Every spinal cord injury and recovery process is unique. This means that it can be hard to spot the signs of recovery from spinal cord injury since every person’s journey is different.
Factors like medical history, type of spinal cord injury, level of injury, age, and overall health contribute to recovery speed. With so many factors at play, you could be recovering and not even notice it.
To help you celebrate even the smallest signs of recovery from spinal cord injury, we’ve gathered some significant milestones in this article. We highly recommend keeping a recovery journal, as having a log of your progress can help you notice changes that you may otherwise overlook.
Additionally, it’s important to keep an eye on both physical and psychological signs of recovery because both are equally important. This article will discuss both.
Use the links below to jump directly to a specific section of this article:
- What to know before looking for signs of recovery
- How spinal shock can cover up signs of recovery
- Physical recovery signs
- Measuring physical recovery signs
- Psychological recovery signs
What to Know Before You Look for Signs of Recovery from Spinal Cord Injury
The spinal cord plays an essential role in movement and sensation throughout the body. Thirty-one pairs of nerve roots enter and exit the spinal cord, spreading out to millions more to transmit messages between the brain and the body. When the spinal cord sustains damage, this communication may be impaired, affecting movement and/or sensation below the level of injury.
Each level of injury corresponds with a specific area of the body. For example, someone who suffers a lumbar spinal cord injury can potentially experience impaired movement or sensation from the lower back and down into the legs.
The rehabilitation process focuses on improving as much mobility and sensation as possible through exercise and movement retraining. Before we dig into the signs of recovery from SCI, however, it’s important to outline the difference between an incomplete and complete spinal cord injury.
With an incomplete SCI, the spinal cord has sustained damage but there are still some connections left intact at the site of injury. Individuals with incomplete SCIs may have impaired movement and/or sensation below the level of injury, but may not have total functional paralysis.
With a complete SCI, the spinal cord has been fully severed and no connections at the site of injury remain intact. Individuals with complete SCIs have no movement or sensation below the level of injury, resulting in paraplegia (paralysis of the lower limbs) or quadriplegia (paralysis of all four limbs).
Generally speaking, the recovery prognosis for an incomplete SCI is more optimistic than a complete SCI. While there are examples of complete SCI survivors progressing to higher ASIA impairment scales (read more below), a spinal cord from an incomplete injury has a stronger chance of utilizing neuroplasticity to strengthen existing pathways and create new ones.
Therefore, it’s important to ask your doctor for information about the completeness of your SCI, and involve a multidisciplinary care team to maximize your recovery outcomes.
How Spinal Shock Can Cover Up Signs of Recovery
In some situations, an incomplete SCI may be confused or even misdiagnosed as a complete SCI due to spinal shock.
Immediately after a spinal cord injury, your spinal cord may enter spinal shock where the body attempts to heal itself by activating an inflammation response. Spinal shock causes a temporary loss of sensory and motor functions below your level of injury, which resembles the symptoms of a complete SCI.
Spinal shock can persist for days to weeks, but typically resolves around 4-12 weeks. After spinal shock subsides, functions may gradually start to return. At this point, you’ll have a better idea of what functions are or are not affected by your SCI.
Therefore, if you’re looking for signs of recovery from spinal cord injury, it’s helpful to understand symptoms of spinal shock, and that functions may improve on their own as inflammation goes down.
Physical Signs of Recovery from Spinal Cord Injury
Now that you understand how SCI recovery is influenced by the severity of the injury and spinal shock (during the early stages), let’s discuss some of the lesser-known physical signs of recovery from spinal cord injury.
Keep in mind that every SCI is different, and every survivor will experience different signs of recovery and at different timelines. These are not hard rules. Instead, these are general patterns that can be viewed as signs of progress.
An improvement in any single one of these symptoms is a sign of physical recovery from spinal cord injury:
Pain Below the Level of Injury
Surprisingly, pain after spinal cord injury can actually be a sign of recovery.
In order to feel pain, sensory signals below the level of injury must reach the brain. This indicates that the spinal cord injury is incomplete rather than complete; and the prognosis for an incomplete SCI is generally more optimistic.
Between 60 and 80% of all survivors experience pain after spinal cord injury. While this is a sign of recovery, it can significantly impact your quality of life. If you experience pain after SCI, discuss management options with your doctor.
Treatment for pain is dependent on its type, ranging anywhere from musculoskeletal, referred, and neuropathic to pain associated with spasticity. Therapy plays a critical role in pain management and prevention after a SCI, and should always complement appropriate medications and other conservative measures.
Spasticity Below the Level of Injury
Spasticity is another surprising sign of recovery from spinal cord injury. Spasticity is due to disrupted signals between the brain and areas below the level of injury, resulting in hyper-reflexia and involuntary muscle contractions. Spasticity is “velocity-dependent,” which means that the quicker a muscle is stretched or moved, the more severely it will contract.
While spasticity and muscle stiffness are conditions that require rehabilitation in order to improve, they are a sign of recovery. This is because motor signals must be able to pass through the spinal cord in order for muscles to contract at all.
In fact, during spinal shock, muscles initially become flaccid, not only becoming paralyzed but also losing tone (i.e. become “floppy”). Flaccid paralysis is a symptom of a complete SCI because no motor signals are able to reach muscles below the level of injury.
That being said, spasticity can be painful and limit movement if goes unmanaged and worsens. Use the presence of spasticity as motivation to keep stretching and practicing spinal cord injury rehab exercises to help improve motor function.
Tingling Below the Level of Injury
Mild tingling after spinal cord injury can also be a sign of recovery. It means that sensory signals below the level of injury are able to reach the brain, once more indicating an incomplete SCI instead of a complete SCI.
While tingling can be a concern, it’s a stronger sign of recovery than a complete loss of feeling and sensation. Even though sensation might be affected, the presence of altered sensation provides hope that sensory function can improve, especially when rehabilitation is pursued.
When injured sensory nerves are regenerating, altered sensations or paresthesias may be present such as tingling, pins and needles, or even burning. Talk to your therapist about methods to address these paresthesias after SCI, such as electrical stimulation, desensitization techniques, or sensory re-education.
How to Measure Physical Recovery After Spinal Cord Injury
There are several ways to measure progress after spinal cord injury. However, use caution when doing so. Fixating on numbers and physical recovery can be disheartening because little improvements between the bigger milestones may go overlooked.
It can be helpful to understand how clinicians measure SCI recovery, but it should not become the end-all-be-all for your recovery goals.
ASIA Impairment Scale
If you’re eager for a way to measure progress, take a look at the ASIA Impairment Scale (AIS). There are five categories, where level A refers to no motor or sensory function below the level of injury (complete SCI) and level E refers to full functional recovery.
Spinal cord injury survivors that pursue rigorous rehabilitation can often “jump up” one level on the ASIA Impairment Scale. For example, a survivor with a consistent home therapy program may “jump” from AIS B (sensory function remains, but no motor function exists) to AIS C (up to half the muscles below the level of injury have some motor function).
Often, it takes months or even years of consistent rehabilitation to move up on the ASIA Impairment Scale. This is why it’s more motivating to focus on small milestones than just the bigger ones.
Your Level of Injury
Many spinal cord injury survivors recover at least a couple levels of muscle movement and sensation, which means symptoms may improve from the current level of injury to a lower level of injury. For example, you can recover a T4 injury to a T5 injury, which presents with fewer impaired functions.
Although this may seem like you’re “only” improving one level of injury, it’s actually an incredible sign of progress. If you continue to pursue therapy both with your therapist and at home, that T5 injury may improve to a T6 injury and so on as neuroplasticity is stimulated and function is slowly regained.
Again, sometimes you may not notice the signs of recovery from spinal cord injury because the bigger milestones, such as walking again, but pull your focus from the little signs of recovery right in front of you and celebrate even the small victories.
For this reason, be sure to keep a recovery journal and participate in a home therapy program that automatically tracks your progress, such as FitMi home therapy.
Psychological Signs of Recovery from Spinal Cord Injury
Many survivors and family members focus only on the physical signs of recovery, but the psychological aspects of recovery should not be overlooked. Mental wellness can promote further physical improvement, so it’s important not to prioritize one over the other. Psychological care is essential after spinal cord injury.
Here are some psychological signs of recovery after SCI:
Seeking Therapy or Counseling
A spinal cord injury presents many challenges and unwanted lifestyle changes, such as using a wheelchair or changing careers. This is one of many causes for depression after SCI.
Poor psychological health can impede motivation to pursue physical recovery, which can lead to a downward spiral. Survivors should not feel shame in seeking psychological help, such as psychotherapy or counseling.
In fact, it could be a sign of recovery, because it means you’re ready to take action to improve how you feel about your situation. Ask your doctor or therapist about local support groups that you can participate in with other SCI survivors.
Furthermore, a survey found that 86% of people with quadriplegia (paralysis from the neck down) rated their quality of life as average or better than average. It can take time to reach this level of acceptance, but it’s something that many survivors have done and you can too, with the right action.
Setting Small and Big Goals
When you only set big goals, you leave a lot of time in between to get discouraged. Therefore, it’s important to step away from an all-or-nothing mindset and set both big and small goals. Not only does this help with motivation, but it helps you see all the signs of recovery that happen along the way.
Staying Cautiously Curious About Your Doctor’s Prognosis
You should always listen to your doctors and therapists, especially when it comes to medical advice, exercises, and guidance. With that said, it can also help your recovery to stay curious about any limitations declared.
For example, if you have an incomplete SCI but your doctor says that you’ll never be able to walk again — but thanks to diligent research you know that an incomplete injury generally offers more hope for recovery — you can kindly remain curious about what you can accomplish and keep pursuing rehab.
Studies have found that anywhere from 20% to 75% of individuals with an incomplete SCI will recover some degree of walking capacity by 1 year post-injury. Neither you nor your doctor know with certainty whether or not you will be part of that percentage. The only thing you can do is stay curious, be diligent, and keep pursuing rehabilitation.
Tracking Your Unique Signs of Recovery from SCI
Physical and psychological signs of recovery from spinal cord injury build off one another and are equally important. You can promote your best recovery by pursuing both a rigorous home exercise program and also tending to your psychological well-being.
Also, talk to your therapist about the AIS Impairment Scale and keep a record of your progress in a recovery journal. While it can take many months or even years to “jump” up a level, many small milestones occur in between, and they deserve to be celebrated.