1. Severe Physical Handicaps
By Andrea Opel, Sondra Deurloo,
Caitlin Robles, and Danielle Harrington

2. Definition and Eligibility
Andrea

3. IDEA Definition/Eligibility
Americans with Disabilities Act (ADA): “a person is considered physically handicapped if he or she has an impairment that substantially limits one or more of life’s daily activities.”
IDEA 2004:
A person with an orthopedic impairment, brain injury, or other health impairment who, by reason of that impairment, needs special education and related services is considered to have a physical disability.
The condition must interfere with or substantially limit the child’s ability to take part in routine school activities.
A physical disability or health condition need not limit activity; instead, it may involve other restrictions, such as a special diet (i.e. celiac-disease) or the student’s need to use medical equipment.
Andrea

4. Special Education Eligibility (cont.)
When physical disabilities adversely affect academic performance, the following special education eligibility categories may be considered:
Orthopedic Impairment
Other Health Impairment
Multiple Disabilities
Traumatic Brain Injury

5. Anatomy of Severe Physical Handicaps

6. The Nervous System
A network of specialized cells (neurons) that coordinate the actions of an animal and transmit signals between different parts of the body
Facts to know:
Peripheral nervous system,the
sympathetic nervous system : “fight or flight”
parasympathetic nervous system : “rest and digest”
Ventricles: open spaces in the brain which are filled with Cerebrospinal Fluid (CSF)
The left half of the body is controlled by the right side of the brain and vice versa.
Sodium and Potassium are vital to neural operations.

7. Parts of the Brain Occipital Lobe Occipital Lobe Frontal Lobe
The ability to concentrate and attend, elaboration of thought, abstract reasoning, problem solving, judgment, muscle memory. Also includes Broca’s area.
Parietal Lobe
Touch perception and goal directed voluntary movements
Temporal Lobe
Hearing ability, memory acquisition and long-term storage (hippocampus), sense of identity, behavior and emotions (amygdala).
Also includes Wernicke’s area.
Occipital Lobe
Primary visual reception area
Brain Stem
Involuntary responses and actions (breathing, heart rate, swallowing, startle response). Damage here can affect level of alertness and ability to sleep.
Cerebellum
Regulation and coordination of movement and balance

8. Neurological Disorder Terms
Aphasia – Language impairment usually due to left hemisphere damage to Broca’s (impairing expression) or Wernicke’s (impairing understanding).
Agnosia – Can’t recognize every day objects
Ataxia – lack of gross motor coordination
Apraxia – inability to carry out directed motor functions even though directions are understood

9. Musculoskeletal System
Composed of bones, muscles, cartilage, tendons, ligaments, joints and other connective tissue
Provides form, support, stability and movement to the body

10. Musculoskeletal System (cont.)
Elements of the musculoskeletal system:
Bones – provide support for the body, protect body organs, produce blood cells, store minerals
Cartilage – a firm substance that prevents bone to bone contact
Tendons – attach the muscle to the bone
Ligaments – attach bone to bone
Skeletal Muscles – attached to the bone by tendons; move bones through contracting
Type 1: slow/endurance
Type 2: fast/sprint

11. Useful Root Words for reading Medical Records
Away or not – eg. Ataxia (not ordered)
Distal
Away from the center – eg. Fingers are distal to the body
Dorsal
Towards the back – eg. Ears are dorsal to the nose
Hemi-
Half – eg. Hemiplegic (paralyzed from the waist down)
Hyper-
Over or above – eg. Psuedo-hypertrophy (fake muscle mass increase)
Hypo-
Under or below – eg. Hypoxia (not enough oxygen)
Myo
Muscles - eg. Fibromyalgia (muscle pain)
Para-
To one side – eg. Paraplegic (paralyzed on one side of the body
Proximal
Towards the center – eg. Shoulders are proximal to the body
Quad-
Four – eg. Quadriplegic (paralyzed in all four limbs)
Ventral-
Towards the front eg. Chest is ventral to the back.
End of Andrea’s slidea

12. Causes of Severe Physical Handicaps
Physical disabilities and health conditions are classified as either congenital or acquired.
Congenital : either are born with physical difficulties or develop them soon after birth
Acquired : developed through injury or disease while the child is developing normally. The age at which a condition develops often determines its impact on the child.
Start Sondra

13. Causes (cont.) Cause Meaning
Trauma
Trauma means injury. Many people become injured through accidents. In these cases the skeletal, muscular or nervous systems may become damaged. Trauma usually happens after birth.
Illness
There are many illnesses that can cause damage to body systems that control movement and may lead to physically disabilities. Many illnesses are caused by a variety of bacteria and viruses. Some illnesses may be inherited and there are some illnesses for which scientists still don't know the cause.
Congenital
Something that is "congenital" means present when a person is born. In these cases, a person is born with a physical disability – doesn’t have to be genetic.
Genetic
Genetic means that something is inherited from a person’s parents. This means that one or both parents passed a gene that carried that disease or disability. Genetic disorders can sometimes be caused by a mutation of a gene. Scientist usually don't know why these mutations happen and when they can happen.

14. Convulsive Disorders

15. Convulsive Disorders Definition
Characterized by having seizures
Seizures occur when a burst of electrical impulses in the brain escape their normal limits. They spread to other areas and create an uncontrolled storm of electrical activity. The electrical impulses can be transmitted to the muscles, causing jerking or convulsions.
Though seizures can be concomitant with other disorders, but when it occurs alone, it is considered epilepsy

16. Convulsive Disorders Causes
In 70% of cases, the cause of epilepsy is unknown.
When the cause is known it is usually due to a brain injury of some kind.
Other possible causes: hypoxia, stroke, abnormal levels of substances (e.g., sodium, blood sugar) that temporarily deprive the brain of required nutrients
About 30% of those with epilepsy are children
“required nutrients” = oxygen, magnesium, calcium

17. Convulsive Disorders Types
There are two main categories of seizures: Generalized Seizures and Partial Seizures
Two most common types of seizures*:
Grand Mal seizures (loss of consciousness, collapse, violent jerking) Video Clip
Absence seizures (mostly in children, brief loss of consciousness, no jerking, may occur several times a day) Video Clip
* There are other types of seizures; however, these two are the most common
1st video clip - 1:53 to 3:14

18. Convulsive Disorders Academic Implications
Common medication side effects
Inattention/Concentration problems
Hyperactivity
Memory problems
Excessive fatigue
Depression
Physical aggression/rage/tantrums/irritability
Cognitive impairment related to injuries and scarring in the brain
Tiredness
Speech slurring
Balance issues, clumsiness
Dizziness and nausea
Mood changes
Memory loss
Irritability
Vision disturbances

19. Convulsive Disorders Recommendations
Social Skills Groups
Structure and consistent schedule
Frequent breaks
Clear and consistent rules at home and at school with consequences for behavior
Check for understanding frequently
Be aware absence seizures may be occurring throughout the day, which may affect memory
End of Sondra’s slides
Social skills groups and consistent schedule: these students commonly have behavior problems

20. Cerebral Palsy
Start Caitlin

21. Cerebral Palsy Definition and Causes
Cerebral palsy is a condition, sometimes thought of as a group of disorders, that can involve brain and nervous system functions such as movement, learning, hearing, seeing, and thinking.
Caused by injuries or abnormalities of the brain
Usually occurs during pregnancy
Risk Factors: premature birth, infections, severe jaundice, hypoxia, traumatic brain hemorrhage, toxicity

22. Cerebral Palsy Symptoms
Most common symptoms:
Muscles that are very tight and do not stretch.
Abnormal walk (gait)
Joints are tight and do not open up all the way
Paralysis
May affect one arm or leg, one side of the body, both legs, or both arms and legs
Spastic:
Abnormal walk (gait): arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on the toes
In handout: (called joint contracture) for tight joints
Paralysis Muscle weakness or loss of movement in a group of muscles (paralysis)
Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress

23. Cerebral Palsy Symptoms
Other Symptoms:
Speech problems
Seizures
Cognitive Impairment (around 50% have ID)
Hearing/vision problems
Difficulty swallowing
These symptoms are most relevant to classroom behavior and performance
There are also a number of other associated symptoms

24. Cerebral Palsy Academic Implications/ Recommendations
Due to physical limitations and speech problems, the following accommodations/modifications are usually necessary :
Physical therapy
Occupational therapy
Speech therapy
Communication devices/computer technology
Special Day Classes, depending on the cognitive and communication level of the student
Video clip
Start video at 30 seconds

25. Fredreich’s Ataxia

26. Fredreich’s Ataxia Definition and Causes
Genetic disorder caused by a defect in the gene Frataxin (FXN), which causes the body to produce too much of part of the DNA called trinucleotide repeat (GAA).
Symptoms are caused by the wearing away of areas of the brain and spinal cord that control coordination, muscle movement, some sensory functions, and may also affect the heart.
Autosomal recessive genetic disorder (recessive gene that both parents must have)

27. Fredreich’s Ataxia Symptoms
Common symptoms include:
Abnormal speech
Changes in vision, particularly color vision
Hearing loss - occurs in about 10% of patients
Jerky eye movements
Loss of coordination and balance, which leads to frequent falls
Muscle weakness
Unsteady gait and uncoordinated movements (ataxia)
Muscle problems (can lead to scoliosis)
Heart disease
Diabetes (later stages)
Ataxia (gross motor – uncoordinated): gets worse with time. Most individuals eventually need a wheelchair.
Muscle problems lead to changes in the spine, which may result in scoliosis or kyphoscoliosis.

28. Fredreich’s Ataxia Academic Implications/ Recommendations
Speech therapy
Physical therapy
Occupational therapy
Walking aids or wheelchairs
Access to keyboard or computer
May need to alter PE requirements
Longer time for tests and in class assignments
Use of a scribe
Letting the student leave a few minutes early for lunch or between classes to miss crowds

29. Neural Tube Defects

30. Neural Tube Defects Definition and Causes
Neural tube defects are birth defects of the brain, spinal cord, or vertebrae.
Causes: environmental (e.g., diabetes, obesity, drugs), nutritional components (e.g., folic acid deficiencies

31. Neural Tube Defects Types
Anencephaly: Most of the brain does not develop. Most fetuses spontaneously abort and those that are born rarely survive.
Encephalocele: The bones of the skull do not completely close and a sac like formation with brain tissue and spinal fluid protrudes outside the head skull.
Spina bifida: the fetal spinal column doesn’t close completely during the first month of pregnancy. There is usually nerve damage that causes at least some paralysis of the legs.

32. Neural Tube Defects Types of Spina Bifida
Spina bifida occulta: The bones of the spine do not close but the spinal cord and meninges remain in place and skin usually covers the defect. Mildest form.
Meningoceles: The tissue covering the spinal cord sticks out of the spinal defect but the spinal cord remains in place. Rarest form.
Myelomeningocele: is a birth defect in which the backbone and spinal canal do not close before birth. Most severe form.

33. Neural Tube Defects Symptoms/Academic Implications
Symtpoms:
Varying degrees of paralysis of the lower limbs
Most children will have some form of a learning disability
Possible bowel and bladder complications
May have hydrocephalus
Academic Implications:
May need a bladder management program
Difficulties with attention
Trouble expressing or understanding language
Problems with reading or math
Depending on cognitive level, may benefit from more intense services such as placement in an SDC class
End of Caitlin’s slides

34. Muscular Dystrophy
Start Danielle

35. Muscular Dystrophy Definition and causes
Also called Inherited Myopathy or MD
Muscular dystrophy is a group of inherited disorders that involve muscle weakness and loss of muscle tissue, which get worse over time.
Incidence: about 1 in 651,450 persons in the United States.
May occur in childhood or adulthood
The more severe forms tend to occur in early childhood.

36. Muscular Dystrophy Types
There are many different types of muscular dystrophy. They include:
Becker muscular dystrophy
Duchenne muscular dystrophy
Emery-Dreifuss muscular dystrophy
Facioscapulohumeral muscular dystrophy
Limb-girdle muscular dystrophy
Myotonia congenita
Myotonic dystrophy
Duchenne’s and Becker’s muscular dystrophies affect males almost exclusively.
Severity depends on type. Duchenne MD is deadly, while others can cause little disability.
The severity of disability depends on the type of muscular dystrophy. All types of muscular dystrophy slowly get worse, but how fast this happens varies widely.
Some types of muscular dystrophy, such as Duchenne muscular dystrophy, are deadly. Other types cause little disability and people with them have a normal lifespan.

37. Muscular Dystrophy Symptoms
Different types of MD present different symptoms and affect specific muscle groups.
All of the muscles may be affected (including the heart). Or, only specific groups of muscles may be affected, such as those around the pelvis, shoulder, or face.
Reading disabilities are common
Mental retardation is present in some types of the condition
Symptoms
Muscle weakness that slowly gets worse
Delayed development of muscle motor skills
Difficulty using one or more muscle groups
Eyelid drooping (ptosis)
Frequent falls
Loss of strength in a muscle or group of muscles as an adult
Loss in muscle size
Problems walking (delayed walking)
Drooling
Some types of muscular dystrophy involve the heart muscle, causing cardiomyopathy or disturbed heart rhythm (arrhythmias).
Academic implications: decreased mobility and ability to care for one’s self. Also,
Cardiomyopathy
Lung failure
Tightening of muscles around the joints (contractures)
Mental impairment (varies)
Scoliosis

38. Muscular Dystrophy Academic Implications/Recommendations
There are no known cures for the various muscular dystrophies. The goal of treatment is to control symptoms.
In some cases, surgery on the spine or legs can improve functioning
Treatment may include:
Physical therapy
Orthopedic appliances such as braces and wheelchairs
Corticosteroids (especially for children)
Maintaining an active lifestyle
Physical therapy to maintain muscle strength and function.
Orthopedic appliances such as braces and wheelchairs can improve mobility and self-care abilities. In some cases, surgery on the spine or legs may help improve function. Corticosteroids taken by mouth are sometimes prescribed to children to keep them walking for as along as possible.
The person should be as active as possible. Complete inactivity (such as bedrest) can make the disease worse.

39. Traumatic Paraplegia and Quadriplegia
From his book Still Me

40. Traumatic Paraplegia and Quadriplegia Definition and Prevalence
“Traumatic” injury: Characterized by damage to the bones of the spine that surround the spinal cord, often resulting in damage to the nerves inside the spinal column.
Traumatic quadriplegia: Spinal cord or nerve root deficit not involving the cranial nerves above and including C8, T1 roots.
Traumatic paraplegia: Spinal cord or nerve root deficit below and including T2.
Complete: Complete motor and sensory deficit below the level of the injury.
Incomplete: Any sensory or motor sparing below the level of injury including perianal sensation.
250,000 Americans are spinal cord injured.
52% paraplegic and 47% quadriplegic.
Higher the location = more serious paralysis

41. Traumatic Paraplegia and Quadriplegia Common Causes
Broken neck or back neck caused by:
Vehicular accidents 37%
Violence 28%
Falls 21%
Sports-related 6%
Other 8% (e.g., complications following surgery)
SCI can also be caused by so-called ‘non-traumatic’ cord injury, such as:
Infection of the spinal nerve cells
Cysts or tumours pressing on the spinal cord
Interruption of the blood supply to the spinal cord
Congenital medical conditions (e.g., spina bifida)
The most rapidly increasing cause of injuries is due to violence; vehicular accident injuries are decreasing in number.
diving accidents cause the overwhelming majority of all spinal cord injuries that are sports related.

42. Traumatic Paraplegia and Quadriplegia Symptoms
Common symptoms include:
Loss of sensation and motor function
Dysfunction of the bowel and bladder
Impaired or lost sexual functioning
Men may have their fertility affected, while a women's fertility is generally not affected.
Low blood pressure
Reduced control of body temperature
Inability to sweat below the level of injury
Chronic pain.

43. Level Abilities Functional Goals
C1-C3
Limited movement of head and neck
Breathing: Ventilator or implant
Communication: Talking can be difficult, very limited or impossible.
Daily tasks: Needs assistive technology for independence
Mobility: Can operate an electric wheelchair with head mouth, or chin C4
Usually has head and neck control. May shrug their shoulders.
Breathing: May initially require a ventilator for breathing
Communication: Normal, may have weaker voice projection
Daily tasks: May have limited independence with specialized equipment C5
Typically has head and neck control, can shrug shoulder and has shoulder control. Can bend his/her elbows and turn palms face up.
Daily tasks: Need some specialized equipment but will have independence with some daily activities (e.g., eating, drinking, grooming)
Mobility: Power wheelchair with hand controls. Driving may be possible. C6
Has movement in head, neck, shoulders, arms and wrists. Can shrug shoulders, bend elbows, turn palms up and down and extend wrists.
Daily tasks: Can perform some daily tasks using specialized equipment (e.g., feeding, bathing, grooming, personal hygiene, dressing, and light housekeeping)
Mobility: Can use a manual or power wheelchair. Some independent transfer. C7
Has similar movement as an individual with C6, with added ability to straighten his/her elbows.
Daily tasks: Able to perform household duties. Need fewer adaptive aids.
Health care: Able to do wheelchair push ups for pressure relief.
Mobility: Daily use of manual wheelchair. Can transfer with greater ease.
C8-T1
Has added strength and precision of fingers that result in limited or natural hand function.
Daily tasks: Can live independently without assistive devices in daily living.
Mobility: Uses manual wheelchair. Can transfer independently.
T2-T6
Has normal motor function in head, neck, shoulders, arms, hands and fingers. Has increased trunk control.
Daily tasks: Should be totally independent with all activities.
Mobility: Possible limited walking with extensive bracing. Requires high energy, offers no functional advantage, and can lead to damage of upper joints.
T7-T12
Has added motor function from increased abdominal control.
Daily tasks: Able to perform unsupported seated activities
Mobility: Same as T2-T6.
Health care: Has improved cough effectiveness.
L1-L5
Has additional return of motor movement in the hips and knees.
Mobility: Walking can be a viable function, with the help of specialized leg and ankle braces. Lower levels walk with greater ease with the help of assistive devices.
S1-S5
Depending on level of injury, there are various degrees of return of voluntary bladder, bowel and sexual functions.
Mobility: Increased ability to walk with fewer or no supportive devices
Christopher Reeve (the actor who starred in Superman) was injured in a horseback riding accident in His injury was between the C1 and C2 cervical vertebrae. The injury required him to use a respirator and prevented movement from the neck down.
Assistive tech for independence (e.g., turning pages, using a telephone, operating lights and appliances)

44. Traumatic Paraplegia and Quadriplegia Academic Implications & Recommendations
Functioning will vary based on location of damage and severity of symptoms
Many require assistance for personal care
Physical therapy
Occupational therapy
Counseling
Adapted power wheelchairs
Tape recorders
Computers
Page turners
Mouth control (sip and puff) units
Voice activation, chin control, head control, eyebrow control, or eye blink
Balanced forearm orthosis (brace) for forearm and wrist stability
- T-1 can perform all motor functions of a non-injured person, with the exception of standing and walking.
- Injuries at the thoracic level and below result in paraplegia, with the hands not affected.
- At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower
- T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control.
T6-12 patients have partial abdominal muscle strength, and may be able to walk independently for short distances with long leg braces and a walker or crutches (The working abdominal muscles are used to throw the paralysed legs forward whilst the body weight is taken on a frame or crutches)
- Tetraplegia/ Quadriplegia: C-4 level may require a ventilator or electrical implant for the person to breathe.

45. Connective Tissue Disease

46. Connective Tissue Disease Definition & Causes
Mixed connective tissue disease (MCTD): uncommon autoimmune disorder that features the connective tissues as a primary target for pathology.
Connective tissues: The structural portions of our body that essentially hold the cells of the body together.
Characterized as a group by the presence of spontaneous overactivity of the immune system which results in the production of extra antibodies into the circulation. Leads to inflammation in tissues.
Classified under autoimmune disorders
Most commonly diagnosed in women in their 20’s and 30’s
Some are inherited (e.g., Marfan Syndrome, Ehlers-Danlos syndrome); others have no known cause or are believed to be triggered by infection
Connective tissue diseases that are strictly due to genetic inheritance include Marfan syndrome (can have tissue abnormalities in the heart, aorta, lungs, eyes, and skeleton) and Ehlers-Danlos syndrome (many types may have loose, fragile skin or loose [hyperextensible] joints depending on type).

47. Connective Tissue Disease Types
Causes overlapping features of primarily three connective tissue diseases —
lupus
scleroderma
polymyositis
May also have features of rheumatoid arthritis
Each can be identified by a blood test and distinctive, classic symptoms
Can be “undifferentiated” at first, as symptom onset can be gradual
Pediatric MCTD occurs in children under the age of 16. MCTD is three times more frequent in girls than boys.
93% of children with pediatric MCTD have arthritis
Juvenile rheumatoid arthritis (JRA) is arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. It affects approximately 50,000 children in the United States. Inflammation causes redness, swelling, warmth, and soreness in the joints, although many children with JRA do not complain of joint pain. Any joint can be affected, and inflammation may limit the mobility of affected joints.

48. Connective Tissue Disease Symptoms
Raynaud's disease — blood vessel spasms that interrupt blood flow to the fingers, toes, ears and nose
Fatigue
General feeling of being unwell (malaise)
Muscle pains (myalgias)
Joint pains (athralgias)
Mild fever
Joint swelling
Swollen hands and puffy fingers
Shortness of breath and chest pain (uncommon but dangerous; could be pulmonary hypertension)
Often begins with fever, decreased energy, and weakness
Can range from mild to life-threatening

49. Connective Tissue Disease Academic Implications & Recommendations
Can be treated with medication; may require only for flare-ups, or all the time
Prognosis can vary; some go into remission, and others have more serious, long-lasting symptoms but can still lead an active, productive life
Pay attention to medication side effects (e.g., nausea, weight gain, hair loss)
Recommendations will vary by symptoms
End of Danielle’s slides

50. Resources Epilepsy.com: www.epilepsy.com
Epilepsy Foundation:
Spina Bifida Asspciation:
The Nemours Foundation. Provides information for kids, teens, and parents: Kidshealth.org
United Cerebral Palsy:
4MyChild:
The Friedreich’s Ataxia Research Alliance:
Muscular Dystrophy Association:
American Autoimmune Related Diseases Association, Inc.:
Sondra

51. References
A.D.A.M., Inc. (2011). Muscular dystrophy. Retrieved from Cincinnati Children’s Hospital Medical Center. (2010). Mixed connective tissue disease (MCTD). Retrieved from Pediatric MCTD occurs in children under the age of 16. MCTD is three times more frequent in girls than boys. Health Grades Inc. (2011). Prevalence and incidence of muscular dystrophy. Retrieved from Hindelman, W. J. (2006). Atlas of functional neuroanatomy, 2nd. Edition, New York: CRC Press. Kanagawa, M., & Toda, T. (2006). The genetic and molecular basis of muscular dystrophy: Roles of cell-matrix linkage in the pathogenesis. Journal of Human Genetics, 51(11), Kondo, A., Kamihira, O. , & Ozawa, H. (2009). Neural tube defects: Prevalence, etiology and prevention. International Journal of Urology, 16(1), Lipman, M. (2006). Epilepsy: One disease, many causes. Consumer Reports on Health, 18(2), 11. Mayo Foundation for Medical Education and Research (MFMER). (2010). Mixed connective tissue disease. Retrieved from MedlinePlus. (2011). Friedreich’s ataxia. Retrieved from National Institute on Neurological Disorders and Strokes. (2011). Friedreich’s ataxia fact sheet. Retrieved from National Institute on Neurological Disorders and Strokes. (2011). NINDS cerebral palsy information page. Retrieved from

52. References
National Institute on Neurological Disorders and Strokes. (2011). NINDS epilepsy information page. Retrieved from National Institute on Neurological Disorders and Strokes. (2009). NINDS spina bifida information page. Retrieved from Obladen, M. (2011). Lame from birth: Early concepts of cerebral palsy. Journal of Child Neurology, 26(2), Paraplegia. (2010). Columbia Electronic Encyclopedia, 6th Edition, 1. PubMed Health. (2010). Epilepsy. Retrieved from PubMed Health. (2010). Myelomeningocele. Retrieved from Rosenzweig, M.R., Breedlove, S.M., & Watson, N. V. (2005). Biological psychology: An introduction to behavioral and cognitive neuroscience, 4th edition, Sunderland, MA: Sinauer Associates. sinai.edu/Patients/Health-Conditions/Mixed-Connective-Tissue-Disease.aspx Shiel, W. C. (2008). Connective tissue disease. Retrieved from Spinal Cord Injury Information Pages (2010). Spinal cord injury facts & statistics. Retrieved from info-pages.com/facts.html Spinal Injury Network ( ). Rehabilitation functional goals. Retrieved from injury.net/rehabilitation-goals-sci.htm. Spinal Injury Network ( ). What is spinal injury? Retrieved from spinal-cord-injury.htm