Comparing Psychosocial Factors of Penetrating Spinal Cord Injury to Blunt Spinal Cord Injury: A Case report and Review of the Literature

Background: The National Spinal Cord Injury (SCI) Statistical Center estimates about 17,900 cases of SCI a year with nearly 14.3% occurring due to violence. Approximately 95% of penetrating spinal cord injuries are secondary to gunshot wounds, and the minority populations such as African Americans and Hispanics are disproportionally affected by gun violence and penetrating trauma. Comparisons between common baseline characteristics of patients with penetrating spinal cord injury (PSCI) and blunt spinal cord injury (BSCI) have recently been investigated but are limited. The purpose of this case report is to highlight how patient characteristics, such as race, psychosocial and socioeconomic level, influenced the rehabilitation management of a client with a PSCI from a gunshot wound that resulted in a complete paralysis (AIS A) below the level of injury. Case Description: A 19-year-old African American male presented to the emergency department with a gunshot wound to posterior left shoulder that caused T2-3 vertebral fractures resulting in a complete spinal cord injury (AIS A at T3). Outcome Measures: Level of injury after in-patient rehabilitation discharge (AIS grade), hospital length of stay, hospital readmission rate, FIM score were used to monitor patient progress and compare to practice guidelines for the more common presentation of a patient with a BSCI. Discussion: Individuals that have a PSCI often come from minority populations with limited access to healthcare services. Our case report demonstrates an example of the challenges a patient with a PSCI had in his recovery of a PSCI due, in part, to his non-modifiable characteristics, such as race, lower socioeconomic level, and lack of health insurance. Additionally, it highlights the importance of acknowledging cultural and socioeconomic influence that impacts our rehabilitation strategies, particularly when there is a lack of evidence to help guide the physical therapy evaluation and management of people with traumatic life-changing injuries.