Ali Karabulut - Spinal Cord Injury (SCI) Pages

1. What is Spinal Cord Injury?
Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. Frequent causes of damage are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida, Friedreich's Ataxia, etc.). The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.

A person can "break their back or neck" yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized.

2. What is the spinal cord and the vertebra?
The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and Parasympathetic Nervous Systems.

The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience. The vertebra are named according to their location. The eight vertebra in the neck are called the Cervical Vertebra. The top vertebra is called C-1, the next is C-2, etc. Cervical SCIs usually cause loss of function in the arms and legs, resulting in quadriplegia. The twelve vertebra in the chest are called the Thoracic Vertebra. The first thoracic vertebra, T-1, is the vertebra where the top rib attaches. Injuries in the thoracic region usually affect the chest and the legs and result in paraplegia.

The vertebra in the lower back - between the thoracic vertebra, where the ribs attach, and the pelvis (hip bone), are the Lumbar Vertebra. The sacral vertebra run from the pelvis to the end of the spinal column. Injuries to the five Lumbar vertebra (L-1 thru L-5) and similarly to the five Sacral Vertebra (S-1 thru S-5) generally result in some loss of functioning in the hips and legs.

3. What are the effects of SCI?
The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.

The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses. Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers.

Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.

Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder. Sexual functioning is frequently affected: men with SCI may have their fertility affected, while women's fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.

4. How many people have SCI? Who are they?
Approximately 450,000 people live with SCI in the US. There are about 8,000 new SCIs every year; the majority of them (82%) involve males between the ages of 16-30. These injuries result from motor vehicle accidents (42%), violence (24%), or falls (22%). Quadriplegia is slightly more common than paraplegia.

5. Is there a cure for SCI?
Currently there is no cure for SCI. There are many researchers attacking this problem, and there have been many advances in the lab. Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug Sygen®appears to reduce loss of function, although the mechanism is not completely understood.

6. Do people with SCI ever get better?
When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to go down and people may regain some functioning. With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning.

7. Does everyone who sustains SCI use a wheelchair?
No. Wheelchairs are a tool for mobility. High C-level injuries usually require that the individual use a power wheelchair. Low C-level injuries and below usually allow the person to use a manual chair. Advantages of manual chairs are that they cost less, weigh less, disassemble into smaller pieces and are more agile. However, for the person who needs a powerchair, the independence afforded by them is worth the limitations. Some people are able to use braces and crutches for ambulation. These methods of mobility do not mean that the person will never use a wheelchair. Many people who use braces still find wheelchairs more useful for longer distances. However, the therapeutic and activity levels allowed by standing or walking briefly may make braces a reasonable alternative for some people.

Of course, people who use wheelchairs aren't always in them. They drive, swim, fly planes, ski, and do many activities out of their chair. If you hang around people who use wheelchairs long enough, you may see them sitting in the grass pulling weeds, sitting on your couch, or playing on the floor with children or pets. And of course, people who use wheelchairs don't sleep in them, they sleep in a bed. No one is "wheelchair bound."

8. Do people with SCI die sooner?
Yes. Before World War II, most people who sustained SCI died within weeks of their injury due to urinary dysfunction, respiratory infection or bedsores. With the advent of modern antibiotics, modern materials such as plastics and latex, and better procedures for dealing with the everyday issues of living with SCI, many people approach the lifespan of non-disabled individuals. Interestingly, other than level of injury, the type of rehab facility used is the greatest indicator of long-term survival. This illustrates the importance of and the difference made by going to a facility that specializes in SCI. People who use vents are at some increased danger of dying from pneumonia or respiratory infection, but modern technology is improving in that area as well. Pressure sores are another common cause of hospitalization, and if not treated - death.

9. Do people with SCI have jobs?
People with SCI have the same desires as other people. That includes a desire to work and be productive. The Americans with Disabilities Act (ADA) promotes the inclusion of people with SCI to mainstreamin day-to-day society. Of course, people with disabilities may need some changes to make their workplace more accessible, but surveys indicate that the cost of making accommodations to the workplace in 70% of cases is $500 or less.

10. Can people with SCI have sex, children?
SCI frequently affects sexual functioning. However, there are many therapies that allow people with SCI to have an active and satisfying sex life. Fertility is also frequently affected in men with SCI. Methods similar to those used for non-disabled men with fertility problems have allowed many men with SCI to father their own children. Of course, adoption is another option. The fertility of women with SCI may be affected in the first months after injury. However, most women regain the ability to become pregnant after SCI. Many women with SCI are able to carry babies to full term. However, it is important that she consult a physician experienced in SCI.

A person with a SCI is no different from a non-disabled individual except in a few ways. People with SCI have the same hopes, interests and desires as other people. People with SCI are interested in sports - or not (just like non-disabled people). Although disabled individuals do some things differently than non-disabled individuals, the result is the same. It's important to remember that although SCI changes a person, they are still people, so treat them that way.

The most important thing to remember is:
Life does not end with spinal cord injury.

Although there is more information available about people who have a spinal cord injury than ever before, much of it is incomplete. Some of the statistical data is summarized below.

We have very little information about disease-induced spinal cord injury, except brief descriptions of the diseases. The following information relates to traumatic spinal cord injury. It was compiled primarily by researchers at the University of Alabama using data from the regional SCI Centers funded by NIDRR. For more information on spinal cord injury statistics call 205-934-3320, the National Spinal Cord Injury Statistical Center, Birmingham, Alabama.

Number of New Injuries per Year
32 injuries per million population or 7800 injuries in the US each year.

Most researchers feel that these numbers represent significant under-reporting. Injuries not recorded include cases where the patient dies instantaneously or soon after the injury, cases with little or no remaining neurological deficit, and people who have neurologic problems secondary to trauma, but are not classified as SCI. Researchers estimate that an additional 20 cases per million (4860 per year) die before reaching the hospital.

Total number of people with Spinal Cord Injury
Current estimates are 250,000 - 400,000 individuals living with Spinal Cord Injury or Spinal Dysfunction.

Acts of violence have overtaken falls as the second most common source of spinal cord injury in the last 4 years.

People who return to work in the first year post-injury usually return to the same job for the same employer.

People who return to work after the first year post-injury either worked for different employers or were students who found work.

THE INJURY
Since 1988, 45% of all injuries have been complete, 55% incomplete. Complete injuries result in total loss of sensation and function below the injury level. Incomplete injuries result in partial loss. "Complete" does not necessarily mean the cord has been severed. Each of the above categories can occur in paraplegia and quadriplegia.

Except for the Incomplete-Preserved motor (functional), no more than 0.9% fully recover, although all can improve from the initial diagnosis.

Overall, slightly more than 1/2 of all injuries result in quadriplegia. However, the proportion of quadriplegics increase markedly after age 45, comprising 2/3 of all injuries after age 60 and 87% of all injuries after age 75.

Most people with neurologically complete lesions above C-3 die before receiving medical treatment. Those who survive are usually dependent on mechanical respirators to breathe.

HOSPITALIZATION
(Important: This section applies only to individuals who were admitted to one of the hospitals designated as "Model" SCI centers by the National Institute of Disability and Rehabilitation Research.)

Only 10-15% of all people with injuries are admitted to the NIDRR SCI system. The remainder go to CARF facilities or to general hospitals in their local community.

There is no apparent relationship between severity of injury and nursing home admission, indicating that admission is caused by other factors (i.e. family can't take care of person, medical complications, etc.) Nursing home admission is more common among elderly persons.

Each year 1/3 to 1/2 of all people with SCI are re-admitted to the hospital. There is no difference in the rate of re-admissions between persons with paraplegia and quadriplegia, but there is a difference between the rate for those with complete and incomplete injuries.

Survival
Overall, 85% of SCI patients who survive the first 24 hours are still alive 10 years later, compared with 98% of the non-SCI population given similar age and sex.

Causes of Death
The most common cause of death is respiratory ailment, whereas, in the past, it was renal failure. An increasing number of people with SCI are dying of unrelated causes such as cancer or cardiovascular disease, similar to that of the general population.

Mortality rates are significantly higher during the first year after injury than during subsequent years.

We here at NSCIA are continually finding out about people who have lived 30, 40, and even 50 years after their injuries.

The Factsheet is provided as an information service to you and is not intended to be comprehensive. The data used in this Factsheet was compiled by the National Spinal Cord Injury Statistical Center at the University of Birmingham. Any information you may have to offer to further update this Factsheet would be greatly appreciated. The National Spinal Cord Injury Association Resource Center (NSCIRC) provides information and referral on any subject related to spinal cord injury. Contact the resource center at 1-800-962-9629.

Introduction
The extent to which sexual function is impaired depends on a variety of factors; the level of injury, the severity of damage, and the individual's gender.

Since a spinal cord injury (SCI) affects virtually every system of the human body, many people who sustain SCI have serious concerns about how their injuries have affected their ability to participate in and enjoy a sexual relationship. This document attempts to address some of the more common questions that arise on the topic of sex after a SCI. It also directs the reader to additional sources of more specific information.

Sexual function in humans is controlled by parts of the central nervous system (CNS), particularly the brain and spinal cord. Interruption to the CNS through injury to the spinal cord will therefore have some effect on sexual function. The extent to which sexual function is impaired, however, depends on a variety of factors including the level of injury, the severity of damage to the spinal cord, and whether the individual is male or female.

NSCIA would like to thank Dan Casady, Thom DeLilla and Robert Oates, M.D., for their help in preparing this fact sheet. This Factsheet is offered as an information service and is not intended to cover all treatments or research in the field nor is it an endorsement of the methods mentioned herein. Any information you may have to offer to further update this Factsheet would be greatly appreciated. The National Spinal Cord Injury Association Resource Center (NSCIRC) provides information and referral on any subject related to spinal cord injury. Contact the resource center at 1-800-962-9629.

It is very important to be confident about the quality of care you or a loved one will receive when entering a rehabilitation program. Very few people have prior experience with rehabilitation or the effects of a spinal cord injury (SCI), thus, assessing the quality of a rehabilitation program is difficult.

Although the final decision will ultimately depend upon individual circumstances such as insurance and location, all rehabilitation programs have features which can be evaluated, regardless of your prior knowledge of rehabilitation or SCI.

It is vital to select a high quality rehabilitation program with skilled professionals to help a newly injured person develop the skills needed to maintain physical and emotional health throughout his/her lifetime.

A Quick Word about Rehabilitation Programs
In order to develop and maintain quality services for individuals with spinal cord injuries, rehabilitation staff and programs MUST specialize in treating SCI. This expertise is best acquired and maintained when staff members treat people with SCI on a regular basis. High quality rehabilitation programs are often located in facilities devoted exclusively to providing rehabilitation services, or in hospitals with designated SCI units.

In-patient SCI rehabilitation programs have features which distinguish them from the hospital programs where most people receive initial treatment. Rehabilitation programs are designed to serve people with a wide variety of skills and must address complex social and community issues. A rehabilitation team comprised of specialized medical personnel is used to accomplish these goals.

Teams should include social workers, occupational and physical therapists, recreational therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists and other specialists. The team is usually directed by a physiatrist, a physician specializing in physical medicine and rehabilitation (see Factsheet #11). Team members are jointly responsible for working with individuals and their families to develop effective rehabilitation and discharge plans.

The team should assign a program manager who will function as a contact with the rest of the team. This contact should meet with the person undergoing rehabilitation on a regular basis to discuss the rehabilitation plan and to address personal or family concerns.

Rehabilitation programs and acute care units may also differ in their emphasis on family and patient participation. Although many factors can contribute to someone's successful return to the community following a spinal cord injury, the education and active involvement of the newly injured person and the family is crucial. Rehabilitation programs should focus on maximizing a person's ability to be independent and should assist in making decisions about treatment and goals.

The following questions were developed to assist you in your decision making process. They can be used as a checklist to obtain the information required to make an informed decision when choosing a rehabilitation program.

General Considerations
Peer support and contact with others who have a SCI can be extremely important in helping a person adjust to the injury. Peer support is generally most helpful and accepted when people share similar problems and issues. This is an especially important consideration when choosing programs for women. It is often difficult for women to find peer support because the incidence of SCI among women is much lower than it is for men.

Pediatric Programs
Because incidence rates of SCI among children are relatively low, rehabilitation hospitals and programs usually do not maintain a separate program or unit exclusively for children with SCI. As an alternative, caregivers may consider facilities/programs which place children with SCI in rehabilitation units with other children with chronic disabilities. Hopefully, this will provide families and children with opportunities to share common experiences and information with each other, and may lead to the development of support networks in the community.

It is possible that children may be placed in units with other children who are too ill for rehabilitation. Children generally derive greater benefit if they undergo rehabilitation with other children who are actively involved in the rehabilitation process.

Ventilator Programs
(See Factsheet #12 for more information on ventilator programs.)

NSCIA is committed to assisting individuals with SCI and other concerned individuals find quality rehabilitation services. If you would like further assistance during the decision making process, please contact us to discuss your concerns.

Spinal Cord Injury Programs Accredited by CARF
The following is a list of SCI programs accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). CARF is a non-profit organization established to adopt and apply standards within facilities throughout the nation. CARF has currently accredited ninety-three Spinal Cord Injury Programs. Accreditation by CARF is voluntary.

This policy and list is current as of March, 1996

Arkansas
HEALTHSOUTH Rehabilitation Hospital of Fort Smith 1401 South J Street Fort Smith, AR 72901 501-785-3300	Baptist Rehab. Institute of Arkansas 9601 Interstate 630, Exit 7 Little Rock, AR 72205-7299 501-223-7578

Arizona
Good Samaritan Regional Medical Center Samaritan Rehabilitation Institute 1111 East McDowell Road Phoenix, AZ 85006 602-239-2119	Samaritan Rehabilitation Institute 1012 E. Willetta St. Phoenix, AZ 85006-2749 602-239-2119

California
Rancho Los Amigos Medical Center 7601 East Imperial Highway Downey, CA 90242 310-940-7022	Leon S. Peters Rehabilitation Center Fresno Community Hospital Fresno and R Streets Fresno, CA 93715 209-442-3957
St. Jude Medical Center 101 East Valencia Mesa Dr. Fullerton, CA 92634 714-871-3280	Center for Diagnostic and Rehab. Medicine Daniel Freeman Memorial Hospital 333 North Prairie Avenue Inglewood, CA 90301 310-674-7050
Long Beach Memorial Rehabilitation Hospital 2801 Atlantic Avenue Long Beach, CA 90801-1428 310-933-2400	Northridge Hospital Medical Center 18300 Roscoe Blvd. Northridge, CA 91328 818-885-5338
Casa Colina Hospital for Rehabilitative Medicine\ 255 East Bonita Avenue Pomona, CA 91767 909-593-7521	Norman B. Nelson Rehabilitation Center Santa Clara Valley Medical Center 751 South Bascom Avenue San Jose, CA 95128 408-299-6841
The Rehabilitation Institute at Santa Barbara 427 Camino Del Remedio Santa Barbara, CA 93110-1399 805-683-3788

Colorado
Craig Hospital 3425 South Clarkson Street Englewood, CO 80110 303-789-8000

Connecticut
Gaylord Hospital, Inc. Gaylord Farm Road Wallingford, CT 06492 203-284-2804

Delaware
Alfred I. DuPont Institute of the Nemours Foundation Division of Rehabilitation Medicine 1600 Rockland Road Wilmington, DE 19899 302-651-5602

District of Columbia
National Rehabilitation Hospital 102 Irving Street, N.W. Washington, DC 20010-2949 202-877-1000

Florida
Pinecrest Rehabilitation Hospital 5360 Linton Boulevard Delray Beach, FL 33484 407-495-0400	HEALTHSOUTH-Sunrise Rehabilitation Hospital 4399 Nob Hill Road Fort Lauderdale, FL 33351-5899 305-749-0300
UpReach Pavilion 8900 N.W. 39th Avenue Gainesville, FL 32606 904-338-0091	Genesis Rehabilitation Hospital, Inc. 3599 University Blvd. South Jacksonville, FL 32216 904-399-6818
HEALTHSOUTH-Rehabilitation Hospital 901 North Clearwater-Largo Road Largo, FL 34640 813-586-2999	Jackson Memorial Rehabilitation Center 1611 N.W. 12th Avenue Miami, FL 33134 305-585-7303
Columbia Park Rehabilitation and Spinal Center Columbia Park Medical Center 818 South Main Lane Orlando, FL 32801 407-649-6148	Rehabilitation Institute of West Florida at West Florida Regional Medical Center 8391 North Davis Highway Pensacola, FL 32523-8900 904-474-4000
HEALTHSOUTH Rehabilitation Hospital of Tallahassee 1675 Riggins Road Tallahassee, FL 32308 904-656-4800	Tampa General Rehabilitation Center Davis Island Tampa, FL 33601 813-251-7750

Georgia
Emory Hospitals Center for Rehabilitation Medicine 1441 Clifton Road, NE Atlanta, GA 30322 404-712-5515	The Shepherd Center for Treatment of Spinal Cord Injuries, Inc. 2020 Peachtree Road, N.W. Atlanta, GA 30309 404-352-2020
Walton Rehabilitation Hospital 1355 Independence Drive Augusta, GA 30901-1037 706-823-8506	Central Georgia Rehabilitation Hospital 3351 Northside Drive Macon, GA 31210 912-471-3500

Hawaii
The Rehabilitation Hospital of the Pacific 226 North Kuakini Street Honolulu, HI 96817 808-531-3511

Illinois
Rehabilitation Institute of Chicago 345 East Superior Street Chicago, IL 60611 312-908-2877	Midwest Institute for Rehabilitation EHS Christ Hospital and Medical Center 4440 West 95th Street Oak Lawn, IL 60453 708-346-5201
Memorial Medical Center Regional Rehabilitation Center 800 North Rutledge Springfield, IL 62781 217-788-3302

Indiana
Rehabilitation Hospital of Indiana 4141 Shore Drive Indianapolis, IN 46254-2607 317-329-2106

Iowa
Younker Rehabilitation Center 1200 Pleasant Street Des Moines, IA 50309 515-241-6434	Covenant Rehabilitation Center Covenant Medical Center 3421 West 9th Street Waterloo, IA 50702 319-291-3336

Kansas
Mid-America Rehabilitation Hospital 5701 West 110th Street Overland Park, KS 66211 913-491-2400

Kentucky
Cardinal Hill Rehabilitation Hospital 2050 Versailles Road Lexington KY 40504 606-254-5701	Frazier Rehab. Center 220 Abraham Flexner Way Louisville, KY 40202 502-582-7400

Louisiana
Rehabilitation Institute of New Orleans 4444 General Meyer New Orleans, LA 70131 504-363-2200

Massachusetts
New England Rehabilitation Hospital Two Rehabilitation Way Woburn, MA 01801 617-935-5050

Maryland
Montebello Rehabilitation Center, Inc. 2201 Argonne Drive Baltimore, MD 21218 410-554-5212	Rehabilitation Center The Good Samaritan Hospital of Maryland, Inc. 5601 Loch Raven Boulevard Baltimore, MD 21239 410-532-3900

Michigan
Rehabilitation Institute of Michigan 261 Mack Boulevard Detroit, MI 48201 313-745-9731	Mary Free Bed Hospital and Rehabilitation Center 235 Wealthy Street, S.E. Grand Rapids, MI 49503 616-242-0404

Minnesota
Regional Rehabilitation Center of Duluth 502 East 2nd Street Duluth, MN 55805 218-720-1248	Sister Kenny Institute 800 East 28th Street at Chicago Avenue Minneapolis, MN 55407 612-863-4463
Mayo Clinic/St. Mary's Hospital Rehabilitation Unit 3 Mary Brigh, St. Mary's Hospital 1216 Second Street, S.W. Rochester, MN 55902 507-255-4613

Missouri
Howard A. Rusk Rehabilitation Center One Hospital Drive Columbia, MO 65212 314-882-1071	The Rehabilitation Institute 3011 Baltimore Ave. Kansas City, MO 64108 816-756-2250
The Jewish Hospital of St. Louis at Washington UniversityDepartment of Rehabilitation Medicine 216 South Kings Highway St. Louis, MO 63110 314-454-5277	SSM Rehabilitation Institute 555 North New Ballas Road, Suite 150 St. Louis, MO 63141 314-768-5304
SSM Rehabilitation Institute/St. Mary's 6420 Clayton Road St. Louis, MO 63117 314-768-5304	St. John's Mercy Rehabilitation Center 615 South New Ballas Road St. Louis, MO 63141 314-569-6041

Nebraska
Immanuel Rehabilitation Center 6901 North 72nd Street Omaha, NE 68122 402-572-2295

New Hampshire
Northeast Rehabilitation Hospital 70 Butler Street Salem, NH 03079 603-893-2900

New Jersey
Children's Specialized Hospital 150 New Providence Road Mountainside, NJ 07092 908-233-3720	Betty Bacharach Rehabilitation Hospital 61 West Jimmie Leeds Road Pomona, NJ 08240-0723 609-748-5460
Kessler Institute for Rehabilitation, Inc. 1199 Pleasant Valley Way West Orange, NJ 07052 201-731-3600

New Mexico
HealthSouth Rehabilitation Hospital 7000 Jefferson, NE Albuquerque, NM 87102 505-766-4700	St. Joseph Rehabilitation Hospital and Outpatient Center 505 Elm Street, N.W. Albuquerque, NM 87102 505-766-4700

New York
University of Rochester Medical Center Strong Memorial Hospital/Rehab. Unit Box 664, 601 Elmwood Avenue Rochester, NY 14642 716-275-3271	Sunnyview Rehabilitation Hospital 1270 Belmont Avenue Schenectady, NY 12308 518-382-4500

North Carolina
Thoms Rehabilitation Hospital Health Services Corporation 68 Sweeten Creek Road Asheville, NC 28803 704-274-2400	Charlotte Institute of Rehabilitation 1100 Blythe Boulevard Charlotte, NC 28203 704-355-4300
Southeastern Regional Rehabilitation Center Cape Fear Valley Medical Center 1638 Owen Drive Fayetteville, NC 28302 919-323-6087

Ohio
Drake Center, Inc. 151 West Galbraith Road Cincinnati, OH 45216 513-948-2500	The Rehabilitation Center Good Samaritan Hospital 375 Dixmyth Avenue Cincinnati, OH 45220-2489 513-872-2481
MetroHealth Center for Rehabilitation 2500 MetroHealth Drive Cleveland, OH 44109-1998 216-459-4874	Ohio State University Hospitals Dodd Hall 480 West 9th Avenue Columbus, OH 43210-1228 614-293-8542
Rehabilitation Institute of Ohio at Miami Valley Hospital One Wyoming Street Dayton, OH 45409 513-220-2065	St. Elizabeth Rehabilitation Center 601 Edwin C. Moses Boulevard Dayton, OH 45408 513-229-6081

Pennsylvania
University Hospital Rehabilitation Center for Children and Adults 500 University Drive Hershey, PA 17033 717-531-7100	HEALTHSOUTH of Pittsburgh dba HEALTHSOUTH Rehabilitation Hospital of Greater Pittsburgh 2380 McGinley Road Monroeville, PA 15146 412-856-2400
Magee Rehabilitation Hospital Six Franklin Plaza Philadelphia, PA 19102 215-587-3000	Thomas Jefferson University Hospital Department of Rehabilitation Medicine 111 South 11th Street 324 Main Building Philadelphia, PA 19107 215-955-6573
Harmarville Rehabilitation Center, Inc. Guys Run Road Pittsburgh, PA 15238 412-828-1300	Allied Services Institute of Rehabilitation Medicine 475 Morgan Highway Scranton, PA 18501-1103 717-348-1300

South Carolina
HEALTHSOUTH Rehab. Hospital 2935 Colonial Drive Columbia, SC 29203 803-254-7777	HEALTHSOUTH Rehab. Center 900 East Cheves Street Florence, SC 29506 803-679-9000
Roger C. Peace Rehabilitation Hospital 701 Grove Road Greenville, SC 29605 803-455-7702

Tennessee
Patricia Neal Rehabilitation Center 1901 Clinch Avenue, SW Knoxville, TN 37916 615-541-1621	Baptist Memorial Hospital Medical Center Rehabilitation Unit 899 Madison Ave. Memphis, TN 38146 901-522-6550

Texas
Baylor Institute for Rehabilitation at Gaston Episcopal Hospital 3505 Gaston Avenue Dallas, TX 75246 214-826-7030	HEALTHSOUTH Rehabilitation Center 2124 Research Row Dallas, TX 75235 214-904-6110
Rio Vista Rehabilitation Hospital 1740 Curie Drive El Paso, TX 79902-2901 915-543-6889	The Institute for Rehab. & Research 1333 Moursund Street Houston, TX 77030-3405 713-799-5000

Utah
Division of Physical Medicine & Rehab. University of Utah 50 North Medical Drive Salt Lake City, UT 84132 801-581-2251

Virginia
The Rehabilitation and Research Center of Medical College of Virginia Hospitals 1300 East MArshall Street Richmond, VA 23298-0661 804-828-8061

West Virginia
Medical Rehabilitation Center at Charleston Area Medical Center 501 Morris Street Charleston, WV 25325 304-348-6327

Wisconsin
The Spinal Cord Injury Center Froedtert Memorial Lutheran Hospital 9200 West Wisconsin Avenue Milwaukee, WI 53226 414-259-3657

NIDRR Model Spinal Cord Injury Systems
The thirteen SCI rehabilitation programs listed below are designated as Model Systems by the National Institute of Disability and Rehabilitation Research (NIDRR). To qualify for designation as a Model System and to receive funding from NIDRR, rehabilitation programs must utilize and evaluate a prototype of SCI treatment based on providing continuity of care through the development of five areas within a system.

Model Spinal Cord Injury Systems must have:

Model systems must also conduct research of interest to NIDRR and collect data on SCI. In order to gain and maintain expertise in treating SCI, designated systems are expected to provide care to a significant volume of people with SCI, although consumers should be advised that designated systems are not evaluated for their quality of care.

As with any treatment decision, NSCIA recommends that persons who have spinal cord injuries should thoroughly investigate any medical or rehabilitation treatment facility before deciding to be admitted.

When someone sustains a spinal cord injury (SCI), one of the most difficult issues to deal with is that there is no "cure" at the present time. One would think that, with the "explosion in scientific knowledge" we hear about almost every day, SOMEONE would be doing SOMETHING to find a cure for people with SCI. If we can achieve the impossible in other areas, like transplanting entire organs and organ systems from one person to another and isolating human genes, why can't we figure out why the spinal cord does not repair itself and then do something to correct this biological problem? Compared to a lot of the scientific puzzles that HAVE been solved, it shouldn't be all that difficult...

Let's look at these issues and put them into the context of what scientists have been doing about SCI over the past half century.

Before World War II, an injury to the spinal cord was considered to be a fatal condition. If you did not die as a direct result of the injury, you probably would die within a few weeks or months from complications, such as a kidney infection, respiratory problems, or badly infected skin sores.

Fortunately, an improved understanding of SCI led to better patient management, enabling many people to survive their injuries and the initial period afterwards. In addition, the discovery of penicillin and sulfa drugs made common, but life-threatening complica-tions like kidney and skin infections manageable conditions rather than potential killers.

Because the spinal cord carries vital information to the brain, the muscles and many organs, the fact that SCI is now a survivable injury is a miracle itself. However, this miracle leads to another pressing need - to find a way to reverse, or at least diminish, the devastating physical effects of the injury.

The Search For the Cure
The 1980's and 1990's have been an exciting time for people interested in spinal cord injury repair and regeneration. Both in terms of treat-ment techniques and general knowledge about nervous system function, the progress that has occurred in recent years is encouraging.

The search for a cure involves one of the most complex parts of the human body. The spinal cord is an integral part of the body's most specialized system, the central nervous system (CNS). The CNS consists primarily of the brain and spinal cord.

A major role of the spinal cord is to carry mes-sages to and from all parts of the body and the brain. Some of these messages control sensation, such as knowing your finger is touching a hot stove, while others regulate movement. The spinal cord also carries mes-sages that regulate autonomic functions such as heart rate and breathing - over which we generally do not exert voluntary control.

The spinal cord carries these messages through a network of nerves which link the cells of the spinal cord to target cells in all other systems of the body. An individual nerve cell is called a neuron, each with receptive branching fibers called dendrites. The axon, carrying an output signal, extends from the cell body, and is covered by a protective fatty substance called a myelin sheath which helps the impulse travel efficiently.

A nerve impulse from one neuron is picked up by the dendrite of the next nerve cell in the pathway at a specialized connection called a synapse. An electrochemical reaction causes the impulse to "jump" across the synapse and the signal stimulates the second nerve cell and the impulse then travels down its axon. The message is picked up and transmitted by a series of neurons until the connection is complete.

There are millions of nerve cells within the spinal cord itself. Some of these lower motor neurons receive motor commands from the brain and send their signals directly to the muscles. Other spinal cord neurons form relay pathways for information travelling up or down the length of the spinal cord. Still other spinal cord neurons remain intact and form intricate circuits below the level of injury. Because cells below the injury are no longer under voluntary control, they cannot be utilized as effectively and may cause unintentional movements such as spasms.

Regeneration
Most of the cells in the human body have the ability to repair themselves after an injury. If you cut your finger, often you have a visible laceration for a few days or weeks, followed by the formation of a scar. In time, you may not be able to tell that the cut had occurred. This indicates that skin cells regenerate, just like cells in the blood vessels, organs and many other tissues. Peripheral nerves (nerve fibers outside the brain and spinal cord), such as those located in your fingertips, also regenerate, although this process is different from that in the skin and other organs.

For years, scientists have focused on the big mystery: "Why doesn't the central nervous system regenerate?" This question is even more perplexing because we know that central nerves in lower animal species CAN regenerate. There are no definite answers to this mystery yet, but scientists are exploring the questions in many ways.

Basic Cell Research
An important avenue of research is to look at normal cell function in the CNS of mammals. Scientists investigating this area of research are attempting to identify and describe cellular interactions in properly working systems. In addition, they are working with SCI models in an attempt to identify and explain what occurs after an injury.

Development of New Therapeutic Approaches
Ongoing research using animal models to test possible new therapies is progressing more rapidly than ever before. This type of research takes several forms that can best be explained as they apply to so