5C. Levels of Injury Explained - Thoracic - Spinal Cord Injury 101

>> JUDY FORTIN: You may hear your loved one’s level of injury mentioned frequently. Level

of injury refers to the location where the spinal cord is still functioning and is also

called neurological level of injury. Doctors determine this by assessing the movement and

sensation at or below a certain level on the spinal cord. The level of injury designation

is a letter followed by a number that corresponds to the spinal nerves. Refer to this sub-chapter

for information if your loved one has a thoracic level of injury from T1 to T12. T stands for

thoracic and the numbers one through 12 correspond with the spinal nerves in that section of

the spinal cord.

Keep in mind that these are general guidelines for levels of injury, and your own, or your

loved one’s injury may differ due to its individual type and severity. The level of

independence achieved also has much to do with the patient’s health at the time of

injury. This includes body type, existing medical conditions, and other

injuries that may have occurred at the time of the accident.

>> DR. JEFFERY SALOMONE: The thoracic portion of the spinal column runs through the majority

of the trunk, between the cervical and lumbar regions. T1 is at the top part of the thoracic

spine, across the shoulder area. T4 is located at the nipple line. T10 is at the bellybutton,

while the lowest section at T12 is at the bottom of the ribs. The lower the level of

injury number, the higher in the body the injury is located. Of the thoracic levels

of injury, a T1 injury impacts movement and sensation the most, while an injury to T12

impacts them the least.

Injuries at or below the thoracic spinal levels result in paraplegia, or loss of the movement

and sensation in the legs, and can also impact control of the trunk. Hands, arms, neck, and

the ability to breathe are usually not affected.

T1 to T5 spinal nerves are connected to the muscles of the hand, upper chest and mid-back.

At this level of injury, arm and hand function is usually normal.

T6 to T12 spinal nerves control all of the chest, trunk and abdominal muscles. The person

injured at this level should be able to cough productively, usually has normal upper body

movement, and fair to good ability to control and balance the trunk.

Additional effects for people with T1 - T12 spinal nerve injury can include weakened breathing

and lower endurance, and little or no voluntary control of bowel and bladder function. People

with T-level injuries can usually learn to manage their personal bowel and bladder programs.

>> JUDY FORTIN: Those with T-level injuries will most likely use a manual wheelchair.

They can in most cases learn to drive a modified car or van, as well as get in and out of it

without assistance. Wide ranges of driving equipment and vehicle

modifications are available today for those who can find sources of support.

People with any T-level injuries most likely can get in and out of bed without assistance,

can perform care tasks such as grooming, bathing and dressing independently. With practice,

they can transfer themselves into and out of their wheelchair, shower or tub. Those

with T1-T10 injuries may be able to stand in a standing frame device, while others may

be able to walk with leg braces for distances up to 150 feet. Persons with T-11 and T-12

injuries may have greater range of mobility.

Persons with T1 to T6-level injuries may require assistance with maintaining their home. People

with T-7 to T12-level injuries will require assistance with heavy housework, perhaps as

much as three hours per day from a loved one or caregiver.

It’s a good idea to begin thinking about family members, friends, community or church

groups that can help with this type of support when the time comes to leave the trauma care

center, or perhaps after additional care at a rehabilitation facility.

Home modifications may be necessary for persons with T-level injuries. Accessibility is key:

widened doorways and ramps instead of stairs will help you or your loved one considerably.

Strongly consider making countertops, sinks and stoves accessible, as well as making bathrooms

as easy to navigate as possible. Ramps, wider doors, special sinks, grab bars

and easy-to-turn doorknobs make it possible for spinal cord injured persons to live more

independently than ever before.

Friends, family, church and community groups may also pitch in to help with home modifications

and fundraisers. Many people receive funding assistance or donations from special events,

local businesses, groups and even individuals.

Later in the rehabilitation process you’ll hear the term functional progression which

refers to expected recovery progress and chance of improved physical functioning as time goes

on. It may partly depend on whether your loved one’s trauma care center stay is followed

up with visits to, or a stay at a rehabilitation facility. No matter what, it’s very important

to develop a consistent care routine to help your loved one’s possible progress.

>> DR. BRUCE DOBKIN: After spinal cord injury, your loved one will gradually improve. One

of the best ways to monitor this is that if there’s any feeling or any movement below

the level of injury, this is a very positive sign. This is something that you can build

upon. Gradually over time, the therapists and rehabilitation

folks will try to help drive greater recovery from that little bit of recovery that you’re

beginning to see. This recovery can occur for weeks, for months, sometimes even years,

so it’s really important that you try to push any gains that you see. But also, it’s

very important to begin to accept any limitations in recovery that may come about, so that your

loved one can move on with life using assistive devices and any other means needed so he or

she can return to a normal life.

>> JUDY FORTIN: At this time, we’ll continue on to the last chapter of the video. Chapter

6 provides practical advice for how to deal with the injury and its consequences to your

loved one and your family. Lee Woodruff starts off the chapter. She has some great advice

because she and her family have been through, and survived, a catastrophic injury themselves.

It’s an important part of the video.