Glossary

Activity-based therapy
Any physical activity using arms and/or legs that elicits beneficial gains of health and fitness. In one context, such exercise has been hypothesized to produce gains of neurological function.
Acute
Refers to a medical condition that is of short duration, rapidly progressive, and in need of urgent care. May also define the abrupt onset of a condition. "Acute" is in contrast to "subacute" and "chronic." "Subacute" indicates longer duration or less rapid change. "Chronic" indicates indefinite duration or virtually no change in condition.
ADL
Activities of daily living ie. Dressing, eating, getting out of bed etc
Arm boards
Used on those with a neck injury to extend arms whilst in bed to minimise shoulder and arm stiffness.
Arm crank ergometer
An upper limb exercise device, involving synchronous or asynchronous arm cranking against resistance
ASIA score

A commonly used clinical assessment for scoring the extent of motor and sensory deficits.

ASIA

A

Complete

No sensory or motor function is preserved in the sacral segments S4 or S5

ASIA

B

Incomplete

Sensory but not motor function is preserved below the neurological level and includes the sacral segments

ASIA

C

Incomplete

Motor function is preserved below the neurological level and at least half of key muscles are graded less than three

ASIA

D

Incomplete

Motor function is preserved below the

neurological level and at least half of key muscles are graded greater than or equal to three

ASIA

E

Normal

Sensory and motor functions are normal

ASIA–ISCoS Impairment Scale,
A measure ofmotor and sensory status taken in all 28-paired dermatomes from the second cervical segment to the or AIS fourth and fifth sacral segments and the10 paired myotomes between the third cervical and first thoracic segments and second lumbar and first sacral segments. Muscle strength is graded as zero (no active movement) to five (normal movement). Based upon the presence or absence of voluntary motor or sensory anal function in the fourth and fifth sacral segments the SCI is ranked as “complete” or “incomplete.”
Autonomic dysreflexia
A complex reflex condition experienced by those with spinal cord damage above T6. It can cause severe high blood pressure and the symptoms include a pounding headache, blotchy or red skin rash and sweating. Those likely to experience this will carry a card explaining the treatment.
Autonomic nervous system
A part of the peripheral nervous system responsible for regulating the activity of smooth muscle and internal organs (eg heart and glands). It includes the sympathetic and parasympathetic nervous systems.
Axon
A single, slender process arising from each nerve cell (neuron). It conducts information from the nerve cell to targets such as muscles, glands or other neurons.
Basic research
Research carried out in the lab, usually on cells, tissues or animals, with the aim of investigating basic mechanisms, such as how tissues respond to injury. This research is usually carried out prior to clinical studies, and can provide baseline data useful for deciding whether to proceed to a clinical study.
Blood brain barrier (BBB)
Blood brain barrier, by which certain compounds in the blood, such as some drugs, are excluded from the brain and spinal cord.
Biomedical research
A general term for all basic research studies in the medical field. It may also be used for clinical studies such as those aimed at establishing biological mechanisms, but is not generally used for describing clinical trials.
Bladder Management
Establishing a routine alternative method of bladder emptying when there is no voluntary bladder control.
Body weight-supported gait training
A form of walking re-training involving stepping on a motorized treadmill (or on the floor) when the client’s body weight is fully or partially supported by an overhead harness.
Brainstem
The major route by which the forebrain sends information to and receives information from the spinal cord and peripheral nerves. The brainstem controls, among other things, respiration and the regulation of heart rhythms. It consists of the mid brain, pons and medulla.
Bulbocavernous or Bulbo
A test to determine the nerve function at the lowest point of the spinal cord.
Cerebrospinal fluid
A clear liquid found within the ventricles of the brain and the central canal of the spinal cord; secreted from the choroid plexus.
Cervical
Refers to the neck region of the spinal column and spinal cord. There are seven cervical vertebrae and eight pairs of cervical spinal nerves, supplying the back of the head, the neck and most of the arms.
CGRP
Calcitonin gene-related protein, a chemical transmitter used in the brain and spinal cord.
Clinical research
A study of a treatment, procedure, or medication carried out on people, usually under medical supervision. Often involves Clinical Research Trials which are carried out to evaluate the effectiveness and safety of medications, medical devices or procedures by monitoring their effects on large groups of people.
Central Nervous system, CNS
This refers to the brain and spinal cord. It is distinguished from the peripheral nervous system (PNS), which comprises the peripheral nerves and sensory and autonomic ganglia. The CNS contains different cells to the PNS and responds differently to injury.
Coccygeal
The lowest region of the spinal column and cord. In adults it usually consists of 1 vertebrae and gives rise to one pair of spinal nerves.
Commode
A wheelchair-like piece of equipment used in the shower and toilet.
Complete and incomplete SCI
The SCI is ranked as “complete” or “incomplete” based upon the presence or absence of voluntary motor or sensory anal function in the fourth and fifth sacral segments, as measured using physical examination.
Contracture
Loss of joint range secondary to muscle shortening due to spasticity or structural changes in the soft tissues overlying joints. These soft tissues could be muscle, ligament or joint capsule.
Controls/ Control group
For good experimental design, this involves the selection and inclusion of a ‘matched’ group of subjects who do not receive the experimental treatment or intervention, but are otherwise subject to all of the same procedures as the group of subjects who receive the experimental treatment. For example, the experimental group may receive an investigational drug, while the control group receives a placebo.
Chronic
Comes from the Greek chromos (time) and means ‘lasting a long time’. A chronic condition is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Hippocrates originally distinguished diseases that were acute (abrupt, sharp and brief) from those that were chronic. Subacute has been coined to designate the mid-ground between acute and chronic.
Cerebrovascular accident (CVA)
Also called “stroke” is a neurological insult caused by one of several pathophysiological processes involving the blood vessels of the brain. This may result in a transient brain ischemic attack (TIA), or permanent brain infarction (ischemic stroke), or the rupture of a vessel in the subarachnoid space or intracerebral tissue may cause subarachnoid hemorrhage or intracerebral hemorrhage (primary hemorrhagic stroke).
Diffuse axonal injury
Traumatic brain or spinal cord injury may result in transient shear strain on a large number of long axons. While this often may not initially result in axon tearing, the axons may subsequently swell and break in the days and weeks following injury, contributing to subsequent neurological dysfunction.
Dorsal horn
An area of the spinal cord where many nerve fibers from peripheral sensory receptors meet other ascending and descending nerve fibers.
Double-blind study
A research method to minimize potential bias or prejudice as a study is conducted. Neither the researcher nor the participant is aware of who is in the experimental group or control groups. Participants are coded at the beginning of the study, and the code is only ‘broken’ (revealed) at the conclusion of gathering all data from experimental and control subjects.
Dorsal root entry zone (DREZ)
This is the region where sensory nerve fibres (axons) enter the spinal cord. It marks the transition between central and peripheral nervous systems.
Evidence-based research
The care of patients using the best of the growing volume of available research evidence to guide clinical decision making.
Functional electrical stimulation (FES)
A form of artificial movement of paralyzed limbs, where by computerized electrical pulses from a neuromuscular stimulator recruit muscles to produce leg exercise or walking.
Functional neuromuscular stimulation (FNS)
Another name for functional electrical stimulation.
Glia (also called Neuroglia):
Specialised non-neuronal cells that lie between neurons; nourish and support neurons.
Glial Scar
Following transection, contusion or compression injury of the spinal cord, astrocytes (a type of glial cell) are activated and form a glial scar, resulting in an impenetrable barrier for growing axons. The astrocytes trigger a physiological stop signal in growing axons that make contact, and the scar itself forms a physical and molecular obstacle to fibre growth and regeneration. Although this property appears to be detrimental when seen in the light of functional recovery, the scar protects the integrity of the tissue by sealing it off from the external environment, e.g. from possible infections.
Gliosis
A proliferation of glial cells (astrocytes) which occurs in damaged areas of the central nervous system (CNS). This reaction of the glial cells to injury usually leads to the formation of a glial scar.
Glutamate
An amino acid neurotransmitter that acts to excite neurons in the CNS. Glutamate stimulates N-methyl-d-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA). AMPA receptors have been implicated in activities ranging from learning and memory to development and specification of nerve contacts in developing animals. Stimulation of NMDA receptors may promote beneficial changes, whereas overstimulation may be a cause of nerve cell damage or death in neurological trauma and stroke.
Grey matter
Brain and spinal cord tissue that contains mainly neuronal cell bodies. It appears grey to the naked eye as it has very little fatty (white coloured) myelin.
Hand splints
Worn mostly whilst in bed to maintain a good hand position and prevent contractures. Other splints may be used to assist with independent activities ie. Writing, eating etc
Hoist
A lifting device with a ‘sling’ used for transferring in and out of bed.
Intracerebroventricular (ICV)
Intracerebroventricular, ie within the venticles (fluid spaces) within the brain.
Indwelling Catheter (IDC)
A catheter which remains in the bladder inserted through the urethra / ‘water passage’.
Intermittent Catheters (IMC)
A method of routinely emptying the bladder, which can be part of bladder management in conjunction with restricted fluids.
Intrathecal
The intrathecal space is the space between the arachnoid and pia mater of the brain and spinal cord. The arachnoid and pia mater are sheath like coverings (meninges) of the brain and spinal cord that lie within the bony spinal canal. The intrathecal space is filled with cerebrospinal fluid. Drugs such as aneasthetic agents, pain relief and muscle relaxants are often introduced into this space. Baclofen for example can be introduced into the intrathecal space at low doses to treat spasticity.
In vitro
Pertains to an experiment or intervention being undertaken outside the body e.g. a study on cells or tissues in the laboratory
In vivo
Pertains to an experiment or intervention being undertaken in or on the body e.g. in an animal or as part of a clinical study in humans.
Lumbar
The lower back region containing the spinal column and cord between the thoracic and sacral regions. It has five vertebrae and five pairs of spinal nerves innervating the lower trunk and legs.
Memokath
A stent/spring which is inserted by the urologist into the bladder outlet of some men to allow better bladder emptying.
Meninges
Three layers of connective tissue called the dura, arachnoid and pia mater, which cover the brain and spinal cord. They lie between the bone and neural tissue. The dura is quite tough and strong, the arachoid finer and the pia very delicate.
Magnetic Resonance Imaging (MRI)
A non-invasive, nuclear procedure used for imaging the chemical makeup of tissues. This technique can distinguish normal, traumatised, cancerous and vascular tissue masses. The procedure is used for the differential diagnosis and evaluation of the patient presenting with traumatic and non-traumatic SCI.
Myelin, Myelin Sheath
Compact fatty material that surrounds and insulates the axons of some neurons, making a fatty sheath around them. The fatty material has a white appearance. Hence places where lots of axons run together, as in tracks in the spinal cord or brain, appear white in colour, so are often referred to as ‘white matter’.
Nerve growth factor
A substance whose role is to guide neuronal growth during embryonic development, especially in the peripheral nervous system. Nerve growth factor also probably helps sustain neurons in the adult.
Nerve guidance /conduit
A device, typically fabricated from a biopolymer or hydrogel material, containing aligned (axial) channels along it’s length, with the aim to guide and/or promote the growth of axons in a controlled and organised manner.
Nerves, general
Nerves are bundles of neural processes, or axons, connecting the CNS with the rest of the body. Typically nerves extend from the basal surface of the brain, the brain stem or spinal cord. Nerves follow specific pathways throughout the body and are part of the peripheral nervous system, distributing motor, sensory and autonomic information.
Neuroplasticity
A general term used to describe the adaptive changes in the structure or function of nerve cells or groups of nerve cells in response to injuries to the nervous system or alterations in patterns of their use and disuse.
Olfactory ensheathing cells (OEC)
OECs are unique glial cells, similar to Schwann cells, that remyelinate axons in the olfactory (nasal) system. They are unique in the fact that they reside in both the peripheral and central nervous system. Therefore, OECs are promising candidates for cellular therapeutic approaches to assist neural regeneration in SCI.
Orthostatic hypotension
The term used to describe the fall in blood pressure when a person sits up or stands (orthostatic = upright posture of the body; hypo = less + tension = pressure).
Paraplegia
Paraplegia (loss of voluntary movement) of the lower part of the body including the legs, and generally the lower trunk. Usually due to disease of, or injury to, the spinal cord in the thoracic, lumbar or sacral regions. (Derived from 'plegia' meaning paralysis). If the arms are also affected by paralysis (due to cervical cord damage), tetraplegia (or quadriplegia) are the terms used.
Parasympathetic nervous system
A branch of the autonomic nervous system that controls and regulates the viscera (organs such as gut, heart, bladder, etc). Particularly concerned with the conservation of the body’s energy and resources during relaxed states.
Peripheral nervous system
A division of the nervous system consisting of all spinal and cranial nerves that are not part of the brain or spinal cord.
Pressure relief
or ‘weight shifts’ are the methods of relieving pressure over the buttocks whilst sitting in the wheelchair.
Pressure sore/area
A red or broken area of skin caused by pressure whilst being in the same position for too long, tight clothing etc.
Proprioception
Awareness of the position of the body and body regions (eg limbs, head) in space, also called position sense. Sensory receptors associated with muscles, tendons, joints and skin all contribute to our sense of position.
Quadriplegia /tetraplegia
These terms mean the same and refer to a condition resulting from damage to the spinal column in the cervical (neck) region leading to complete or partial paralysis in all four limbs. Quadriplegia ranges from no function in the upper limbs with ventilator assistance required for breathing (C2-C4 injury) to almost full function of the upper limbs except for the thumbs and fingers (C6-C7 injury). People with C5, C6 and C7 injuries can lead (largely) independent and productive lives in the community”. For more information see http://www.healthline.com/sw/gsa-spinal-cord-injury
Reflex(es)
An involuntary and almost immediate response to a stimulus. In the context of spinal cord activity, commonly tested reflexes include deep tendon responses. For example, the application of a tap to quadriceps tendon (at the front of the knee) using a tendon hammer, will produce a brisk and immediate contraction of the quadriceps muscle and result in straightening of the knee. Deep tendon reflexes will be preserved and even amplified in the case of an upper motor neuron injury (about T10 and above). In the case of a cauda equina or lower motor neuron injury, reflexes are generally absent.

Reflexes are also responsible for some bladder and bowel activities. Reflexes can happen independently of any input from the brain. In the case of the bowel, reflex evacuation may occur in response to anal stimulation.
Regeneration
The stimulation and/or growth of new or damaged neural tissue in the spinal cord. Usually requires overcoming the inhibitory mechanisms associated with the glial scar and secondary degeneration following spinal cord injury.
Rehabilitation engineering
A clinic which assists with getting the wheelchair appropriate for you and a cushion which will minimise pressure over the buttocks.
Renal ultrasound
An examination of the kidneys, ureters and bladder performed before discharge and every year.
Residual
The amount of urine left in the bladder after emptying.
Restricted fluids
A part of bladder management where the fluid intake is controlled to prevent harmful over distension of the bladder ie. 125mls of oral fluid every 2 hours.
Sacrum
Lower part of the spinal column and spinal cord associated with the sacral bone. It has five pairs of spinal nerves, supplying the back of the legs and buttocks.
Slideboard
A board used to assist transfers.
Somatic
The somatic nervous system is the part of the nervous system that is responsible for reception of external stimuli such as touch, hearing and sight and controls voluntary movements.
Spasm
A term used to describe the involuntary jerky muscle movements that can be experienced below the level of spinal injury. It is important not to confuse these with voluntary controlled movement.
Spasticity
An increase in muscle tone at rest and/or during activity. A spastic muscle is characterised by an abnormal and velocity dependent response to stretch. For example, lengthening a spastic muscle slowly will have a less marked response than if the same muscle is stretched quickly. A spastic muscle will often be stiff or may even become permanently shortened over time.
Suprapubic catheter (SPC)
A catheter which remains in the bladder that is surgically inserted through the abdomen.
Stem cell
Unspecialised (undifferentiated) cells that renew themselves for long periods through cell division and from which other cells can be formed.
Substance P
A neurotransmitter often associated with pain
Sympathetic nervous system
A branch of the autonomic nervous system. Together with the parasympathetic nervous system it controls and regulates the viscera (organs such as gut, heart, bladder, etc). Responsible for mobilizing the body’s energy and resources during times of stress and arousal.
Thoracic
The part of the spinal column and spinal cord associated with the sacral bone. It has five pairs of spinal nerves, supplying the back of the legs and buttocks.
Transfer
A term used to describe a method of getting from wheelchair to bed, commode etc.
Turns
A routine change of posture to relieve pressure whilst in bed. Initially performed by the ‘turning team’ or nurses and ultimately by you with or without assistance.
Urodynamics
A bladder investigation to assess the bladder muscle activity and the bladder outlet.
Vertebra(e)
An individual bone in the spinal (vertebral) column that surrounds and protects the spinal cord.
Vertebral column (spine)
The spine or spinal column is made up of 26 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 1 sacral, 1 coccygeal) which run from the base of the skull to the coccyx (tail!). Each is separated from its neighbours by a disc of cartilage which contributes to the flexibility of the spine. The adult spine is not straight, but S-shaped, and injury can modify these normal curves.
Wallerian degeneration
Process by which an axon degenerates after it has been cut or crushed.
White matter
The part of the brain and spinal cord that contains myelinated nerve fibers. The white matter is white