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PATHOLOGY PERSPECTIVES SPINAL CORD INJURY Spinal cord injury (SCI) is defined by damage to nerve tissue in the spinal canal. How that damage is reflected in the body depends on where and how much of the tissue has been affected. Traumatic spinal cord injuries fall into one of five categories: Concussions, in which tissue is • jarred and irritated but not structurally damaged. • Contusions, in which bleeding in the spinal cord damages tissue. • Compression, in which a damaged disc, a bone spur, or a tumor puts mechanical pressure on the cord. • Laceration, in which the spinal cord is partially cut, as with a gunshot wound. • Transection, in which the spinal cord is completely severed. Motor vehicle accidents cause about 50 percent of all spinal cord injuries. Falls are responsible for 24 percent, gunshot wounds and other acts of violence cause 11 percent, and sports- related injuries account for 9 percent. About 11,000 Americans experience an SCI each year, and about 250,000 people in the United States are SCI survivors. Male patients outnumber females by more than 4 to 1. Statistics on other forms of spinal cord injury are not kept, but some estimates suggest that more people have been disabled by non-traumatic damage to the spinal cord (from arthritis, bone spurs, tumors, or other causes) than from accidents and injuries. STROKE Stroke or cerebrovascular accident (CVA) is the result of neuron damage related to ischemia or lack of blood supply. This can happen in one of two ways: 1) an ischemic stroke: a blood vessel becomes blocked with plaque, a clot, or other debris that develops on-site or travels from elsewhere, 2) a hemorrhagic stroke: a blood vessel ruptures and bleeds. Stroke is the most common type of central nervous system disorder, the third leading cause of death in the United States, and the leading cause of adult disability. About 700,000 people have a stroke each year in this country. Of them, 500,000 are first attacks, and 200,000 are repeat strokes. About 160,000 people die of stroke annually. Close to 5 million stroke survivors are alive in this country today. No matter what type of CNS injury occurs, internal edema, bleeding, and tissue damage may take several weeks to resolve. Most recovery of function appears to happen during this time. This is also when any residual motor impairment becomes apparent: damage to lower motor neurons reflects as flaccid paralysis, while damage to upper motor neurons shows as spastic paralysis—that is, flexors and extensors become progressively tighter, and ultimately the flexors win and the extensors let go. THE TRADITIONAL CNS INJURY PARADIGM Understanding of the structure and function of the CNS has always suggested that the environment inside the brain and spinal cord is not conducive to healing and replacement of damaged cells, and that any damage or injury here is permanent and irreversible: the best anyone could hope for would be to prevent the damage from getting worse. Generations of observation show that in individuals with a CNS injury, the affected area Inc. Constraint-induced movement therapy. 2007. www.strokeassociation. org/presenter.jhtml?identifier=3029931 (accessed June 2008). Bruno-Petrina, A. Motor Resources American Heart Association, recovery in stroke. WebMD. www. emedicine.com/pmr/TOPIC234. HTM (accessed June 2008). Cardenas, D and M. Jensen. 2006. to recovery after central nervous system injury. West J Med 159:56–60. www. pubmedcentral.nih.gov/articlerender. fcgi?artid=1022159 (accessed June 2008). Kluger, J. 2008. Walking away from paralysis. Time Inc. www.time.com/time/ magazine/article/0,9171,1612709,00. html (accessed June 2008). Nair, P. 2006. Neuroplasticity after Treatments for chronic pain in persons with spinal cord injury: survey study. Spinal Cord Med 29, no. 2:109–117. American Paraplegia Society. www. pubmedcentral.nih.gov/articlerender. fcgi?artid=1864800 (accessed June 2008). Dobkin, B. 1993. Neuroplasticity—key spinal cord injury and training: an emerging paradigm shift in rehabilitation and walking recovery. American Physical Therapy Association, Inc. www.thefreelibrary.com/r oplasticity+after+spinal+cord+injury+ and+training:+an+emerging...-a0156552626 (accessed June 2008). RAND Corporation. 2008. One in five Iraq andAfghanistan veterans suffer from PTSD or major depression. www.rand.org/news/ press/2008/04/17/ (accessed June 2008). Tolias, C. 2008. Initial evaluation and management of CNS injury. WebMD www.emedicine.com/MED/ topic3216.htm (accessed June 2008). Werner, R. 2009. A massage therapist's guide to pathology. Fourth edition. Baltimore: Lippincott, William & Wilkins, 297–313. 112 massage & bodywork september/october 2008