People working in certain professions are at a higher risk of suffering a spinal cord injury due to inherent dangers of the job. The construction industry is well established as one of the most dangerous for workers. There are many hazards, such as working at high elevations, the potential for ladder falls, a scaffolding collapse, falling tools or other items, as well as roof falls that can lead to a serious or permanent spinal cord injury. Vehicle accidents and falls also are responsible for causing spinal cord damage leading to a long-term disability.
There are staggering statistics on spinal cord injuries to construction workers. Accidental falls account for almost 29% of all spinal cord injuries, and these include cases involving falls from, out of or through a structure, from a ladder, from one level to another, and from scaffolding.
Damage to the spinal cord is associated with a range of symptoms. The spinal cord is protected by the 32 vertebrae in the spine, and is a complex bundle of nerves that sends messages through the body’s nerve channels to all parts of the body. When the spine is injured in a fall, accident or other heavy impact, the message transmission system of the body is damaged, and depending upon the severity of the injury, can lead to a permanent loss of mobility below the area of impact.
The cervical bones are those vertebrae at the top of the spine. The high cervical nerves in the spinal cord are protected by these bones, which are named C1 – C8. An injury to the top four bones, C1 – C4, is the most severe of all spinal cord injuries, as the entire body is affected. If the impact led to a torn or crushed spinal cord in the C1 – C4 area of the spine, the patient will be paralyzed and unable to control or move the hands, arms, trunk and legs. The injured person may need assistance for breathing, and may completely or partially lose the ability to speak. There is an inability to control bladder or bowels.
Persons with severe injury to the cervical area of the spinal cord will usually require 24-hour personal care and are often unable to manage the basic needs of life without assistance. All daily activities will require care, including eating, bathing, dressing and all activities that require movement. There have been significant advances in medical equipment or “adaptive technology” to improve the quality of life for those suffering from quadriplegia. The various types of equipment for those who have lost mobility in the entire body due to a severe injury to the top of the spinal cord include:
Damage to the lower cervical nerves of C5 – C8 is also capable of causing paralysis, although the injured person is usually able to speak normally and breathe without the assistance of a ventilator. Below is an outline of damage to each separate bone:
Injury to C5
The person retains the ability to raise the arms and bend the elbow, but may have partial or full paralysis of the wrists and hands, as well as the trunk and legs. Breathing will be weakened, but the person is able to control the diaphragm and speak. Much assistance with daily living activities will be required. With sufficient rehabilitation and training, there is a great deal of independence that the individual can regain with the use of adaptive technology.
Injury to C6
The injured person will experience paralysis in the hands, trunk and legs in most cases, but retains the ability to bend the wrists back, can speak and breathe without a ventilator. The ability to breathe is frequently weakened. The patient, through training, can regain a great deal of independence with the use of the most recent adaptive technologies.
Injury to C7
The nerves in this area are those that give a person the ability to control elbow extension and some part of finger extension. Most people with an injury to C7 have retained the ability to straighten their arms and can move their shoulders. There will be assistance required for the more difficult tasks, but the person is often eventually able to drive a vehicle that has been adapted with hand controls. The bowel and bladder are affected, but special equipment allows the individual to manage these bodily functions without help.
Injury to C8
This part of the spinal cord controls hand movements, and the person is often able to grasp objects, which allows for a greater amount of independence. Most injured people can learn to drive a vehicle adapted for paraplegics and to take care of themselves. Certain difficult tasks may still require assistance. This level of injury means little or no bowel or bladder control.
The thoracic vertebrae are located in the mid-back, and are listed as T-1 to T-5. The nerves in this area affect the muscles, the upper chest, the mid-back and the muscles located in the abdominal area.
Injuries to T1 – T5
These injuries mean that arm and hand function are normal, but the trunk and legs are affected. A manual wheelchair can be used, and a vehicle modified for paraplegics can be driven, with training. There is equipment available that allows the injured person to stand in a frame, and some can actually walk with the use of special braces.
Injuries to T6 to T12
The lower mid-section of the spinal cord, when injured, results in paraplegia, or a normal use of upper body and a fair ability to control the trunk. The bladder and bowels cannot be controlled, but with training, the person can manage these personal tasks alone. The ability to drive a modified vehicle, stand up in a special frame and use a modified wheelchair is usually possible. There is a great deal of independence that is possible with this injury through training and rehabilitation.
The lumbar is the lower portion of the back, and the nerves travelling through this area control the hips and legs. These vertebrae are known as L1 – L5.
Injuries to L1-L5
There will be some loss of ability to control the hips and legs, and little to no control over the bowels and bladder, but the individual can manage these issues with special equipment and training. Leg strength can vary, and a wheelchair may be necessary, or some can walk with the assistance of braces.
The sacral nerves are at the bottom of the spine, and are known as S1 – S5.
Injuries to S1- S5
Injured persons will experience some level of loss of function in controlling the hips and legs, and most often do not have control over the bowels or the bladder. There can be weakness or paralysis of the hips and legs. This nerve system sends signals to the thighs and the lower legs, feet and genitals. A great deal of independent movement is possible, but there will be challenges that will need to be resolved through rehab and training.
The degree of the injury will determine the person’s ability to regain motion. A seriously bruised spinal cord often leads to many months of paralysis that can subside to some degree over time. A torn spinal cord may have left some nerves functioning, and some motion may be possible. These are termed incomplete injuries. There is some level of transmission of signals through the nerves, which in some cases can be improved. Each case is specific to the individual. A complete injury occurs when the spinal cord has been severed or is so heavily damaged that there is no ability to transmit signals through the spinal cord to the body parts below the injury, and the paralysis in the area is permanent, with no sensory function or control.
Spinal cord injuries caused by the fault of another person or business may allow a victim to recover compensation for damages. The settlement or jury award provides the injured person the ability to have higher quality care and treatment, needed equipment, and a better quality of life overall.
Shepherd Center: http://www.spinalinjury101.org/details/levels-of-injury
Able Data: http://www.abledata.com/abledata_docs/Asstv-Tech-for-Quads.pdf
Christopher and Dana Reed Foundation: http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4514603/k.77E9/Spinal_Cord_Injury_Types.htm