Replaces the term “quadriplegia” to denote four limbs are involved, maintaining consistency with Greek derivation (tetra = 4; para = 2).

Cervical segments of spinal cord are affected, with impairment or loss of motor and/or sensory function below this level.

Primary impairment of function in arms, trunk, legs, and pelvic organs.

Does not include brachial plexus lesions or injury to peripheral nerves outside neural canal.

Thoracic, lumbar, or sacral segments of spinal cord, with impairment or loss of motor and/or sensory function below this area.

Arm function intact, trunk, legs, and pelvic organs may be affected.

Refers to cauda equina and conus medullaris injuries, but not to lumbosacral plexus lesions or injury to peripheral nerves outside the neural canal [2].

“Complete SCI” refers to an injury resulting in complete loss of function below the neurological point of injury. “Incomplete SCI” refers to an SCI in which partial sensation or movement is evident below the point of injury.

Traumatic SCI is the direct result of trauma to the spinal cord from sudden application of physical force or movement that injures the cord by stretching, bruising, or displacement. Nontraumatic SCI designates injuries that occur because of medical conditions such as ischemia, spinal stenosis, infection, congenital disease, or tumor.

Nontraumatic SCI represents a significant portion of patients in rehabilitation, and some studies suggest similar incidence and prevalence as traumatic SCI [3, 4].

Rehabilitation needs are the same for all etiologies of SCI [5].

Individuals with traumatic SCI often achieve greater overall functional improvement, possibly due to younger mean age at injury [6].

“Dysreflexia” refers to the abrupt onset of excessively high blood pressure caused by overactivity of the autonomic nervous system, triggered by a noxious stimulus below the level of injury. Individuals with SCI at T-6 or higher are most at risk.

AD can be potentially life-threatening if not treated promptly and thus constitutes a medical emergency. AD occurs as a result of disconnection between the sympathetic and parasympathetic branches of the autonomic nervous system (ANS). For example, an overfull bladder sends sensory impulses toward the brain but is blocked by the lesion at the level of injury. The impulses evoke a reflex that increases the activity of the ANS, resulting in spasms, narrowed blood vessels, and an increase in blood pressure.

Symptoms of AD include pounding headache, sweating above the level of injury, cold clammy skin below level of SCI, goose bumps, flushed face, slowed pulse (<60 beats per minute), blotching of the skin, and nausea.

AD is caused by anything that would have been painful, uncomfortable, or physically irritating before the injury. Common causes of AD include blocked urinary catheter, bowel problems (e.g., distention and impaction), skin irritation or injury (e.g., an object in shoe/chair, overly tight clothing, wounds, and broken bones), and sexual activity (e.g., overstimulation, menstrual cramps, and labor and delivery).

Persons with SCI at risk for AD need to learn to recognize symptoms and how to implement interventions (e.g., keeping head elevated, loosening clothing, checking for urinary blockage, and monitoring blood pressure).

Spasticity refers to sustained, involuntary muscle contractions and heightened muscular reflexes that occur below the neurologic level of injury. The majority of persons with SCI experience some degree of spasticity, which can limit function, cause contractures, and contribute to pain. Spasticity management often entails a long-term daily program of stretching exercises to maintain range of motion and the use of muscle relaxants such of baclofen or tizanidine.

Involves loss of voluntary bowel and bladder control caused by disconnection of sacral segments from the brain. Teaching strategies for maintaining bowel and bladder continence represents a major focus for rehabilitation.

Managing neurogenic bladder usually necessitates some form of catheterization (i.e., using a tube to allow the bladder to drain). An indwelling catheter (“Foley”) remains in the bladder for continuous drainage, whereas intermittent catheterization (IC) entails inserting a catheter every 4–6 h. The use of IC is generally preferable because it is associated with a lower incidence of urinary tract infections, a common secondary complication of SCI. Suprapubic catheterization requires a surgery (cystostomy) to insert a catheter into the bladder through the abdominal wall. Advantages include prevention of damage to the urethal/sphincter tissue, maintenance of access for sexual activity, and reversibility.

Includes techniques for enabling the bowel to empty in a regular fashion and to prevent stool incontinence. A bowel program involves the use of suppositories, enemas, laxatives, stool softeners, digital stimulation of the rectum to trigger colonic reflexes, or manual removal of stool. Regulation of diet, especially fiber intake, also plays a role. The combination of techniques that is effective varies from person to person.

People with SCI, especially AIS A injuries, have impairments in sensation and movement that interfere with spontaneous weight shifts while sitting or lying down. Prolonged pressure from stationary positioning causes compression and ischemia of soft tissue that can lead to deep tissue injury and open wounds over bony prominences, including the ischium, trochanter, and sacrum. Approximately 80 % of persons with SCI will develop a pressure injury at some point in the course of their disability, and 30 % will have more than one pressure injury [7].

Pressure injury risk factors include completeness of SCI, time since SCI, age, and nutritional status. Individuals with SCI need to develop new skills for skin care, such as turning in bed every two hours, and deliberately shifting weight while seated several times per hour.

Specialized wheelchair cushions and air mattresses are often prescribed for skin maintenance.

Behavioral factors such as psychiatric disorders, cognitive impairment, substance abuse, and smoking may increase risk for pressure injuries.

FIM is a rating technique for describing a person’s level of independence with respect to the motor and cognitive abilities required for basic activities of daily living, such as mobility, grooming, dressing, bathing, and toileting. FIM is based on a scale ranging from 7 (complete independence with no helper or assistive device needed) to 1 (helper or is needed for 100 % of task completion). FIM is the mostly widely utilized measure for tracking progress and measuring outcome of acute SCI rehabilitation.