Friday 8:00 – 10:40
Spinal Cord Injury
Table of Contents
Information: Pages 3-5
Websites: Pages 6-9
Article Reviews: Pages 10-13
Organizations: Pages 14-17
Teaching Strategies: Pages 18-19
Activity Description: 20-21
A spinal cord injury can be defined as the disruption of communication between the brain
and additional sections of the body. The extent of trauma to the spinal cord is reliant on the
severity and location of the injury. Because messages no longer have the capacity to flow
beyond the damaged region, the end result is a loss of or impaired functioning which initiates a
decrease in mobility or sensation.
There are two categories of spinal cord injuries, complete and incomplete. The first type,
complete, signifies an injury in which there is no sensation or voluntary movement beneath the
damaged area of the spine. Characterized by limited functioning below the damaged spine, an
individual with an incomplete spinal cord injury may retain increased mobility in one limb rather
than the other or have feeling in areas of the body which have no movement.
Additionally, quadriplegia is a term used to describe the most severe spinal cord injury.
Quadriplegics injuries occur between the first cervical vertebrae down through the first thoracic
vertebrae, affecting all four limbs. Paraplegia, a less severe yet devastating injury, refers to the
state in which the lower limbs are primarily affected.
According to the National Spinal Cord Injury Association in 2003, ranked first among
major causes of spinal cord injuries was automobile accidents, accounting for forty-four percent.
Furthermore, twenty-four percent were caused by acts of violence; twenty-two percent were the
result of falls; eight percent were the result of athletic injuries; and the remaining two percent the
result of other accidents.
Other characteristics of individuals afflicted with a spinal cord injury include autonomic
dysreflexia, pressure sores, spasticity, difficulties with thermoregulation, and respiratory
complications. Autonomic dysreflexia occurs in individuals with an injury above the sixth
thoracic vertebrae. This complication initiates an increase in heart rate and blood pressure to
unsafe levels. Autonomic dysreflexia can be activated by numerous factors which include
expanding pressure from an overfull bladder or bowel, restrictive clothing, and pressure sores.
Left untreated, this condition may become life-threatening.
Decubitus ulcers, more commonly referred to as pressure sores, a condition from which
the late Christopher Reeve suffered, is characterized by a lack of blood supply to the tissue
beneath the skin. A person remaining in the same position for a prolonged period of time
triggers tissue breakdown. Because trauma to a person’s spinal cord prevents messages from
accessing the brain, a person is unable to feel the tenderness which would typically initiate a
change in position. Left unchecked or untreated, pressure sores can lead to infection,
amputation, and even death.
A third characteristic of individuals with spinal cord injuries is spasticity. This condition
is an involuntary exaggeration of normal reflexes when the body is stimulated in particular ways.
Triggering such spasms include stretching of muscles or irritation of some sort below the level of
Individuals with spinal cord injuries also experience difficulties with thermoregulation,
regulation of the body’s internal temperature in response to the external environment. Because
these individuals have lost the capability to sweat, their internal temperature quickly changes in
response to the temperature of the external environment. Without close watch, these individuals
may become overheated or even hypothermic.
Lastly, persons with spinal cord injuries often experience respiratory complications.
When a spinal cord injury affects the thorax, complications in normal breathing patterns become
the result. Because these muscles in the thoracic region are impacted as a result of the injury,
these individuals have difficulty coughing which predisposes them to a higher risk of acquiring
Kelly, L. E. (2005). Spinal cord disabilities. In J. P. Winnick (Ed.), Adapted physical education
and sport (pp. 275-305). Illinois: Champaign.
Paralyzed Veterans of America. (2006). Spinal Cord Injury. Retrieved December 1, 2006, from
Retrieved December 1, 2006
The first website which focuses on spinal cord injuries is PE Central. This website
provides a disability fact sheet specific to spinal cord injuries. This site first provides a
definition of the disability, and then continues with a comprehensive overview of the condition.
With headings and sub-headings, this website is constructed in an easily readable format so as to
quickly identify the pertinent information when searching for specifics.
PE Central provides general information regarding spinal cord injuries such as
characteristics, causes, etiology and prognosis, as well as possible complications associated with
the disease. More importantly, this website provides a great deal of information applicable to
teaching physical education to a student with a spinal cord injury through a chart with functional
goals specific to the level of a complete spinal cord injury, implications for physical education,
and recommended activities.
Towards the bottom of the website, PE central provides a list of references and resources
relevant to the topic. A colorful diagram of the vertebral column is the lone illustration on this
website. This illustration easily depicts the four sections of the vertebrae through the use of four
separate vibrant colors. In addition, it labels each vertebra and provides its function. For
example, T7 through T11 control the abdominal muscles.
The second half of this page provides significant information relative to teaching physical
education to a student with a spinal cord injury. Provided are suggestions for physical education,
including important safety considerations and the importance of exercise. Under recommended
activities, it offers a variety of aerobic exercises, strength training exercises, and flexibility
training exercises. Overall, this website as a whole is beneficial to persons wanting to gain an
understanding of a spinal cord injury and is specific to individuals with spinal cord injuries and
their participation in physical education.
Retrieved December 1, 2006
The second website, which similar to PE Central provides a disability information sheet
specific to spinal cord injury, is also a valuable electronic resource. Following the general
summary of what constitutes a spinal cord injury is a list of hyperlinked references. These
references pertain to spinal cord injury on a large scale. Additionally, listed at the bottom of the
website are several links to numerous sport associations, for example, National Wheelchair
Basketball Association, American Wheelchair Bowling Association, National Wheelchair
Softball Association, and many more.
Similar to PE Central, this website does not offer superfluous pictures or illustrations;
however, the few that are shown should be recognized. There are four illustrations scattered
throughout the website which are colorful cartoon representations of people participating in
various sports with the use of a wheelchair. One character is backhanding a tennis ball, another
participating in archery, another in basketball, and the last participating in road or long distance
racing. Although these may seem trivial, these illustrations portray the reality that people with
spinal cord injuries can too participate in the numerous physical activities with few
With regard to information useful in teaching physical education to a student with a
spinal cord injury, this webpage, and those directly linked are extremely useful. When scrolling
through the webpage, a section labeled “Adapted Sports and Recreation” is provided. Beneath
this section are several sports which offer techniques in modifying the sport in order for
individuals with spinal cord injuries to successfully partake in the excitement of these physical
activities. For example, a modification which allows quadriplegics to participate in table tennis
includes taping or strapping the paddle to the individual’s hand.
Although a variety of the sports do not provide modifications, hyperlinked directly under
the sub-heading are the association websites which correlate with the particular sport. Here an
individual is able to view the official rules of the chosen sport, which may conceivably initiate
one’s own ideas as to the way the sport can be modified or adapted to their own physical
education class. By and large, this website which focuses on spinal cord injury and sport is
As a result of reading “Spinal Cord Injury Patients Often Succumb to Bed Sores”
published in USA Today, three concepts were learned regarding the assigned disability of spinal
The first concept learned, Concept A, is the severity of the pressure sores, a secondary
complication affecting individuals with spinal cord injuries. Of the 250,000 people living in the
United States with spinal cord injuries, greater than one-third of these individuals develop
pressure sores. Moreover, 60,000 Americans, approximately eight percent of those with spinal
cord injuries, die per year from complications stemming from pressures sores. This statistic is
twice the amount of those who die from prostate cancer. Even for individuals who receive top
treatment, pressure sores can be difficult to prevent.
When the body presses on a vulnerable area and restricts blood supply, pressure sores are
initiated. Within hours, tissue can die. Sepsis, an infection developed when bacteria spreads to
the blood from an infected pressure sore, is fatal in at least half of the incidences.
The second concept learned, Concept B, is Christopher Reeve’s struggle with his spinal
cord injury. In October of 2004, the Man of Steel died at the age of 52 due to a system-wide
infection, the result of a pressure sore. The infection eventually led to heart failure and a coma.
Following his 1995 accident, Christopher Reeve fought numerous life-threatening difficulties
which included “bone fractures, pneumonia, blood clots, a collapsed lung, repeated
hospitalizations and dozens of infections, including an infected ankle that could have led to
In 1999, at Washington University in St. Louis, Reeve began an “activity-based
recovery” program. Assisting Reeve in exercising was a specialized bicycle and electrical
stimulation. As a result of Reeve’s three years of rehabilitation, his muscles strengthened, his
osteoporosis disappeared, and the incidence of infection decreased by ninety percent.
Christopher Reeve, a quadriplegic, regained feeling in a majority of his body and recovered
minimal use of his extremities.
The last concept learned, Concept C, is risk reducers and important advances with regard
to pressure sores. While pressure sores cannot be prevented, proper nutrition and diets with
sufficient protein are said to lessen one’s risk for developing pressure sores. Furthermore,
shifting a person’s weight when seated in a wheelchair will release pressure in areas susceptible
to pressure sores.
Important gains are said to have been made relating to spinal cord injury. Urinary tract
infections resulting in kidney failure and death are now rare. Steroid injections can decrease
damage following spinal cord injuries. Lastly, hospitals are moving forward in preventing
deaths from sepsis.
Szabo, L. (2004, October 24). Spinal cord injury patients often succumb to bed sores. USA
As a result of reading “Quad Rugby: A Strength and Conditioning Program for the Elite
Athlete,” published in Strength and Conditioning Journal in August of this year, three concepts
were learned regarding the assigned disability of spinal cord injury.
The first concept learned, Concept A, is the popularity of disabled sports, more
specifically quad rugby, and an understanding of the concept behind this wheelchair sport. Three
Canadians originated quad rugby, also referred to as wheelchair rugby, or murderball. In 1981,
quad rugby came to the United States. Developed to endorse and standardize the sport, was the
United States Quad Rugby Association in 1988. Quad rugby is characterized as being the fastest
growing wheelchair sport, and is an international event.
In order to be eligible for participation in quad rugby, individuals must have a mixture of
both upper and lower extremity injury. Participants are organized into one of seven categories
and given a specified number of points depending on the severity of their impairment. Four
players are allowed on the playing court at once, with a maximum of eight points. Quad rugby is
performed on a basketball court, with players scoring by passing or carrying the ball across the
end line. Depending on one’s physical limitations, a selection of methods are used to pass the
ball, which are comprised of the one handed pass, two handed pass, or punching at the ball.
Players use their wheelchairs on defense to obstruct opponents and collide into them in an effort
to free the ball.
The second concept learned, Concept B, is the astounding level at which quad rugby is
played. As a result of escalating competition, the physical stresses placed on quad rugby
participants have been lifted to a new level. The objective of preseason training is to improve
one’s overall strength and conditioning. This can be achieved through flexibility, strengthening,
plyometrics, and endurance training. Preseason training includes a five-day schedule with the
remaining two days off for recovery purposes. The training schedule includes three strength
sessions, and two plyometrics and cardiovascular sessions per week.
In-season training for quad rugby varies from the off-season with focus shifting from
conditioning towards technical skill. In-season training, similar to the preseason, includes a five-
day schedule with the remaining two days off for recovery purposes. In relation to preseason,
there is one less strength-training session with the addition of three skills sessions per week.
The third concept learned, Concept C, is the needs of athletes with spinal cord injuries are
met with the execution of the same fundamental concepts as exercised by able-bodied athletes.
This exercise program is intended to increase flexibility, strength, and endurance of a quad rugby
participant who endures a spinal cord injury. However, after perusal of the article and the
descriptions of countless exercises, noticeable was the similarity between the exercises
performed by quad rugby athletes and those learned in Kinesiology intended for able-bodied
Gulick, D., Berge, B., Borger, A., Edwards, J., Rigterink, J. (2006). Quad rugby: A strength and
conditioning program for the elite athlete. Strength and Conditioning Journal, 28, 10-18.
Paralyzed Veterans of America
801 Eighteenth Street, NW
Washington, DC 20006-3517
The first organization which focuses on spinal cord injury is Paralyzed Veterans of
America. The purpose of this organization is to capitalize on the value of life for members and
all individuals affected with a spinal cord injury. Paralyzed Veterans of America is a primary
promoter for health care, research and instruction, veterans’ benefits and rights, accessibility and
the elimination of architectural obstacles, sports programs, and disability rights.
More specifically, Paralyzed Veterans of America presents each year the National
Veterans Wheelchair Games, the world’s largest annual wheelchair sports competition. It is
here, throughout the week, where more than five hundred veterans, athletes with novice and
experienced abilities, recognize their capabilities and potential while taking pleasure in the spirit
of healthy activity and camaraderie.
The 27th National Veterans Wheelchair Games will take place in June, 2007 in
Milwaukee, Wisconsin. Contestants will participate in a variety of games, all of which include:
9-ball, air guns, archery, basketball, bowling, handcycling, motorized wheelchair rally, power
soccer, power 220, powerchair relay, quad rugby, softball, swimming, table tennis, track and
field, weightlifting, and wheelchair slalom.
The purpose of the National Veterans Wheelchair Games is to provide veterans with
benefits to the mind, body, and spirit. Paralyzed Veterans of America is committed to
encouraging veterans to become aware of their aptitude, fostering better health through sports
competition, and revitalizing the spirit of competition. Since the annual National Veterans
Wheelchair Games began in 1981, thousands of veterans affected by spinal cord injuries have
benefited from their participation in sports.
The National Spinal Cord Injury Association
6701 Democracy Boulevard
Bethesda, MD 20817
The second organization which focuses on spinal cord injury is The National Spinal Cord
Injury Association, NSCIA. As the nation’s oldest and largest civilian association, it is devoted
to improving the excellence of life for thousands of Americans affected by spinal cord injuries,
as well as their families. Founded in 1948, the NSCIA answers thousands of calls and e-mails
and provides information and referrals to individuals; provides peer assistance programs across
the country, connecting people with spinal cord injuries to one another; publishes and distributes
SCI Life magazine; works with partners to prevent violently acquired spinal cord injury; and
supports lawmaking proposals concerning issues affecting individuals with spinal cord injury.
The National Spinal Cord Injury Associations mission is the following:
“Enable people with spinal cord injury and disease to achieve their highest level
of independence, health, and personal fulfillment by providing resources,
services, and peer support.”
The National Spinal Cord Injury Association offers an A-Z resource center. Found here
are virtually all subjects with any correlation to spinal cord injuries. Furthermore, there are lists
of fact sheets which provide additional information, statistics, and frequently asked questions.
Besides the national level, the National Spinal Cord Injury Association has regional affiliate
chapters as well as local resources. Lastly, NSCIA devised a discussion forum for people with
spinal cord injuries. At the NSCIA community forum, people are able to discuss a broad range
of topics with others encountering similar experiences, to name a few: mobility equipment,
rehabilitation, sexuality and spinal cord injury, financial planning and new injuries. The
discussions are endless, and members can even create new forums. The National Spinal Cord
Injury Association is a remarkable organization which provides over a million individuals who
are affected by spinal cord injuries, their families and friends, medical, scientific, community
service and business professionals, the media, students, government, elected officials, and the
public with comprehensive information and resources to meet their needs.
To maximize the potential of a student who suffers from a spinal cord injury, teaching
strategies allow for successful participation in planned activities, ending in a positive learning
experience for all individuals.
One appropriate teaching strategy for individuals with spinal cord injuries is modifying
the environment. Some changes to the environment applicable to individuals with spinal cord
injuries include reducing the dimensions of the playing field by means of decreasing boundaries.
Another adaptation of the environment is perhaps changing the surface of the playing area.
Because the majority of students with spinal cord injuries are dependent on wheelchairs as means
of locomotion, these modifications help to equalize the playing field, thus allowing an individual
a greater chance for success.
Equipment adaptations are another appropriate teaching strategy when educating students
with spinal cord injuries. Equipment modifications include changes in size, length, weight, and
texture, as well as using specialized equipment. Introduction of lighter equipment for individuals
with spinal cord injuries may be extremely beneficial for the reason being that these individuals
may be deficient in strength of the lower extremities especially, the area responsible for the
majority of a person’s force. Specialized equipment includes any additional equipment used to
guarantee success, for example bumpers in bowling. Equipment adaptations decrease an
individual’s chance of injury, as well as increase their chance for success.
A third teaching strategy suitable for instructing students with spinal cord injuries
incorporates peers as tutors. Because the physical educator’s attention is focused on the class in
its entirety, peer tutors provide continuous feedback on a one-on-one basis which many benefit
individuals with disabilities. Additionally, this teaching strategy increases socialization which is
imperative for all individuals, especially those individuals who are not a part of any social
Modifying basic rules of activities is fitting when teaching students with spinal cord
injuries. Because these students may not be as physically fit as others within the class, these
individuals may become fatigued more easily. To accommodate these individuals, the length of
playing time may be shortened, or a game may be completed when reaching a lesser amount of
points. Another example of modifying basic rules for less mobile players, may be allowing two
or three bounces to get to the ball when playing tennis.
Lastly, a teaching strategy that is appropriate when teaching all individuals, regardless of
a person’s capabilities is positive feedback. However, in reference to those students with spinal
cord injuries, because physical limitations may be grounds for difficulty in performing certain
activities, encouraging words or phrases may motivate individuals towards striving for success
within the physical education setting. This is crucial because a physical educator’s objective is
to promote life-long physical activity. If a student is turned away from partaking in any form of
physical activity during their school years, this may result in complications as an adult.
Texas Woman’s University. (1997). Examples of basic strategies to accommodate learners with
disabilities in regular physical education. Retrieved December 1, 2006, from
The following activity descriptions and accommodations are established for a student
with a T6 spinal cord lesion. This individual possesses trunk stability, however, is dependent on
a wheelchair as primary means of locomotion.
The activity chosen for an elementary physical education class is bowling. Although the
individual possesses trunk stability, the student may have difficultly in being successful when
bowling because of range of motion limitations. Because bowling is an individual sport
performed in a more relaxed atmosphere, defining player roles may be less critical.
The length of the bowling lane will remain the same for this individual; however, the
individual may utilize a specialized piece of equipment, a bowling ramp. This student is
permitted to reposition the bowling ramp to a desired position for optimal success in knocking
down all ten pins. Because this individual is using a bowling ramp, a heavier ball may ensure
Paired with other classmates, a predetermined rotation is necessary for maintaining a
smooth class period. Assuming the student with a spinal cord injury began as the bowler, at the
completion of his or her frame, he or she would wheel themselves towards the end of the lane.
Here the individual would wait for the second bowler to complete his or her turn. The individual
with a disability would then gather the knocked over pins and realign them in a pyramid. The
classmates would continue this rotation throughout the class period.
The activity intended for a middle school physical education class is volleyball. Various
modifications are appropriate in order to maximize participation and success. With regards to
space, additional players may participate; therefore there is less area for each individual to
defend. The individual with the disability will be placed closer to the net, allowing for ease in
returning the ball.
Additionally, modifications in basic rules include allowing the individual to catch the ball
before returning the ball back into play or allowing the ball to bounce. An equipment adaptation
includes using a lighter, softer, beach ball to reduce the speed of the ball. Lastly, bright colored
balls can be used for increased motivation and excitement.
The activity designed for a high school physical education class is dance. Dance is a
magnificent activity for the non-ambulatory student as well as the ambulatory students. It is
essential for the physical education teacher to partner the student with a spinal cord injury with a
trustworthy and caring peer for safety precautions, as well as they themselves maintain a
watchful eye throughout the class period.
When performing a partner dance, the ambulatory student must place one hand on the
wheelchair, with their other hand on the person to direct the wheelchair while maneuvering
throughout a dance step. Twirl steps can be performed during wheelchair dancing with the
ambulatory peer twirling underneath the raised arm of the individual with a spinal cord injury.
Lastly, the physical education teacher must stress the importance that under no circumstances
should a peer be pulling or tugging on the student with a spinal cord injury.