Look for loss of movement and ask about loss of feeling in the arms and legs, which may indicate a spinal cord injury (SCI). This loss of function may be at any level from the shoulders down. Loss of movement or feeling in the arms or hands suggests an injury in the neck; loss of movement or feeling from the chest down suggests an injury in the back. Pain in the spine may or may not be present.

If there is any suspicion of a spinal cord injury, even if there is no loss of movement or feeling, treat the person as if they have a spinal cord injury until proved otherwise.

The neck and spine should be kept still while waiting for ambulance personnel, who should have special collars to immobilize the neck. The person should be transported with their spine immobilized on a firm stretcher or backboard to an acute hospital capable of treating major trauma.

The person will be assessed first in an emergency room to determine whether they have any other injuries. They will then be admitted to the hospital and may have an operation to stabilize their spine. Their breathing and blood pressure will also be stabilized. Their bladder will probably be drained by a catheter initially, and their bowels should be emptied regularly to avoid constipation. It is important for them to be turned or moved every couple of hours to avoid prolonged pressure on the skin over bony areas.

After being stabilized medical and surgically it is important to go through comprehensive inpatient rehabilitation to learn the skills of living with a SCI and to improve the prospects of a good quality of life. Look for a SCI Unit or Center specializing in this type of rehabilitation as described below. Lists of such centers are available at the websites below [1, 2].

Inpatient SCI rehabilitation requires a specialized team of physicians, nurses, occupational and physical therapists, psychologists, social workers and other staff, with appropriate experience and equipment. They provide specialized training in learning to live with loss of movement or feeling and managing the many other consequences of spinal cord injury such as altered bladder and bowel function, and restoring sexual function such as erection and the ability to have children. They provide information about control of blood pressure and temperature, pain, and spasticity that can produce involuntary contractions of muscle and jerking of the limbs. They also provide specialized training in learning to prevent complications such as pneumonia, urine infection and pressure ulcers. They also assist with emotional adjustment of the person injured and their family, and social adaptations such as housing, driving, education and employment.