Preventing spinal cord injuries through safety education programs - Spinal Cord Injury, Part 3

American Rehabilitation,  Spring, 1997  by Pat O'Hare,  Karyl M. Hall

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"It was just a leisurely day...," "Didn't have a care in the world...," "I was a passenger...," "I didn't know what 55 meant...," "Dove into the water..., " "That was it, first and last time..." -- Words spoken by survivors of spinal cord injury as they try to describe the incident that changed their lives forever. These young adults are trying to make an impression through their candid conversations in the film, "Harm's Way," sponsored by the American Academy of Neurological Surgeons and Congress of Neurosurgeons. Their message? "Think First!" "Don't take foolish risks!" "Prevent the injury from happening!"

Injuries in general are beginning to get the recognition they deserve as serious health problems. Healthy People 20001, published in 1990, sets goals and priorities for health promotion, health protection, and preventive services. This comprehensive report states, "Spinal cord injuries are catastrophic health events resulting in enormous human and economic costs." The State of California, in recognizing the work done in the report, Recommendations for Research on Spinal Cord Injury in California, hag continued the effort at reducing spinal cord injuries (SCI) by making specific recommendations.[2,3]

Healthy People estimates of SCI in the United States range from 2.8 to 5 per 100,000 people. hi California, there may be as many as 35,000 people with SCI, With about 1,000 new injuries occurring each year.[2] Estimated lifetime costs for medical treatment and rehabilitation of SCI can be as much as $750,000 per individual. The economic costs are staggering. Depending on the method used to measure costs, estimates are approaching $200 billion per year.[3]

Background

The spinal cord is an extension of the brain, and sends electrical impulses to and from the brain. The brain controls movement, sensation and bodily functions. A spinal cord injury (SCI) is paralysis, to a greater or lesser extent, as a result of damage to the spinal cord. The cord is protected by 33 vertebrae. The vertebrae are generally grouped into four sections: cervical, thoracic, lumbar, and sacral (illustration). Depending on the level of injury, the paralysis is described as tetraplegia (or quadriplegia), referring to all four extremities affected, and paraplegia, referring to paralysis from approximately the waist down. There is no known cure for an SCI, and the results of the injury are considered permanent.

SCI can occur in a number of ways, but we will focus on traumatic injuries, that is, those injuries caused by an external force. The population most at risk for SCI are young males, 15 to 25 years of age. The most frequent cause of injury is motor vehicle crashes (including motorcyle), followed by falls and sports. A most alarming trend, however, is the increased incidence of injury because of violence/violent behavior.

The multiple consequences of SCI -- including permanence of injury, risk to our youth, and economic impact -- demand that we use every means at our disposal to prevent the injury from occurring.

Types of Prevention

There are several ways to categorize prevention efforts: primary, secondary, and tertiary prevention.

Primary prevention seeks to "reduce susceptibility, eliminating or minimizing behaviors and environmental factors that increase the risk of injury."[3] Environmental, legislative, and educational activities are examples of prima prevention.

Secondary prevention is the effort aimed at reducing or halting the progression of the disabling condition after the initial injury has occurred (i.e., specialized emergency medical services for those who sustain an SCI).

Tertiary prevention refers to preventing or limiting conditions associated with the SCI such as decubitus ulcers (pressure sores), and contractions. Secondary and tertiary levels of prevention work in concert to prevent the disabling condition from becoming a handicap.

Primary Prevention

A number of agencies, institutions, and organizations have worked to form strategic plans to address injury prevention. The three broad approaches for injury prevention programs are:

* Environmental Modification. Engineering has addressed the need for passive intervention in prevention -- the installation of air bags in passenger vehicles, shock absorbent guardrails on the highways, improved lighting -- all of which contribute to making our environment safer.

* Legislation that requires change in behaviors. Several laws have been passed in California which require helmet use on motorcycles, more stringent guidelines on child occupant seats, mandatory helmet use for bicyclists under the age of 18, and lowering of blood alcohol content required to qualify driving under the influence (DUI).

* Education of persons at risk for injury. These programs are designed to give information about the types of injury, how these injuries occur, what people can do to minimize risks, and why it is worth their effort to do so.

The rehabilitation professional is most often able to influence the reduction of injuries through education. In order to make a significant change in an individual's behaviors, he/she must first be aware of the problem. Santa Clara Valley Medical Center (SCVMC), together with the Traumatic Brain Injury (TBI) and SCI Model Systems (programs funded by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education) support an educational program to middle and high school students. The Safety Education Program at SCVMC has reached more than 82,500 people, including those in several special programs supported specifically by law enforcement agencies in Santa Clara County.