven by controls you operate with your head, chin, or mouth.
- If your level is from C3-C4, you may have head and neck control. At C4, you may be able to shrug your shoulders.
- You may initially require a breathing machine but should be able to breathe without it over time.
- You will probably be unable to feed yourself without help but may be able to drive a motorized wheelchair with either a head or hand control.
- You may initially require a breathing machine but should be able to breathe without it over time.
- You will probably be unable to feed yourself without help but may be able to drive a motorized wheelchair with either a head or hand control.
- If your level is at C5, you will have head, neck, and shoulder control. You can bend your elbows and turn your palms up.
- You may be able to wash your face and brush your teeth with special equipment and help getting started.
- You may be able to push a manual wheelchair short distances but may also need a motorized chair for school and long distances.
- If your injury is at C6-C7, you will have movement in your head, neck shoulders, arms and wrists.
- You can be independent with feeding and grooming and may be able to dress and do light household chores with the help of special equipment.
- You may get in and out of bed with the aid of a transfer board. You can use a manual wheelchair for some activities but may need a power wheelchair for school and long distances.
- If your injury is at C8, you will also have the use of your hands.
- You will be able to live independently and care for yourself without help
- You may also be able to stand or walk for short distances using long leg braces and crutches or a walker.
Children with injuries in the thoracic, lumbar or sacral regions have full use of their arms. An injury in any of these areas is referred to as “paraplegia.”
Thoracic SCI
If your level of injury is between T1 and T6, you will have normal motor function in your head, neck, arms, shoulders, hands, and fingers, as well as increased use of your rib and chest muscles. You maybe able to walk with leg braces and crutches or a walker.
Lumbar SCI
If you have a lumbar injury, you may be able to walk with leg and ankle braces, and you may or may not need a walker or crutches.
Sacral SCI
If you have a sacral spinal cord injury, you may have some control over bowel or bladder function, as well as improved movement in your legs. You may be able to walk with little or no help.
Changes to the Body Due to SCI:
An SCI injury affects the child’s entire body, no matter what the severity of the injury. Here are some examples.
- Your child may need help to empty their bowels or bladder, and may be unable to do so on their own.
- Skin is at risk for breakdown. Normal sensation no longer exists and the child won’t be able to tell if there is a problem, so excellent skin care is a must.
- Breathing is affected, and the higher up the injury the more difficult breathing will be. Children will not be able to clear mucus from their lungs and can develop respiratory infections and pneumonia easily.
- Lack of activity puts the child at risk for weight gain and/or bowel problems.
- Muscle tone will either be floppy or spastic, depending on the type and location of the injury.
Treatment of Spinal Cord Injuries:
Shriners Hospitals for Children® not only offers advanced medical and rehabilitative care for children with spinal cord injuries, we also offer a host of services and support for the wellbeing of the entire family. Our comprehensive inpatient and outpatient care works to maximize the function of children and adolescents.
Treatment for SCI may include:
- Comprehensive rehabilitation, medical and surgical care.
- Innovative rehabilitation techniques, including activity-based rehabilitation; aqua therapy and pet therap; sports programs like scuba; adapted sports like cycling, sailing, wheelchair basketball, kayaking, rock climbing; wheelchair tennis, wheelchair softball and more.
- Nutritional evaluation and assessments.
- Fitness training.
- Annual specialty camps to build social skills and self-esteem.
- Transition program to ease the transition to college and adulthood.
Spinal cord injuries are among the most devastating injuries a person can sustain. They are also traumatic for the child’s family as they learn to cope with the changes disability can bring to every aspect of the child and family’s life. That’s why we also offer a variety of programs to help the whole family adjust to a new way of life. These programs include:
- Patient and family education
- Psychological/psychiatric counseling
- Social work/case management