Diagnosing an SCI: Identification and Paralysis Types

Notice: This blog is not to provide medical advice. If you suspect you might have a spinal cord injury, you should see a doctor right away.

The spinal cord could be considered an MVP of our body, acting as the primary message carrier between our brain and other systems. But when a Spinal Cord Injury (SCI) occurs, it disrupts how the spinal cord relays messages that facilitate our body’s movement. Approximately 17,000 people in the US are diagnosed with an SCI each year, and between 250,000 and 500,000 globally. 

When evaluating how a determination of an SCI is made, there is no one-size-fits-all diagnosis, but instead, doctors use a combination of tests and assessments to discover the degree of injury severity and paralysis for each individual. Read on to learn more about how SCIs are diagnosed. 

Medical History

Various diagnostic tools are helpful when an SCI is suspected. A doctor will first ask about the person’s medical history and state of their health before the injury occurred, including any pre-existing neck and back pain or injuries, extremity weakness, or bladder or bowel control issues. 

Physical Examination

A physical exam also helps detect damage to the vertebrae.

• The cervical spine in the neck consists of C1-C8 vertebrae and supplies the nerves for the neck, shoulders, arms, and hands. 
• The thoracic spine runs from the base of the neck to the abdomen and consists of the T1-T12 vertebrae. It supports the neck, rib cage, and lower back. 
• The lumbar spine comprises the L1-L5 vertebral bones, intervertebral discs, nerves, muscles, ligaments, and blood vessels controlling the legs, bladder, and bowel functions. 
• The sacral spine is a large, flat triangular-shaped bone between the hips, consisting of 5 fused vertebrae S1-S5 and the coccyx’s 3-5 small bones. 

The doctor may also run messaging tests to gauge responses to temperature, pain, pressure, muscle messages, and reflex responses to stimuli.

Diagnostic Testing

Neurological exams are performed a few days after the injury occurs, giving the swelling time to go down, and therefore, making diagnosis easier. 

Computerized Tomography (CT) Scan

A CT scan creates cross-sectional images that allow doctors to pinpoint exactly where damage exists on the spine and to what extent. 

Magnetic Resonance Imaging (MRI) Scan

Using magnetic and radio waves, a computer shows the spine in great detail, allowing a doctor to identify any present herniated disks, blood clots, mass formations, and other abnormalities.

X-Rays

A radiologist may run a myelogram using contrast dye or a spine x-ray to show damage or fracture to the spinal bones. 

Somatosensory Evoked Potential (SSEP) Testing 

SSEP Testing assesses how well signals pass through the arms and legs to the spinal cord and brain. Doctors can measure how long it takes a mild electrical stimulus to pass through electrodes attached to the wrist and back of the knee to electrodes on the scalp. 

Neurological Examination

A few days following the SCI, healthcare providers perform a complete neurological exam, including those evaluating muscle strength and sensitivity to touch, which helps determine the injury severity and rehabilitation or recovery odds. 

The ASIA (American Spinal Injury Association) Impairment Scale and the FIM (Functional Independence Measure) Assessment are the most commonly used tools. 

ASIA Impairment Scale

The ASIA Impairment Scale classifies spinal cord damage from A-E, with A being complete neural loss and E being normal function. 

• A indicates complete impairment with no motor or sensory function beneath the injury level. 
• B indicates incomplete impairment in that motor function is diminished, but the sensory function remains in the first normal level above the injury, and sacral segments S4 and S5. 
• C indicates incomplete impairment in that motor function is intact beneath the injury level, but more than half the key muscles in that area of the body are not strong enough to move against gravity. 
• D indicates incomplete impairment where motor function remains intact beneath the injury level, but at least half the key muscles located in that area of the body can be moved against gravity. 
• E indicates a full range of normal motion where all motor and sensory functions are intact. 

 FIM (Functional Independence Measure) Assessment

The FIM Assessment quantifies if a person with paralysis can live independently. Comprising 13 motor tasks and 5 cognitive tasks, the FIM Assessment is rated on a 7 point scale, from complete dependence to complete independence, with scores ranging from 18-126. 

The motor tasks observed include the following. 

• Eating
• Grooming
• Bathing
• Dressing upper body
• Dressing lower body
• Toileting
• Bladder management
• Bowel management
• Bed to chair transfer
• Toilet transfer
• Shower transfer
• Locomotion at ambulatory or wheelchair level
• Stairs

The cognitive tasks observed include the following. 

• Cognitive comprehension
• Expression
• Social interaction
• Problem-solving
• Memory

Types of Paralysis

The higher the SCI or the closer the injury is to the brain, the more of the body the paralysis will affect. 

Monoplegia 

This paralysis type only affects a single part of the body, usually the arm. Symptoms of monoplegia include muscle stiffness, spasms, numbness, tingling, decreased feeling, muscle tone loss, or curling of fingers or toes. Monoplegia can improve over time or may be permanent. 

Hemiplegia 

This paralysis affects an arm, leg, and face on only one side of the body. Hemiplegia symptoms include muscle spasticity, poor fine motor skills, difficulty walking, impaired balance, inability to grasp objects, and muscle weakness on one side of the body.

Paraplegia

Paraplegia leads to paralysis in the lower limbs and can affect the legs, hips, sexual function, and other processes, resulting in movement loss. This type of paralysis results when the thoracic or lumbar spinal areas are injured. Symptoms of paraplegia can include loss of feeling in the lower half of the body, chronic or phantom pain, loss of bladder or bowel control, and the inability to walk or stand. 

Quadriplegia

Quadriplegia, also known as tetraplegia, results from cervical spine injury and affects all upper and lower extremities, although a loss of function varies from person to person. Other symptoms include incontinence, sexual dysfunction, pain, muscle spasms, or the inability to feel temperature fluctuations. 

SCI Treatment

There are currently no treatments that can completely reverse spinal cord damage in aall cases of SCI and recovery will vary greatly based on the nature and severity of the injury, but certain medications, therapies, and prostheses can help regenerate nerve cells or improve function in many cases. SCI treatments focus on helping people who have experienced an SCI live as independently as possible while preventing further injury. 

• Surgery to remove fluid, tissue, bone fragments, or foreign objects from the spine and fuse spinal bones or implant spinal braces. 
• Traction to stabilize and realign their spine. 
• Methylprednisolone (Medrol) given within 8 hours of injury to mitigate nerve cell damage and decrease inflammation. 
• Experimental treatments (stem cell therapy, cryotherapy, intermittent hypoxia, etc).

People with SCIs can also benefit from rehabilitation, including physical therapy, assistive mobility and communication devices, occupational therapy, coping strategies, vocational therapy, recreational therapy, and exercise and diet strategies. 

Functional Electrical Stimulation

One such strategy is Functional Electrical Stimulation (FES), a medical technology that helps restore muscle health for people with paralysis. FES uses electrical signals passed through electrodes to elicit muscle movement despite paralysis, helping to re-educate muscles, relax muscle spasms, prevent atrophy, improve blood circulation, and maintain or increase range of motion. 

MYOLYN Is Here for You Beyond Your Diagnosis

If you have been diagnosed with an SCI, you may feel overwhelmed or unsure of what the future looks like — but you are not alone. At MYOLYN, we are committed to providing people with paralysis the opportunity to benefit from FES therapy with our MyoCycle. The entire MYOLYN team is here for you to guide you through how FES therapy can help you navigate life with SCI-related paralysis. Contact us to learn more.