and Grundy, 2002). “Up until the 1940s, spinal cord injury was essentially a death sentence. If the injury itself didn’t prove fatal, then the complications … became fatal” (Kreutz, 2004). Since then, the development of antibiotics, improvements in general medical care, and advances in rehabilitation medicine and in technologies such as respirators have resulted in gains in patient survival, care, and life expectancy. Although the life expectancy for an individual with a spinal cord injury has improved dramatically, it remains lower than that for the general population (Charlifue and Lammertse, 2002).

EXTENT AND COSTS

It is estimated that 11,000 spinal cord injuries occur each year in the United States and that 247,000 Americans are living with a spinal cord injury (NSCISC, 2004). Most individuals with spinal cord injuries are young adults, primarily males (78.2 percent of cases since 2000) (NSCISC, 2004). The average age at the time of injury has increased in recent years, from an average of 28.6 years in 1979 to the current average of 38 years. Explanations for this trend include greater numbers of injuries in the population over 60 years of age (the percentage of individuals older than 60 years of age at the time of injury increased from 4.7 percent before 1980 to 10.9 percent since 2000) and the general aging of the U.S. population (NSCISC, 2004). Only about 5 percent of spinal cord injuries occur in children, usually as a result of traffic accidents or falls (Swain and Grundy, 2002).

Historical trends in spinal cord injury incidence in the United States showed an increase from 22 per million population in the period from 1935 to 1944 to 71 per million population from 1975 to 1981. That rate has fallen, however, to the current rate of approximately 40 incidents of spinal cord injuries per million population each year, a rate that has remained stable for the past 20 years (Sekhon and Fehlings, 2001; DeVivo, 2002). These statistics indicate that unless new treatments or preventive measures are developed, spinal cord injuries will likely continue to be the source of severe disability and loss of function for thousands of Americans each year.

On the basis of reports to the National Spinal Cord Injury Statistical Center (NSCISC), the major causes of spinal cord injuries in the United States are motor vehicle crashes and traffic accidents (50.4 percent); followed by falls (23.8 percent); violent acts (11.2 percent), primarily gunshot wounds; and recreational sports activities (9.0 percent) (NSCISC, 2004). Recent trends, however, show a decrease in work-related causes of injuries and an increase in sports and recreational causes (Sekhon and Fehlings, 2001). Causes of injuries also vary between regions of the country and between urban and rural locations. Table 1-1 provides NSCISC demo-



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