Life with more than a SCI

TD · 08-29-2001, 05:21 PM

I am new to this forum and would like to ask if there are any members who deal with injuries other than their SCI. I was in a head-on collision on 4-1-95 and suffered more than a SCI. I also suffer from mild to moderate brain damage and, having been crushed from the waist down, I deal with more than the normal SCI pain.

Even though I fractured C1/C2 my paralysis was caused by lack of blood supply to my spinal cord.
I am a member on several SCI websites trying to deal with everything from pain to controling UTIs. It will help me greatly to know that there are other "multiple injury" members here.

"And so it begins."

KLD · 08-30-2001, 03:41 PM

You might also try posting at www.newmobility.com as there are several people there who have both SCI and TBI.

Wise Young · 08-30-2001, 04:46 PM

TD, thank you for your posting. About 25% of people with cervical spinal cord injuries have concomitant closed head injuries. The figure of combined injuries is even higher in children where as many as 38% of cervical spinal cord injury cases have associated closed head injuries. I have asked the question on this forum before, specifically how many people don't remember their spinal cord injuries (indicative of retrograde amnesia) or were in coma for any period of time. Many people, however, may not even considered themselves to have had head injury. I apologize for all the abstracts below but I thought that you might want to know that your condition is much more common than most people think and you are in good company here. Wise.

• Brown RL, Brunn MA and Garcia VF (2001). Cervical spine injuries in children: A review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 36 (8): 1107-14. Summary: PURPOSE: Cervical spine (C-spine) injuries occur infrequently in children but may be associated with significant disability and mortality. The purpose of this study was to review the experience of a level 1 pediatric trauma center to determine the epidemiology, risk factors, mechanisms, levels, types of injury, comorbid factors, and outcomes associated with these potentially devastating injuries. METHODS: A retrospective analysis of 103 consecutive C-spine injuries treated at a level 1 pediatric trauma center over a 9(1/2)-year period (January 1991 through August 2000) was performed. RESULTS: The mean age was 10.3 +/- 5.2 years, and the male-to-female ratio was 1.6:1. The most common mechanism of injury was motor vehicle related (52%), followed by sporting injuries (27%). Football injuries accounted for 29% of all sports-related injuries. Sixty-eight percent of all children sustained injuries to C1 to C4; 25% to C5 to C7; and 7% to both. Spinal cord injury without radiographic abnormality (SCIWORA) occurred in 38%. Five patients had complete cord lesions involving the lower C-spine (C4 to C7); 4 of these were motor vehicle related, and all 4 patients died. Isolated C-spine injuries occurred in 43%, whereas 38% had associated closed head injuries (CHI). The overall mortality rate was 18.5%, most commonly motor vehicle related (95%), occurring in younger children (mean and median age 5 years) and associated with upper C-spine injuries (74%) and CHI (89%). C1 dislocations occurred in younger children (mean age, 6.6 years), most often as a result of motor vehicle- related trauma (especially pedestrians) and were associated with the highest injury severity score (ISS), longest length of stay (LOS), most CHIs, and the highest mortality rate (50%). C-spine fractures with or without SCI occurred most commonly as a result of falls and dives. Sporting injuries occurred almost exclusively in adolescent boys (mean age, 13.8 years) and were isolated injuries associated with a relatively low ISS and shorter LOS. Interestingly, 75% of sporting injuries showed SCIWORA, and all infants suffering from child abuse had SCIWORA. CONCLUSIONS: Mechanisms of injury are age related, with younger children sustaining C-spine injuries as a result of motor vehicle-related trauma and older adolescents commonly injured during sporting activities. C-spine injuries in children most commonly involve the upper C-spine, but complete lesions of the cord are associated more frequently with lower C-spine injuries. The type of C-spine injury is related to the mechanism of injury: SCIWORA is associated with sporting activities and child abuse, C-spine dislocations most commonly result from motor vehicle-related trauma (especially among pedestrians), and C- spine fractures occur most commonly as a result of falls and dives. Predictors of mortality include younger age, motor vehicle-related mechanism, C1 dislocations, high ISS greater than 25, and associated CHI. A high index of suspicion for SCIWORA is essential when evaluating adolescents with neck trauma associated with sporting injuries or victims of child abuse. J Pediatr Surg 36:1107-1114. Copyright 2001 by W.B. Saunders Company. <http://www.ncbi.nlm.nih.gov/htbin-po...r&uid=11479837
<A HREF="http://www.jpedsurg.org/script_s/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs& id=ajpsu0361107&target" TARGET=_blank>http://www.jpedsurg.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs& id=ajpsu0361107&target</A>=> Children's Hospital Medical Center, Division of Trauma Services, Cincinnati, OH.

• Karacan I, Koyuncu H, Pekel O, Sumbuloglu G, Kirnap M, Dursun H, Kalkan A, Cengiz A, Yalinkilic A, Unalan HI, Nas K, Orkun S and Tekeoglu I (2000). Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study. Spinal Cord. 38 (11): 697-701. Summary: STUDY DESIGN: An epidemiological study conducted all over the country. OBJECTIVE: The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey. SETTING: Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals. METHODS: Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors. RESULTS: Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/- 14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies. CONCLUSION: Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11114778> Bakirkoy Istanbul, Turkey.

• Iida H, Tachibana S, Kitahara T, Horiike S, Ohwada T and Fujii K (1999). Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma. 46 (3): 450-2. Summary: BACKGROUND: Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. METHODS: 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. RESULTS: Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. CONCLUSIONS: Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10088849> Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.

• Dowler RN, Harrington DL, Haaland KY, Swanda RM, Fee F and Fiedler K (1997). Profiles of cognitive functioning in chronic spinal cord injury and the role of moderating variables. J Int Neuropsychol Soc. 3 (5): 464-72. Summary: A traumatic spinal cord injury (SCI) is accompanied by a documented moderate to severe head injury in significant numbers of SCI patients. In a previous study (Dowler et al., 1995), cognitive deficits were found in 41% of the SCI individuals who were studied with a chronic injury from a traumatic event. The present study investigated whether clinically useful subtypes of normal and impaired cognition could be identified in a chronic (M = 17 years postinjury) SCI sample using a cluster analysis of neuropsychological test performance. A battery of 16 neuropsychological tests was administered to 91 SCI patients and 75 control participants. Composite scores, reflecting performance in different cognitive domains, were derived from a factor analysis of the battery, and these scores were then used in the cluster analysis. A six- cluster solution generated the most distinct and clinically relevant SCI group profiles. Two of the cognitive profiles were characterized by normal functioning in all cognitive domains, but they were distinguished by differences in performance levels. The remaining four SCI groups (60% of the sample) showed clinically significant deficits in one or more cognitive domains, with different groups showing moderate attention and processing speed deficits, mild deficits in processing speed, executive processing difficulties, or moderate memory impairments. Though age and premorbid intellectual ability were strong predictors of the cognitive profiles of some SCI groups, when these factors were controlled, the findings suggested that the patterns of cognitive impairment were likely due to a potential concomitant head injury. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9322406> University of Alabama, Birmingham, USA.

08-29-2001, 05:21 PM	#1
TD Senior Member Join Date: Aug 2001 Location: Phoenix, AZ, USA Posts: 649	Life with more than a SCI I am new to this forum and would like to ask if there are any members who deal with injuries other than their SCI. I was in a head-on collision on 4-1-95 and suffered more than a SCI. I also suffer from mild to moderate brain damage and, having been crushed from the waist down, I deal with more than the normal SCI pain. Even though I fractured C1/C2 my paralysis was caused by lack of blood supply to my spinal cord. I am a member on several SCI websites trying to deal with everything from pain to controling UTIs. It will help me greatly to know that there are other "multiple injury" members here. "And so it begins."

08-30-2001, 03:41 PM	#2
KLD Senior Member Join Date: Jul 2001 Location: California Posts: 866	Resource You might also try posting at www.newmobility.com as there are several people there who have both SCI and TBI.

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08-30-2001, 04:46 PM	#3
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	TD, thank you for your posting. About 25% of people with cervical spinal cord injuries have concomitant closed head injuries. The figure of combined injuries is even higher in children where as many as 38% of cervical spinal cord injury cases have associated closed head injuries. I have asked the question on this forum before, specifically how many people don't remember their spinal cord injuries (indicative of retrograde amnesia) or were in coma for any period of time. Many people, however, may not even considered themselves to have had head injury. I apologize for all the abstracts below but I thought that you might want to know that your condition is much more common than most people think and you are in good company here. Wise. • Brown RL, Brunn MA and Garcia VF (2001). Cervical spine injuries in children: A review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 36 (8): 1107-14. Summary: PURPOSE: Cervical spine (C-spine) injuries occur infrequently in children but may be associated with significant disability and mortality. The purpose of this study was to review the experience of a level 1 pediatric trauma center to determine the epidemiology, risk factors, mechanisms, levels, types of injury, comorbid factors, and outcomes associated with these potentially devastating injuries. METHODS: A retrospective analysis of 103 consecutive C-spine injuries treated at a level 1 pediatric trauma center over a 9(1/2)-year period (January 1991 through August 2000) was performed. RESULTS: The mean age was 10.3 +/- 5.2 years, and the male-to-female ratio was 1.6:1. The most common mechanism of injury was motor vehicle related (52%), followed by sporting injuries (27%). Football injuries accounted for 29% of all sports-related injuries. Sixty-eight percent of all children sustained injuries to C1 to C4; 25% to C5 to C7; and 7% to both. Spinal cord injury without radiographic abnormality (SCIWORA) occurred in 38%. Five patients had complete cord lesions involving the lower C-spine (C4 to C7); 4 of these were motor vehicle related, and all 4 patients died. Isolated C-spine injuries occurred in 43%, whereas 38% had associated closed head injuries (CHI). The overall mortality rate was 18.5%, most commonly motor vehicle related (95%), occurring in younger children (mean and median age 5 years) and associated with upper C-spine injuries (74%) and CHI (89%). C1 dislocations occurred in younger children (mean age, 6.6 years), most often as a result of motor vehicle- related trauma (especially pedestrians) and were associated with the highest injury severity score (ISS), longest length of stay (LOS), most CHIs, and the highest mortality rate (50%). C-spine fractures with or without SCI occurred most commonly as a result of falls and dives. Sporting injuries occurred almost exclusively in adolescent boys (mean age, 13.8 years) and were isolated injuries associated with a relatively low ISS and shorter LOS. Interestingly, 75% of sporting injuries showed SCIWORA, and all infants suffering from child abuse had SCIWORA. CONCLUSIONS: Mechanisms of injury are age related, with younger children sustaining C-spine injuries as a result of motor vehicle-related trauma and older adolescents commonly injured during sporting activities. C-spine injuries in children most commonly involve the upper C-spine, but complete lesions of the cord are associated more frequently with lower C-spine injuries. The type of C-spine injury is related to the mechanism of injury: SCIWORA is associated with sporting activities and child abuse, C-spine dislocations most commonly result from motor vehicle-related trauma (especially among pedestrians), and C- spine fractures occur most commonly as a result of falls and dives. Predictors of mortality include younger age, motor vehicle-related mechanism, C1 dislocations, high ISS greater than 25, and associated CHI. A high index of suspicion for SCIWORA is essential when evaluating adolescents with neck trauma associated with sporting injuries or victims of child abuse. J Pediatr Surg 36:1107-1114. Copyright 2001 by W.B. Saunders Company. <http://www.ncbi.nlm.nih.gov/htbin-po...r&uid=11479837 <A HREF="http://www.jpedsurg.org/script_s/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs& id=ajpsu0361107&target" TARGET=_blank>http://www.jpedsurg.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs& id=ajpsu0361107&target</A>=> Children's Hospital Medical Center, Division of Trauma Services, Cincinnati, OH. • Karacan I, Koyuncu H, Pekel O, Sumbuloglu G, Kirnap M, Dursun H, Kalkan A, Cengiz A, Yalinkilic A, Unalan HI, Nas K, Orkun S and Tekeoglu I (2000). Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study. Spinal Cord. 38 (11): 697-701. Summary: STUDY DESIGN: An epidemiological study conducted all over the country. OBJECTIVE: The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey. SETTING: Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals. METHODS: Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors. RESULTS: Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/- 14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies. CONCLUSION: Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11114778> Bakirkoy Istanbul, Turkey. • Iida H, Tachibana S, Kitahara T, Horiike S, Ohwada T and Fujii K (1999). Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma. 46 (3): 450-2. Summary: BACKGROUND: Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. METHODS: 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. RESULTS: Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. CONCLUSIONS: Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10088849> Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. • Dowler RN, Harrington DL, Haaland KY, Swanda RM, Fee F and Fiedler K (1997). Profiles of cognitive functioning in chronic spinal cord injury and the role of moderating variables. J Int Neuropsychol Soc. 3 (5): 464-72. Summary: A traumatic spinal cord injury (SCI) is accompanied by a documented moderate to severe head injury in significant numbers of SCI patients. In a previous study (Dowler et al., 1995), cognitive deficits were found in 41% of the SCI individuals who were studied with a chronic injury from a traumatic event. The present study investigated whether clinically useful subtypes of normal and impaired cognition could be identified in a chronic (M = 17 years postinjury) SCI sample using a cluster analysis of neuropsychological test performance. A battery of 16 neuropsychological tests was administered to 91 SCI patients and 75 control participants. Composite scores, reflecting performance in different cognitive domains, were derived from a factor analysis of the battery, and these scores were then used in the cluster analysis. A six- cluster solution generated the most distinct and clinically relevant SCI group profiles. Two of the cognitive profiles were characterized by normal functioning in all cognitive domains, but they were distinguished by differences in performance levels. The remaining four SCI groups (60% of the sample) showed clinically significant deficits in one or more cognitive domains, with different groups showing moderate attention and processing speed deficits, mild deficits in processing speed, executive processing difficulties, or moderate memory impairments. Though age and premorbid intellectual ability were strong predictors of the cognitive profiles of some SCI groups, when these factors were controlled, the findings suggested that the patterns of cognitive impairment were likely due to a potential concomitant head injury. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9322406> University of Alabama, Birmingham, USA.