Spinal Cord Injuries and the Law

What is a spinal cord injury?

A spinal cord injury is essentially damage of the spinal cord that causes changes in its function, either temporary or permanent. These personal injury changes translate into loss of muscle function, sensation, or autonomic function in parts of the body served by the spinal cord below the level of the lesion. Spinal injuries include fractures, contusions, and compressions of the vertebral column. These injuries usually result from trauma to the head or neck, typically caused by :

• car accidents
• motorcycle accidents
• slip and falls
• trucking accidents
• pedestrian accidents and
• bicycle accidents

The real danger lies in complications such as spinal cord damage arising from a spinal injury. Spinal fractures most commonly occur at C5, C6, and C7, T12 and L1.

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Classifications of Spinal Cord Injuries

Complete Spinal Cord Injury – in most cases, means the loss of sensation and motor ability associated with a complete spinal cord injury caused by caused by bruising, loss of blood to the spinal cord or pressure on the spinal cord, cut the severed spinal cord are rare. Generally, complete spinal cord injuries results on total loss of the sensation and movement below the site of the injury.

Incomplete Spinal Cord Injury – does not result in complete loss of movement and sensation below the injury site. Incomplete spinal cord injuries can be sub-classified into a variety of patterns such as:

• Anterior cord Syndrome – result from damage to the motor and sensory pathways in the anterior areas of the spinal cord. Effects include loss of movement and overall sensation although some sensations that travel by way of the still intact pathways can be felt.
• Central Cord Syndrome – results from injury to the center of the cervical area of the spinal cord. The damage affects the corticospinal tract, which is responsible for carrying signals between the brain and spinal cord to control movement. Patients of central cord syndrome experience weakness or paralysis in the arms and some loss of sensory reception. The loss of strength and sensation is much less in the legs than in the arms. Many patients with central cord syndrome spontaneously recover motor function and others experience considerable recovery in the first six weeks following the injury.
• Brown-Squad Syndrome – result from injury to the right or left side of the spinal cord. On the side of the body where the injury occurred movement and sensation are lost below the level of injury. On the side opposite the injury, temperature and pain sensation are lost6 due to the crossing of these pathways in the spinal cord.
• Injuries to individual nerve cells – result in loss of sensory and motor function in the area of the body to which the injured nerve root corresponds.
• Spinal Contusions – the most common type of spinal cord injury. The spinal cord is bruised, not severed, but the consequences in inflammation and bleeding from blood vessels near the injury. A spinal contusion result in temporary (usually 1 to 2 days) incomplete or complete debilitation of the spinal cord.

Paraplegia – meaning paralysis of the lower body as result of a person suffering a spinal cord injury at the thoracic level or below.

Tetraplegia (formerly called quadriplegia) – which can result in a partial or total sensory and motor loss of the four limbs and torso or the paralysis of all four extremities. The injuries that occur above level C4 often result in respiratory deficiency.

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What are some Spinal Cord Injury Risk factors?

• Age – people aged 18–35 are more likely to sustain spinal cord injuries from car or motorcycle accidents, and the elderly aged  65 and above are more likely to become injured in falls.
• Gender– males are more at risk of developing SCI due to having more strenuous activities than females.
• Alcohol and drug use – alcohol can damage nerve function when it accumulates inside the body. Heavy alcohol intake for extended periods of time can lead to alcoholic neuropathy, a serious form of nerve damage.
• Athletes – gymnasts, skiers, hockey players, divers, and surfers are at increased risk. Diving into too-shallow water or playing sports without wearing the proper safety gear or taking proper precautions can lead to spinal cord injuries. 
• Having a bone or joint disorder – people with diseases that affect the bones and joints are also more susceptible to spinal cord injuries.

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What are most Common Causes of Spinal Cord Injures?

Traumatic Spinal Cord Injuries       

Traumatic spinal cord injuries in Canada are often caused by:   

• Traumatic spinal cord injuries are the most frequent cause of adult SCI in Canada
• Result from:
• Motor vehicle accidents,
• Falls
• Gunshot wounds

Non-traumatic Spinal Cord Injuries

• In Canada, approximately 30% of all SCI result from diseases or pathological influence such as cancer, arthritis, osteoporosis and inflammation of the spinal cord – which can also can cause spinal cord injuries.
• Vertebral subluxations due to Rheumatoid Arthritis or Degenerative Joint Disease
• Infections
• Multiple Sclerosis (MS) – spinal cord plaques (patches of myelin loss) due to MS in the neck (cervical) region can cause cape like sensation loss in both shoulders and in the upper arms. Quadriplegia is the great danger in cervical region MS. Anesthesia in a band like distribution around the trunk can be experienced in MS patients with mid spinal cord inflammation. Such patients may become paraplegic.
• ALS – which is a rare group of neurological diseases that mainly involve the nerve cells (neurons) responsible for controlling voluntary muscle movement. Voluntary muscles produce movements like chewing, walking, breathing and talking. The disease is progressive, meaning the symptoms get worse over time. Currently, there is no cure for ALS and no effective treatment to halt, or reverse, the progression of the disease. ALS belongs to a wider group of disorders known as motor neuron diseases, which are caused by gradual deterioration (degeneration) and death of motor neurons. Motor neurons are nerve cells that extend from the brain to the spinal cord and to muscles throughout the body. These motor neurons initiate and provide vital communication links between the brain and the voluntary muscles.  Messages from motor neurons in the brain (called upper motor neurons) are transmitted to motor neurons in the spinal cord and to motor nuclei of brain (called lower motor neurons) and from the spinal cord and motor nuclei of brain to a particular muscle or muscles.

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What are some Signs and Symptoms of a Spinal Cord Injury?

Symptoms vary somewhat depending on the location of the injury. Spinal cord injury causes weakness and sensory loss at and below the point of the injury. The severity of symptoms depends on the whether the entire cord is severely injured (complete) or only partially injured (incomplete).

Cervical (Neck) Injuries

When Spinal Cord Injuries occur in the neck area, symptoms can affect the arms, legs and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can include:

• breathing difficulties (from paralysis of the breathing muscles, if the injury is higher up in the neck)
• loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
• numbness
• sensory changes
• spasticity (increased muscle tone)
• pain

Thoracic (Chest level) Spinal Cord Injuries

• loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
• numbness
• sensory changes
• spasticity (increased muscle tone)
• pain
• weakness, paralysis

Lumbosacral (Lower Back) Spinal Cord Injuries

When spinal injuries occur at the lower back level, varying degrees of symptoms can affect one or both legs as well as the muscles that control the bowel and bladder:

• numbness
• sensory changes
• spasticity (increased muscle tone)
• pain
• weakness, paralysis

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What are come Complications of Spinal Cord Injuries?

Autonomic Dysreflexia – is a condition that occurs when a stimulus (e.g., blocked catheter, skin irritation) below the injury site triggers a message to the brain that cannot be received. This causes a reflex that constricts blood vessels and results in a reduced heart rate and high blood pressure. Autonomic dysreflexia increases the risk for stroke and rarely, seizures. Sometimes this condition can be resolved if the patient changes position or the stimulus is removed.Pubmed tells us that it is a very dangerous complication occurring in patients with lesions above T6. Also known as autonomic hyperreflexia, autonomic dysreflexia is a serious medical condition that occur after resolution of spinal shock. Emergency recognition and management is a must. Suspect autonomic dysreflexia in the patient with a history of spinal cord trauma at level T6 and above who exhibits cold or goose-fleshed skin below the lesion level, bradycardia, and hypertension. The hypertension is generally accompanied by severe, pounding headache.

Common symptoms of autonomic dysreflexia include a high BP, severe HA, blurred vision, stuffy nose, profuse sweating, goose bumps below & vasodilation (flushing) above the level of the injury. Common causes of autonomic dysreflexia are distended or full bladder, kink or blockage in the catheter, bladder infection, pressure ulcer, extreme temperature change and tight clothing.

Orthostatic Hypotension – is a particular common problem for patient with lesions above T7. In some patients with tetraplegia, even slight elevations of the head can result in dramatic decreases in blood pressure. Close monitor of vital signs before and during position changes. Activity should be planned in advance, and adequate time should be allowed for a slow progressive of position changes from recumbent to sitting and upright.

Spinal Shock – is the loss of autonomic, reflex, motor and sensory activity below the level of the cord lesion. It occurs secondary to damage of the spinal cord. Signs of spinal shock include flaccid paralysis, loss of deep tendon and perianal reflexes, and kiss of motor and sensory function. Until spinal shock has resolved (usually 1 to 6 weeks after injury), the extent of the actual cord damage can’t be assessed. The earliest indicator of spinal shock resolution is the return of reflex activity.

Neurogenic Shock – is a temporary loss of autonomic function below the level of injury that produces cardiovascular changes. Signs include orthostatic hypotension, bradycardia and loss of ability to sweat below the level of the lesion. This abnormal vasomotor response occurs secondary to disruption of sympathetic impulses from the brain stem to the thoracolumbar area and is seen most commonly in cervical cord injury.

Pneumonia and Asthma – are common long-term complications because muscles associated with breathing usually are weakened. Breathing assistance may be necessary if the nerves to the diaphragm are damaged. Medications may be used to regulate breathing issues and patients are encouraged to get an annual flu shot. The heart rate can slow down considerably, or increase to an alarming level following spinal cord injury. This may cause heart problems and low blood pressure that may require intravenous blood infusions.

Blood clots – these are of particular concern for spinal cord injury patients, as immobility reduces blood flow through the veins. Patients often are prescribed medications to prevent clotting.

Pressure Sores – when a patient has been sitting or lying in the same position for a long time, pressure on the skin can cause the tissue to deteriorate resulting in pressure sores (also called bedsores). If feeling has been lost in certain parts of the body, the patient may not even be aware of these sores. Patients who develop pressure sores should change positions frequently, should take measures to maintain healthy skin, and should follow a balanced diet. Patients or caregivers also should inspect all areas of the skin carefully for cuts and sores.Neurogenic pain (i.e. pain that originates from nervous tissue) and burning and stinging sensations are common and may even occur in limbs that no longer have movement or feeling. Using other parts of the body to compensate for paralyzed limbs (e.g., using the arms to move a wheelchair) can also cause pain. Treatment includes medications, acupuncture, surgery, and spinal or brain electrical stimulation.

Spasms are reflexes that cause uncontrolled limb movement. Spasticity is a term used to describe spasms of increased tone. These conditions occur when nerves in the spinal cord are affected by the injury and the brain and nerves can no longer communicate and control the movements. Medical treatments are available to help reduce spasticity. In some cases, spasms are actually beneficial, as they can improve muscle tone in the affected areas and allow some patients a little stability of the limb, which can improve mobility.

Urinary problems (e.g., urinary tract infection [UTI], kidney infection) and bowel difficulties occur when the nerves controlling these functions are damaged. The brain and body can no longer coordinate and the bladder and bowel may eliminate uncontrollably. Drinking plenty of water and incorporating more fiber into the diet can sometimes help both of these problems. In some cases, catheters and medications also are used.

Sexual dysfunction and fertility problems – spinal cord injuries often result in sexual dysfunction and fertility problems. Typically, these problems affect men more often than women. Doctors can prescribe medication and other treatments to increase fertility. In many cases, spinal cord injury does not affect a woman’s fertility; however, pregnancy is considered high risk and should be considered only under the care of a qualified health care provider. For both men and women, specialists can provide advice for intimacy.

Weight loss or gain can also occur, since spinal cord injuries affect diet as well as the patient’s ability to exercise. Physical therapists and nutritionists can help patients maintain healthy habits through exercise and diet.

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Spinal Cord Injury Compensation in Ontario

If you are a loved one has suffered a spinal cord injury in a motor vehicle accident, then there are two routes of recovery. The first is through no-fault benefits and the second is through pursuing litigation against the negligent driver the cause your injuries.

The no-fault accident benefits schedule sets out the details of various benefits available in the Ontario accident benefits regime, as well as how to apply for them. No-fault benefits in Ontario are terribly complicated – but in quick summary, a spinal cord injury victim is entitled to a maximum of $1 million over his or her life for medical, rehabilitation and attendant care benefits.

Medical and rehabilitation benefits are the most common types of all benefits available to motor vehicle accident victims under the no-fault regime. These benefits are what would typically fund such items as:

• physical rehabilitation
• psychological rehabilitation
• vocational evaluation therapy
• transitional living therapy
• equipment such as wheelchairs, batteries, chargers, cushions etc.
• orthotics
• beds, power beds, maintenance, no turn air mattresses, hoyer lift ect
• medication (routine pharmaceuticals and over-the-counter pharmaceuticals)
• portable ramps
• adaptive clothing
• supplies for ADLs and bowel and bladder care
• skin supplies
• skin inspection and more

Attendant care benefits allow claimants to be reimbursed for expenses related to hiring an aide or attendant to help them with their day-to-day functions. These functions include help with dressing and personal grooming, bathing, cooking and feeding, and getting around. Attendant care also includes paying for a stay in a long-term health facility or home, if not covered by the Ontario Health Insurance Plan (OHIP). Attendant care benefits pay up to $6000.00 a month for incurred expenses of professional attendance. Non-professional attendance can only be compensated for the amount of income the person has given up in order to care for the claimant, if any.

Other no-fault benefits available to spinal cord injury victims include transportation costs, case management services, housekeeping and home maintenance benefits (to pay for hiring someone to clean and otherwise maintain the home and are only available to catastrophically injured claimants), income replacement benefits (or non-earner benefits), visitor expenses, lost educational expenses and other miscellaneous expenses.

If the claimant is purchased optional benefits. Then that claimant may be entitled to an additional $1 million for medical, rehabilitation and attendant care benefits including assessment costs.

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Filing a Legal Claim against those Responsible

If you have suffered a traumatic spinal cord injury you will also have the option to pursue damages or compensation against the person(s) insurance company that caused your injuries. Typically, most insurance policies in Ontario carry $1 million in third-party limits – meaning that no matter what your lifecare plan may estimate that you to require in terms of needs over your lifetime, there may only be $1 million available – at maximum – to claim against the at-fault driver. In some cases there may be $2 million available in third-party limits. In trucking cases, there is typically 5 million to 10 million available in third-party limits.

Compensation that would be claimed would include damages for pain and suffering, loss of enjoyment of life, loss of amenities, loss of interdependent relationship, past loss of income, future loss of income, future health care expenses (over and above the 1 million in no-fault benefits) housekeeping and home maintenance benefits as well as management fees to assist with your money.

Unfortunately in Ontario, there is never enough compensation to assist a spinal cord injury victim over his or her life. In our experience, depending on the level of injury (where the lesion lies – in the type of spinal cord injury) as well as the age of the victim, damages could range anywhere from $5 million to $15 million over a person’s lifetime. Sadly – even in the worst of crashes, there is never enough money.

In order to protect your needs as best we can, our personal injury lawyers would work with a structured settlement company in order to invest your awarded compensation into a stream of tax-free payments paid out over your life, rather than a one-time lump sum payment which can be eroded quite quickly.

Structured settlements are guaranteed tax-free annuities which allow the claimant or injured victims to better budget monthly. Structured settlements can be tailored to the needs of an individual and to the amount awarded to that particular injured individual.

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Have you suffered a spinal cord injury?

Matt Lalande has been representing spinal cord injury victim since 2003. He has written extensively about spinal cord injuries and spinal cord injury Law over the past near 20 years – and is recovered millions of dollars for spinal cord injury victims across Ontario.

Our Hamilton spinal cord injury lawyers will get the justice that you deserve and ensure that you are protected as best could be, over your life. Our personal injury lawyers work with the best experts, the best accountants, economic valuators, occupational therapists and life-care planners. We can assist with hiring the right OT for you, help with your discharge home, help make sure that modifications are in place and that you are fully accommodated and as comfortable as can be upon your return. Then, we would ensure that your insurance benefits are fully put into place, a full-time case manager is assigned to your case and a life care valuation is completed and support of your damages.

Call us today not matter where you are in Ontario, at 1-844-LALANDE or local in the Burlington/Hamilton/Niagara areas at 905-333-8888 today. Alternatively, you can send us a confidential email through our website and we will get right back to you.

We are here to help 24/7 and our consultations are 100% FREE.

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LALANDE PERSONAL INJURY LAWYERS  – HAMILTON OFFICE
1 King Street East, Suite 1705
Hamilton, On L8P 1A4
Local: 905-333-8888
Toll Free: 1-844-LALANDE

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Thank you to pubmed, Spinal Cord Injuries: Management And Rehabilitation (Peter Ponce), Spinal Cord Injury Pain (Christine Sang Claire Hulsebosch) and well as the following websites:

https://www.tasanet.com/Knowledge-Center/Articles/ArtMID/477/ArticleID/1251816/Life-Care-Planning-For-Spinal-Cord-Injurieshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419658/
https://sci-can.ca/
https://pubmed.ncbi.nlm.nih.gov/22555590/