Diagnosis

WHAT YOUR INJURY CLASSIFICATIONS MEAN

 Complete.

The diagnosis sounds so final. Permanent.I had never felt more incomplete in my life. Was there really nothing I could do to improve my situation? Was there truly nothing modern medicine could do to restore my motor function?


I took no comfort in knowing I wasn’t the first person to have their life violently altered by a spinal cord injury, and I don’t expect you to, either. But in the decade since my diagnosis, I have turned to the quadriplegic community hundreds of times—for solidarity, support, hard-earned advice, and truth. 

At first, I was shocked to meet complete quadriplegics who were living full, meaningful lives: holding careers, raising children, dating, creating art, pursuing passions. Others lived in circumstances that made thriving nearly impossible, often not because of their bodies, but because of a lack of access, education, or support. I was one of them once. 

 Complete vs Incomplete

Individuals who sustain spinal cord injuries (SCI) are diagnosed as complete or incomplete. Quadriplegics who have a chance to regain function, or don't lose all of it, are diagnosed as "incomplete". A "complete" injury means no motor or sensory function is preserved below the level of injury. No therapy can return this function and no time can heal it. Medical science is getting there but it's not there yet. The American Spinal Cord Injury Association (ASIA) classifies complete quadriplegia with the letter "A". So another term for complete SCI is ASIA A.

Only 12% of America's 300,000 spinal cord injuries result in complete quadriplegia. I know; it sure doesn't make us feel very lucky.

Our diagnosis may not be clear at first. Swelling plays a major role. The neurologist will decide when it is appropriate to perform a test of sensory and motor function to determine if the injury is complete.

A motor skills exam will evaluate your control of the muscles in your arms and legs. A sensory exam will test your response to two kinds of touch (light touch and pinprick) at spots that correspond with different levels. 


A physician may also perform a NCSCI test. If the nerves for the anal sphincter located at the very base of the spinal cord are still communicating with the brain, it indicates that the spinal cord has not been "completely" severed or blocked, classifying the injury as incomplete (ASIA B, C, or D). 

Injury Levels

When we sustain a complete spinal cord injury we become physically limited to the function of our body above the level of injury. The actual injured location on the spinal cord determines where motor function stops. 


The higher up on the spinal cord your injury is, the more sensory (touch) function and motor (movement) function we lose.

About half of spinal cord injuries that occur are to the cervical region (neck) whether complete or incomplete.

C-1 injuries are characterized by the inability to flex, bend and turn the neck and hold up the head. Sensation may be lost in the scalp and face. A ventilator will be needed for breathing and speaking may be difficult. You may be able to use adaptive tech and control a custom power chair.

C-2 injuries allow for a little more neck and head control. You may be able to take breaks from the ventilator.

C-3 injuries allow for the tilting of the head which can help with some assistive devices like call buttons. Your diaphragm may be significantly compromised and a ventilator may be required.
C-4 injuries allow for shrugging of shoulders. A ventilator may be required at first but you may be weaned off. The mouth can be used to control assistive technology and a power chair can be driven with head, chin and breath controls. 

C5 injuries allow for lifting the shoulders and flexing the biceps, bending the elbows and turning palms face up. Using "universal cuffs" or splints you may be able to hold utensils or toothbrushes and perform tasks like washing your face. Some C5s use a power wheelchair with a hand toggle or even drive a car with hand controls.

C6 injuries allow for manipulation of the wrists. You may be able to bend your elbows and pull your wrists back, but lack the strength to push your arms straight against gravity. You may be able to use wrist extension to passively close the fingers for grasping. You may need help with lower body dressing but be able to eat independently with adaptive tools. Some C6s have potential to perform independent self-catheterization with adaptive tools.

C7 injuries allow for movement of the triceps muscle. The defining motor function is elbow extension. You may have the ability to push yourself up, which is critical for independent movement and transfers. C7s often manage a more functional grasp/release through improved arm positioning. 


C8 injuries may have full arm and finger movement, including grasp and hand function.

All levels lack leg function and bowel/bladder function. Receiving a complete quadriplegia diagnosis feels devastating and overwhelming. Your way of life will drastically change. You may struggle with mental health. Coping with loss of life as we knew it isn’t easy, and neither is learning this new way of life. 


With proper care, therapy, and support, all secondary symptoms of quadriplegia are manageable. And those of us with complete injuries can still go on to live complete lives.

Before you can thrive you've got to survive though. That means understanding all the secondary complications that come with injury. 
NEW INJURY
SURVIVE
THRIVE
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