Spinal cord injury: as many as 500 000 people suffer each year

2 December 2013 | GENEVA - As many as 500 000 people suffer a spinal cord injury each year. People with spinal cord injuries are 2 to 5 times more likely to die prematurely, with worse survival rates in low- and middle-income countries. The new WHO report, "International perspectives on spinal cord injury", summarizes the best available evidence on the causes, prevention, care and lived experience of people with spinal cord injury.

Males are most at risk of spinal cord injury between the ages of 20-29 years and 70 years and older, while females are most at risk between the ages of 15-19 years and 60 years and older. Studies report male to female ratios of at least 2:1 among adults.

Causes: 90% traumatic

Up to 90% of spinal cord injury cases are due to traumatic causes such as road traffic crashes, falls and violence. Variations exist across regions. For example, road traffic accidents are the main contributor to spinal cord injury in the African Region (nearly 70% of cases) and the Western Pacific Region (55% of cases) and falls the leading cause in the South-East Asia and Eastern Mediterranean Regions (40% of cases). Non-traumatic spinal cord injury results from conditions such as tumours, spina bifida, and tuberculosis. A third of non-traumatic spinal cord injury is linked to tuberculosis in sub-Saharan Africa.

Consequences of spinal cord injury

Most people with spinal cord injury experience chronic pain, and an estimated 20-30% show clinically significant signs of depression. People with spinal cord injury also risk developing secondary conditions that can be debilitating and even life-threatening, such as deep vein thrombosis, urinary tract infections, pressure ulcers and respiratory complications.

Spinal cord injury is associated with lower rates of school enrollment and economic participation. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to socio-economic participation, with a global unemployment rate of more than 60%. Spinal cord injury carries substantial individual and societal costs.

Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments that exclude people with spinal cord injury from participation in their communities. Full Implementation of the Convention on the Rights of Persons with Disabilities is urgently required to address these gaps and barriers.

“Spinal cord injury is a medically complex and life-disrupting condition,” notes Dr Etienne Krug, Director of the Department of Violence and Injury Prevention and Disability, WHO. “However, spinal cord injury is preventable, survivable, and need not preclude good health and social inclusion.”

Essential health measures

Essential measures for improving the survival, health and participation of people with spinal cord injury include:

• timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury, rapid evaluation and initiation of injury management, including immobilization of the spine;
• acute care appropriate to the level and severity of injury, degree of instability and presence of neural compression;
• access to ongoing health care, health education and products such as catheters to reduce risk of secondary conditions and improve quality of life;
• access to skilled rehabilitation and mental health services to maximize functioning, independence, overall well-being and community integration;
• access to appropriate assistive devices that can enable people to perform everyday activities, reducing functional limitations and dependency; and
• specialized knowledge and skills among providers of medical care and rehabilitation services.

Essential social and economic measures

Essential measures to secure the right to education and economic participation include legislation, policy and programmes that promote:

• physically accessible homes, schools, workplaces, hospitals and transportation;
• inclusive education;
• elimination of discrimination in employment and educational settings;
• vocational rehabilitation to optimize the chance of employment;
• micro-finance and other forms of self-employment benefits to support alternative forms of economic self-sufficiency;
• access to social support payments that do not act as disincentive to return to work; and
• correct understanding of spinal cord injury and positive attitudes towards people living with it.

"International perspectives on spinal cord injury" was developed in association with the International Spinal Cord Society and Swiss Paraplegic Research, and launched on the occasion of the International Day of Persons with Disabilities on 3 December 2013.

For more information please contact:

Laura Sminkey
WHO Geneva
Telephone: +41 22 791 4547
Mobile: +41 79 249 3520
E-mail: sminkeyl@who.int

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Environmental enrichment for traumatic brain injury patients may reduce shrinkage in brain

Sep. 24, 2013 — Greg Noack was 24 when he moved from Ontario to Victoria, B.C. He had just graduated from college and was looking forward to a fresh start.

One early morning in 1996, as he was returning home from his graveyard shift at the hotel, Noack was attacked from behind by a group of men.

He doesn't remember being struck on the head. He does remember waking from a 15-day coma to learn he had suffered a traumatic brain injury (TBI).

Noack, through the care of his health-care team, relearned how to walk, write, and feel particular emotions.

"I was enamoured by what my therapists were able to do for me," said Noack. "I was lucky that I got back most of my function."

Three years post-injury, Noack enrolled in Sault College's Occupational Therapist Assistant/Physical Therapist Assistant Program and graduated with honours.

Shortly after, Noack was hired by the Toronto Rehab Acquired Brain Injury Rehab team as an occupational therapist assistant and later became a rehab therapist.

Most recently, he was seconded to Dr. Robin Green's traumatic brain injury research team.

Dr. Green, Senior Scientist and Neuropsychologist, Toronto Rehab and Canada Research Chair in Traumatic Brain Injury, and her Toronto Rehab team have been studying impediments to brain injury recovery as well as treatments to offset the impediments.

Dr. Green's work suggests that moderate-severe TBI may be a progressive neurological disorder -a whole new way of perceiving the condition.

"What may be occurring after a serious brain injury," said Dr. Green, "is that damaged tissue is leaving healthy areas of the brain disconnected and under stimulated. Over time, healthy areas may deteriorate."

Importantly, they discovered that in people with chronic moderate-severe TBI, environmental enrichment -- increased physical, social and cognitive stimulation -- can offset this deterioration.

Her research paper, entitled "Environmental enrichment may protect against hippocampal atrophy in the chronic stages of traumatic brain injury," was published September 24 in Frontiers in Human Neuroscience.

In their study of 25 patients with moderate-severe TBI, her team found a positive reaction to environmental enrichment.

Those who reported greater amounts of environmental enrichment -- for example, reading, problem solving exercises, puzzles, physical activity, socializing -- at 5 months after their injury showed less shrinkage of the hippocampus (associated with memory functioning) from 5 to 28 months post-injury.

"People with moderate-severe TBI are commonly unable to return to the same level of engagement in their work, school or social lives as before the injury," said Dr. Green. "However, those with greater environmental enrichment may be keeping vulnerable areas stimulated. Environmental enrichment is also known to increase production of neurons in the hippocampus and to promote their integration into existing brain networks."

Based on the findings from their study, Green's team is now engaged in research designed to proactively offset deterioration, which includes the delivery of environmental enrichment to patients. Noack is instrumental in delivering enriched therapy for TBI patients who are enrolled in one of Dr. Green's research studies.

"One thing I loved about this study is that it facilitated greater customization of a patient's care," said Noack. "I could see how my patients benefited from the increased amount of stimulation through extended therapy."

"Although the brains of patients are showing negative changes, patients are still showing recovery of their functioning in spite of it," said Dr. Green. "If we are able to offset the negative brain changes through the treatments we are developing, we may be able to very significantly improve patients' recovery and the quality of their aging with a brain injury."

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