What Does The Future Hold?
Anyone who sustains a spinal cord injury wants to know, what’s going to happen to me? When will I get better, and how much recovery can I hope for? What am I going to be able to do on my own? When? How much help do I need? What sort of equipment do I have to get to live my best life?
It may be difficult to feel much optimism in the early days after a major traumatic injury, but across the board survivors and their families will tell you: It gets better. Yes, it takes time to know what a spinal cord injury has done to your body. It takes time to know what you can and cannot do. But it always gets better. It isn’t possible to predict the future, but your rehab team will help you and your family manage expectations and set goals to move your life forward.
Doctors can measure your injury with several diagnostic assessments to give you an idea of what you may be able to do and when. They can use MRI or other tools to visualize the damage. They can compare your injury to other injured people they have seen who have rebuilt their lives. They can make what they call an “outcome prediction,” which, while not a guarantee, can give you hope for the future.
Keep in mind, however, that your situation is unique and may not fit the usual pattern. You could recover much more than expected. There is also a chance your recovery might not meet your doctor’s outcome expectations.
The following information is based on what usually occurs for people with various levels of injury, gathered over many years at U.S. rehab centers. It’s important to know that no two spinal cord injuries are exactly alike, and many variables come into play that affect recovery – your age, other injuries or health conditions you may have, your state of mind, even your drive and desire.
There is usually hope for at least a little improvement after spinal cord injury, but even with the most sophisticated tools, no one can predict your exact future.
- Generally, those with a complete injury (no muscle power or sensation below the level of injury) often regain one or two levels of injury.
- 80 percent to 90 percent of those with complete injuries will remain complete.
- The majority of those with motor incomplete injuries recover some ability to walk.
- As long as you continue seeing improvement, such as increasing muscle movement, chances for improvement are better.
- The longer you go without improvement, chances for improvement are lower.
- Those with an incomplete injury (some muscle or sensory function below level of injury) are more likely than those with a complete injury to regain movement. There is no way to know how much will return.
- Younger people have better odds of recovery than older people.
- Generally, most recovery takes place in the first year after injury, however doctors have seen recovery after two years and some people with even older injuries continue to recover.
Presented by level of injury, below are summaries of general outcome expectations (remember, these are general outcomes, based on a large number of patients. They are not cold, hard, facts and your situation may be very different).
People with incomplete injuries are especially variable, and therefore hard to categorize across all measures of function.
Data comes from the Consortium for Spinal Cord Medicine, which publishes clinical practice guidelines for spinal cord injury. See full report here.
The highest levels of spinal cord injury involve total paralysis of the trunk and arms and legs. People injured at the top of the spinal cord, often referred to as high quads, most likely will require mechanical ventilation and typically need 24-hour help for daily activities, including management of bowel, bladder, bed mobility, transfers, eating, dressing, grooming, bathing and transportation. High quads may require a mechanical lift with a sling. Most people with high level paralysis can power an electric wheelchair and can handle independent communication with the right equipment; they can also manage their caregivers if they are able to explain everything and express themselves.
Full body paralysis with some neck and shoulder movement, usually able to breathe without a ventilator. Similar profile as above for the high quad group. People injured at C4 probably require a wheelchair with a power recline and/or tilt. They usually can use a standing table. Total assistance needed for all tasks of daily living, except power wheelchair use, but they are generally able to communicate needs.
This is the most common level of spinal cord injury. People injured at C5 retain possible shoulder and elbow flexion, but have weak hands and wrists. Many C5s use hand splints. Some can push a manual wheelchair with adaptive rims. Breathing endurance is reduced and they may not be able to cough, thus needing help with secretions. C5s can eat independently if meals are set up. Personal care assistance is needed daily, especially for grooming, bed transfers and dressing. Some C5s can drive a vehicle with the right specialized gear and training.
Those injured at C6 have total paralysis of trunk and legs but are generally more independent. There may be some compromised vital capacity. Some help may be needed for bowel, uneven transfers and bathing. Wrist flexion and hand movement are impaired so some adaptive gear may be helpful. A C6 can usually push a manual chair though, and do weight shifts without assistance. Personal care is usually required for getting up in the morning, grooming and going to bed. Driving is not complicated.
C7/8 injuries typically cause paralysis of the trunk and legs but greater arm and hand dexterity remain, including elbow, wrist and thumb extension. People injured at this level are mostly independent for bladder and bowel self-care, eating, grooming, etc. A personal care attendant will still be helpful, but potentially only needed on a limited basis.
T1-9 injuries usually cause lower trunk paralysis and somewhat limited trunk stability, but full arm and hand function remain. Vital capacity may be somewhat impaired but these paraplegics are mainly independent for daily living, work and homemaking.
T10-L1 injuries cause paralysis of legs but injured people retain good trunk stability and intact respiratory systems. Mid-level paras are mainly independent in most functional activities but benefit from gear and services.
Those injured at L2-S5 have partial paralysis of legs, hips, knees, ankles and feet but good trunk support. They are mainly independent for wheelchair life.
This article does not constitute a guarantee, warranty or prediction regarding the outcome of your legal matter.