Joseph E. Hornyak IV, Michael W. Wheaton, and Virginia S. Nelson

Children and adolescents with spinal cord injury (SCI) must deal with the multisystem involvement imposed by the injury that is compounded by physical and psychological growth and development, which cause complications not seen in the adult. Rehabilitation is a process that extends at least until the child is physically and psycho-socially an adult. Involvement by a team that is expert in the management of children and adolescents with SCIs should continue throughout this period. This chapter discusses some of the main points to be considered by those who are involved in assisting this rehabilitation process. Advances have been made in the acute management of pediatric SCI, and there is new equipment and technology for rehabilitation, but the basics of rehabilitation in this area remain the same.



Compared to other disorders discussed in this text, SCI is a relatively rare disorder in the general population. The most comprehensive data on the epidemiology of SCI comes from the National SCI Database (NSCID), which is generated by the Model SCI Care Systems. The Model SCI Care Systems is a network of 28 past and current centers funded by the National Institute on Disability and Rehabilitation Research, an institute in the U.S. Department of Education. Since SCI is not a reportable condition, data collection is limited. The NSCID estimates that it collects data on 13% of the new SCI cases per year. From this data, the incidence of adult traumatic SCI is estimated to be approximately 40 cases per million in the United States, or roughly 12,000 new cases per year. This data does not include injuries that resulted in death prior to hospitalization (1). Selvarajah and colleagues used data taken from the Nationwide Emergency Department Sample from 2007 to 2009 and estimated the incidence of traumatic adult SCI to be higher at 56.4 cases per million

(2). Using the same sample data set from 2007 to 2010, it was estimated the incidence of childhood and adolescent SCI presenting to emergency departments to be 17.5 cases per million, which represents 1,308 new cases per year (3). Acute SCI primarily occurs in young adults, though the average age has been rising. In the 1970s, the average age of injury was 28.7 years; since 2010, the average has increased to 42.6 years. The cause in this shift is unknown, though the incidence in SCI over the age of 60 has more than doubled since the 1980s. Other factors, such as prevention programs, advances in automobile safety, or referral patterns to Model Systems, may also be affecting the data. It was previously reported that 3% to 5% of all SCI occurred in children under age 15 and 20% of injuries occurred in those under 20. In their February 2013 report, the NSCID estimated that there were between 238,000 and 332,000 people living in the United States with SCI.


Publications have combined data from the Shriners Hospitals for Children and the NSCID. As in adults, males are four times more likely to have SCI than females overall, with the ratio being 1.5:1 in children under age 9 years. In children under 3 years, females have outnumbered males in some studies. The cumulative incidence of SCI in child and adolescent males was estimated to be between 2.4 to 2.8 times greater than females from the period of 2007 to 2010 (3). In younger children, there are no statistically significant racial trends. In those over age 15, there is an increased risk in African American and Hispanic American populations. These figures are all from specialized hospital data and may not represent those with milder injuries (eg, incomplete lesions and paraplegia) who are treated in smaller hospitals or in adult settings. Since the year 2010, the ethnic make-up for SCI treated in the Model Systems has been 67% White, 24.4% Black, 7.9% Hispanic, 2.1% Asian, and 0.8% Native American (1).

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