Spinal cord injury, or SCI, is a term used to describe damage to the nerves that send and receive messages from the body to the brain. The spinal cord runs from the top of the neck to the low back and is surrounded by bones called vertebrae.

An SCI can occur because of damage directly to the nerves or bones and tissue surrounding the spinal cord. SCIs vary greatly in severity and from one person to another. Causes include injury, illness, or the presence of tumors. Some children are born with SCIs.

In the United States, spinal cord injury is estimated to occur in 1.99 per 100,000 children each year. Teens make up more than 95% of the yearly cases. SCI is four times more likely to occur in adolescent males than in females.

Those experiencing SCI may need specialized equipment to help them regain function and move more independently. Equipment might include wheelchairs, leg or trunk braces, or walkers and crutches. Physical therapists recommend equipment to help an adult return to daily activities and a child return to school and play as independently as possible.

Physical therapists partner with people with SCI to help them recover movement and function to the fullest extent possible. They train patients and caregivers regarding basic daily activities and movements. These activities include transfers (getting on and off the floor and getting in and out of the bed, shower, car, etc.), mobility (walking or using a wheelchair), and helping modify home or school environments for best accessibility and safety.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can see a physical therapist directly for evaluation and treatment without a physician’s referral.* To find a physical therapist in your area, visit Find a PT.

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*A referral may still be required by your insurance policy, corporate policies, or state practice laws (some states limit the type of treatment or number of visits without a referral).

On this page

• What Is a Pediatric Spinal Cord Injury?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is a Pediatric Spinal Cord Injury?

Pediatric spinal cord injury, or SCI, is damage or dysfunction that affects the nerves and nerve fibers of a child's spinal cord. Pediatric SCI can occur because of an injury, illness, or tumor, or from incomplete development in utero. Some children are born with the condition. This is called congenital SCI and includes a condition commonly known as spina bifida, also called myelomeningocele , which occurs in about 1,400 babies born in the U.S. annually.

SCI may affect how a child moves, goes to the bathroom, and breathes. It may change the way a child interacts with their environment and participates in daily activities. It can affect movement, strength, feeling, and body functions below the affected spine area. Damage to the spinal cord may remain the same, progress, or reoccur and have temporary or permanent effects. This depends on the cause of injury or dysfunction.

The spinal cord runs the length of the spine. It is protected by the bones that make up the spine, called vertebrae. The spine is divided into three segments. Each segment has a specific number of vertebrae. Nerve roots (bundles) travel in and out from the spinal cord between the vertebrae.

• Cervical: 7 bones with nerve roots classified as C1-C8.
• Thoracic: 12 bones with nerve roots T1-T12.
• Lumbar: 5 bones with nerve roots L1-L5.

These nerves are responsible for our movements, feeling, strength, and position in space at each area of the body. The location of the spinal cord damage helps predict what areas and functions will be involved.

SCIs are classified or named by the spinal cord level where the injury occurs, whether any nerve signals can pass across the damaged area, and the level where full strength and sensation are still present. The American Spinal Injury Association International Standards for Neurological Classification of SCI can help classify the type of SCI your child has experienced. Results may not be accurate until the child is 10 years old.

After determining the level of injury, further classifications of SCI include:

• Tetraplegia: The injury involves the arms, trunk, and legs.
• Paraplegia: The injury Involves the legs and may affect the trunk.
• Complete: There is no motor or sensory function below the injured level of the SCI. This means signals are not getting to or from the brain below the level of injury.
• Incomplete: There are some motor and/or sensory functions below the injured level of the SCI. This indicates that some signals can pass back and forth from that body level to the brain.

SCIs are also identified by their cause:

• Traumatic: This type of SCI is caused by a single event, such as:
  • Car accidents.
  • Violence.
  • Sports injuries.
  • Falls.
• Non-traumatic: This type of SCI is caused by gradual damage to the spinal cord over time from conditions such as:
  • Spinal cord tumor.
  • Spinal defects present at birth.
  • Infections or illness.
  • Spina bifida.
  • Swelling of the spinal cord, or transverse myelitis.
  • Acute flaccid myelitis, a spinal cord condition.
  • Guillain-Barre syndrome, an autoimmune disorder.

Signs and Symptoms

Spinal cord injuries have different signs and symptoms depending on the area of the spinal cord that is affected. SCI that occurs closer to the head affects more of the body and body systems. Injuries that occur lower in the back affect the lower part of the body and body functions. Depending on your child's level of injury, they may experience some or all of these signs and symptoms, as well as ones not included on this list:

• Difficulty breathing. May require support for breathing.
• Inability to regulate body temperature. May easily overheat or get too cold.
• Weakness. Muscles get smaller from not being used, known as atrophy.
• Paralysis. Movement is lost in parts of the body.
• Numbness, tingling, or loss of sensation. Changes occur in the ability to feel hot, cold, touch, or pain.
• Difficulty going to the bathroom. May be unable to urinate or have a bowel movement, or may have accidents.
• Muscle spasms. May have tight muscles or involuntary limb movements.
• Pain. May experience pain from muscle spasms or the injury, if one occurred. There may be areas on the skin with increased sensitivity that may be painful to the touch.

How Is It Diagnosed?

SCI is diagnosed by a physician. The process of diagnosis depends on the cause of the injury. Diagnostic tests, like CT scans, X-rays, and MRI, may be ordered by a physician or, in some cases, a physical therapist. These imaging tests help identify damage to the nerves of the spinal cord, the surrounding tissues, and bones.

Congenital SCI, like spina bifida, is often diagnosed before or right after the child is born.

Traumatic SCI can be diagnosed by a clinical exam or medical assessment. The exam is typically performed by a physician, physical therapist, or occupational therapist who will:

• Assess your child’s strength in key muscle groups.
• Test your child's ability to feel light touch and pinprick sensations across different body areas.

Non-traumatic SCI may be diagnosed when seeking medical attention for other changes in your child such as:

• Onset of muscle weakness and/or rapid progression of weakness.
• Inability to move or to walk.
• Changes in the ability to go to the bathroom.
• Changes in muscle tone, tested by measuring muscle tension at rest.

Pediatric spinal cord injuries are typically diagnosed in a hospital setting. Once SCI is diagnosed, your medical team will consult physical and occupational therapy professionals. In the hospital, your physical therapist will perform a full evaluation to assess your child's injury and its impact on motor function.

In the hospital/acute rehabilitation setting, the goals of physical therapy are to help restore function, provide caregiver education, and identify equipment to allow your child to safely leave the hospital and return home. The physical therapist will ask you questions about your child's development, the setup of your home, and activities your child likes.

Following release from the hospital, your child will continue a physical therapy program in outpatient, home health or early intervention, and/or school settings. The physical therapist may ask you:

• What is your child having trouble doing?
• What kind of equipment or home modifications do you have?
• What activities would your child like to return to?
• How is your child staying active?

Your child's physical therapist will conduct a physical exam, which may include:

• Hands-on assessment of the child's strength, flexibility, and muscle tone.
• Functional mobility assessment, such as transfers, moving in bed, and walking.
• Assessment of skin health in areas that are at risk for pressure injuries.
• Observation of the child's movement abilities in various positions.
• Balance assessment while sitting and standing, if appropriate.
• Assessment of bracing and other assistive equipment, if appropriate.

How Can a Physical Therapist Help?

Physical therapy for a pediatric SCI may take place in different settings. It starts in the hospital and progresses to home, outpatient, and school-based physical therapy. Each setting will have specific types of physical therapy goals; some goals may overlap. Your physical therapist will work with you and your child to identify what is important for them to be able to do. Treatment will be based on your child's type and level of injury and goals. Activities that include weight bearing, active use of the arms and legs, and task-specific strengthening have been shown to help with recovery after SCI. These activities can also help to decrease the risks and effects of living with SCI, promote fitness, and improve quality of life.

Your physical therapist will use the best available evidence to develop a treatment program for your child's specific needs, challenges, and goals living with SCI. They will work with you and your child to:

• Maintain flexibility of muscles and joints to avoid the onset of or decrease the risk of conditions such as:
• Scoliosis.
• Contractures, a permanent tightening of muscles, tendons, or ligaments that limits movement of a joint or body part.
• Restore function.
• Identify equipment needs.
• Promote standing/weight bearing for bone health.
• Explore new movement patterns that may help improve mobility or prevent injuries such as fractures or sprains.
• Address fitness and alternative ways to stay active and healthy.
• Promote independence with preferred and other mobility-related activities of daily living.

Physical therapy is involved in each stage of a child's recovery and development after SCI. It helps restore function, build strength, and identify equipment to help your child participate in age-appropriate activities. As children with SCI grow and develop, their needs and goals for physical therapy change. Patient care is tailored to the different needs and goals of the individual child. Physical therapy may occur in the hospital, home, clinic, and/or school setting during the various stages of development and recovery. Your physical therapist partners with you and your child to help them reach and maintain the highest level of daily activities possible in every setting.

Physical therapy for young children with SCI focuses on:

• Caregiver education.
• Mobility/exploring different environments.
• Developmental activities and motor milestones.
• Weight bearing for bone health.
• Positioning, strengthening, and stretching for play or daily activities.

Physical therapy for school-aged children adds focus on:

• Independently navigating the environment with assistance from equipment, if needed, such as:
  • Power wheelchair.
  • Manual wheelchair.
  • Walker.
  • Crutches.
  • Bracing or splinting.
• Independently performing transfers, including:
  • Moving between their wheelchair and bed.
  • Moving between their wheelchair and the floor.
  • Getting in and out of the car.
  • Getting in and out of the shower or bathtub.
  • Getting on and off the toilet.
• Performing weight shifts for pressure relief and skin checks with children who have impaired or absence of feeling below the area of their injury.
• Identifying participation activities for life-long health and fitness.

Physical therapy for teens and young adults focuses on:

• Independent navigation over long distances, such as:
  • Larger school campuses.
  • Work settings.
  • Social and community-based activities.
• Driving readiness:
  • How to get their wheelchair in and out of their vehicle independently.
  • How to use adaptive equipment for driving.
• Mobility skills required for independent living:
  • Bathing/toileting.
  • Transfers.
  • Ongoing assessments for new equipment
• Modifications to daily environments:
  • Ramps for access to home or care.
  • Equipment for bathing, dressing, meal preparation, and feeding.

Your physical therapist also will partner with other members of your health care team as needed to address any related problems, advancements, and your child's needs as they grow and adapt.

Your child’s physical therapy program may include:

Patient and family education. Your physical therapist will educate you and your child on how to perform transfers. They will teach you proper techniques and mechanics to prevent injury to you or your child. They will educate you on recommended equipment to ensure everyone is safe and comfortable using it.

Patient and family education will also focus on skin health. If your child will use a wheelchair, the physical therapist will teach you and your child how to perform weight shifts for pressure relief and skin checks. This is a critical skill for early detection and prevention of pressure injuries.

Manual therapy. Your physical therapist will provide manual (hands-on) therapy. They will help your child keep their muscles long and flexible. Muscles may become tight and short if your child is unable to move their limbs on their own after a SCI. The child will learn how to give cues to their body to help some muscles turn on and others relax.

Balance and gait training. Your physical therapist will work on sitting and standing balance with your child as appropriate. Balance is important in all the activities we do. It is crucial for independent mobility and walking. Balance training for your child will be specific to their needs and abilities.

Some children will be able to stand and walk depending on the level of their SCI. Training for walking may require different kinds of equipment and types of support to give your child the benefit of being upright and weight bearing through their lower body. Your physical therapy team will help your child move their legs in a walking pattern if they are unable to on their own This may be done in a harness over a treadmill. Being upright also will challenge the muscles used for head and trunk control, allow your child to practice familiar movements, and promote interaction for social participation.

Muscle strengthening. Muscles may be weak after SCI. Your physical therapist will work with your child on restoring strength to weakened muscles. They will work to help strong muscles get even stronger. This may help with transfers, driving a wheelchair, and assisting other body parts that are unable to move on their own.

Strengthening looks different depending on the age of your child. Strengthening may include lifting weights or pulling and pushing activities. It may be doing activities where your child supports their own weight or holds a certain position. Tasks tailored to your child's likes and age helps them stay actively engaged and get stronger.

Equipment and modifications. Your physical therapist may help choose and prescribe special equipment, often called DME or durable medical equipment, for use at home, school, or daily environments. Equipment can assist in mobility (bracing or wheelchairs), transfers (lifts or suspension supports), hygiene (bath or shower chairs), school or work tasks (supportive seats, modified switches or controls), or access (ramps, lifts).

If Surgery Is Needed

Sometimes, surgery is needed after SCI to take the pressure off the spinal cord or to help support and stabilize the spine. Depending on the type of surgery, your child's physical therapist will teach you how to safely move.

Can This Injury or Condition Be Prevented?

We are unable to prevent most SCIs. The effects of SCI are life-long and may affect other functions of the body as your child continues to grow and age. Physical therapists help educate and empower you and your child to reduce the impact of SCI on their health and well-being.

Physical therapists help to minimize the effects of some common problems that can occur after SCI. The following are examples that require monitoring and treatment:

• Overuse injuries.
• Pressure injuries.
• Scoliosis.
• Hip displacement.
• Contractures (muscle shortening).
• Low blood pressure.
• Pain.
• Bowel and bladder problems.
• Autonomic dysreflexia (a sudden, severe rise in blood pressure that requires immediate medical attention).

Partnering with your child’s physical therapist to create an individualized plan and to promote active participation in your child’s physical therapy program from the time of injury through adulthood may help your child avoid complications and maximize their activity and quality of life. There have been many advancements in treatment and technology that allow persons with SCI to be independent in their daily lives. Physical therapists are uniquely trained to help their patients and clients access these options.

What Kind of Physical Therapist Do I Need?

All physical therapists are trained through education and experience to evaluate, manage, and treat various symptoms and conditions. You may want to consider seeing a physical therapist who:

• Is experienced in treating pediatric or neurological conditions.
• Is a board-certified clinical specialist in pediatric or neurologic physical therapy, or who has completed a residency or fellowship in pediatrics or neurology. These physical therapists have advanced knowledge, experience, and skills that may apply to spinal cord injuries.
• Has a practice that focuses on neurorehabilitation or pediatrics.

You can find physical therapists in your area with these credentials and clinical expertise through Find a PT, provided by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the PT's experience treating spinal cord injuries before you make an appointment.
• Be prepared to describe your child's symptoms in as much detail as possible. Make a note of what makes your child's symptoms worse or better.

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Additional Resources

• National Institute of Neurological Disorders and Stroke - Spinal Cord Injury
• The Christopher and Dana Reeves Foundation
• SCIRE Community
• Spina Bifida Association