Spinal Cord Injury Overview
Spinal cord injury (SCI) results from trauma, disease, or compression that disrupts the normal transmission of signals through the spinal cord. Traumatic SCI most often results from motor vehicle accidents, falls, sports injuries, and violence. Non-traumatic causes include spinal cord tumors, vascular events, infections, and progressive compression from disc herniation or spinal stenosis.
SCI is classified by the American Spinal Injury Association (ASIA) Impairment Scale — from complete injuries (no motor or sensory function below the injury level) to incomplete injuries (partial preservation of function). The injury level determines which muscle groups and sensory regions are affected: cervical injuries affect the arms and legs (tetraplegia); thoracic, lumbar, and sacral injuries affect the trunk and legs (paraplegia) with varying degrees of hand and respiratory involvement.
Functional Impact and Secondary Complications
- Motor — paralysis or paresis of muscles below the injury level
- Sensory — loss of or altered sensation, proprioception deficits
- Spasticity — involuntary muscle overactivity that can impair function and cause pain
- Neurogenic bladder and bowel — requiring structured management programs
- Neuropathic pain — central or peripheral nerve pain below the injury level
- Autonomic dysreflexia — a potentially dangerous blood pressure crisis in high-level SCI
- Pressure injuries — skin breakdown from reduced sensation and mobility
- Respiratory compromise — in cervical-level injuries
- Overuse injuries — shoulder and wrist pathology from wheelchair propulsion
Rehabilitation Goals and Approach
SCI rehabilitation at CHLMD focuses on maximizing residual function, preventing secondary complications, and achieving the highest possible level of independence. For incomplete injuries, therapeutic exercise programs target preservation and recovery of voluntary motor function. Spasticity management — through stretching, positioning, pharmacological agents, and injection therapy when appropriate — reduces pain and improves functional movement.
Overuse injuries of the upper extremities — particularly shoulder pain from wheelchair propulsion and transfers — are treated with targeted injection therapy, exercise, and equipment modification. Neuropathic pain below the injury level is managed with mechanism-specific pharmacological and rehabilitative interventions. Neurogenic bladder and bowel management, skin care, and autonomic health are coordinated through Dr. Lichtblau's physiatric oversight.
Long-Term Physiatric Care
SCI is a lifelong condition requiring sustained medical management. CHLMD provides ongoing physiatric care to monitor for late complications, optimize functional status as the patient ages with SCI, manage equipment needs, and support community participation and quality of life. Dr. Lichtblau coordinates care with urology, pulmonology, and other specialists as clinical needs evolve.
