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Raising the Bar in Rehab

Gun Control

Published December 13, 2012 11:33 AM by Lisa Mueller

At one of my clinicals, I worked with two patients with cervical-level spinal cord injuries caused by gunshot wounds. These patients were young men who described their accidents as "being in the wrong place at the wrong time," or something to that effect. Their lives went quickly from revolving around friends and weekend parties to learning how to sit up and get out of bed without help.

I was raised in a relatively quiet part of Wisconsin where crime remains at a low level compared to other areas of the country. A little more than a year ago, Wisconsin adopted a concealed-carry law, allowing individuals to apply for a license giving them the right to carry a concealed weapon. At that time there was a lot of media attention on the consequences and risks of that law as well as many discussions on the second amendment as part of the foundation of our country. One year later, the few news articles I've read today reviewing the concealed-carry law agree that there was little drawback to the change.

After the news of the tragedy between Jovan Belcher of the Kansas City Chiefs and his girlfriend, as well as the comments and opinions of Bob Costas, I started to think about the impact gun violence has within the physical therapy profession. Gunshot wounds are the second most-common cause of spinal cord injuries, behind only motor-vehicle accidents. In 2003, a research article about gunshot wounds and spinal cord injuries found the average cost of one day in a rehabilitation hospital to be approximately $1,900.

Aside from spinal cord injuries, gunshot wounds can result in various musculoskeletal, neuromuscular and even cardiopulmonary damage depending on the path of the bullet. Regardless of your position on gun control or a person's right to bear arms, it's clear that injuries from guns impact our profession across all settings.

Now, I don't know a lot. I don't know what's required to purchase a gun or where safety classes are offered. I'm not an expert on constitutional rights or the history of guns in America. But, I do know what it's like to look at patients following a gunshot injury and see their faces as they struggle to complete what they once took for granted. I've heard the message these patients say to their friends and families -- that violence with guns wasn't worth the price they paid in the long run.

It seems like this is an area where we could work together to reduce the number of injuries resulting from gunshot violence, or accidents. There are two general areas of "gun control" to reduce the number of casualties; either by limiting the number of guns in the population (or limiting who uses them), or by changing the culture surrounding how guns are used (such as the "guns don't kill, people do" mentality). Which perspective do you see as a more effective way of reducing gun-related injuries?

What do you think about this particularly sensitive subject? Have you ever worked with a gunshot wound victim? What do you think about the laws for or against weapons?


Waters, R.L., & Sie, I.H. Spinal cord injuries from gunshot wounds to the spine. Clin Orthop Relat Res. 2003 Mar; (408):120-5.

Smith, W., Simmonds, J.O., Alam, Z.A., & Grand, R.E. Spinal cord injury caused by gunshot wounds: the cost of rehabilitation. Clin Orthop Relat Res. 2003 Mar; (408):145-51.


Guns need to be more strictly controlled AND mental healthcare needs to be addressed. Both of these issues are at the forefront especially since last week. Unfortunately, the focus will most likely only be on guns and the sorry state of mental healthcare will continue.

Jeanne December 21, 2012 8:44 AM

When we compare death rates (whatever the cause) there seems to be an uproar if someone kills multiple people with a gun.  Mcveigh killed 19 children but I can still buy fertilzer and rent a box truck without difficulty.  Did people petition box trucks and fertilizer? NO. But thats what caused all those deaths.  

Someone will say Mcveigh lit the fuse, just like someone has to pull the trigger on a gun.  Is it the gun (box truck and fertilizer) or the person behind the item that kills and causes destruction?

I appreciate the discussion and can see your points. I will agree that fewer guns MAY prevent unwanted deaths but those deaths are caused by irresponsible people who hold the weapon.

Even the government (who used taxpayers money) has bought and sold semiautomatic  guns through the "fast and furious" sting operation. If our own government can purchase (and lose) 2,000 guns why can't a citizen buy one and lock it up in a gun safe?  

Karen December 18, 2012 4:16 PM

Janey raises an interesting point for discussion. Let's examine the statistics in the same way we would look at a disease and a vaccine. We compare two populations. Those populations have different total numbers so we look at the rate or incidence of disease. In one population it is 2.98/100,000 in the other it is 0.03/100,000. Now we are comparing apples to apples. Now let us say we have a vaccine to combat that disease. The uptake of that vaccine is 88.8/100 and 6.7/100 respectively. What we see it that the population that has a higher uptake of the vaccine actually has a higher incidence of disease! The vaccine is actually a risk factor. Would you want your kids to take that vaccine?

What does this have to do with the discussion on gun control? The numbers are the homocides from guns in the USA and the UK followed by the gun ownership in the USA and the UK for 2009. ( It would be impossible to say that the UK has fewer homocides because more armed civilians stepped forward to intervene. They didn't have the guns to do so. It is also clear that regardless of how many civilians stepped forward to intervene and prevent a homocide in the USA, it has not resulted in fewer deaths overall. It is ineffective at reducing the incidence of deaths.

Karen, I did go to the link you provided. Perhaps Im misunderstanding, but I fail to see how comparing the number of deaths by reptile to deaths by guns supports your discussion.

Dean Metz December 18, 2012 9:09 AM

It took me a few days to process the comments to realize what was niggling me: statistics exist for only one side of this argument. I frequently hear how many people are killed/injured by guns. I have never heard a statistic on how many people have been saved by civilians who owned guns and stepped forward to prevent a crime. You have to be in the right place at the right time to even hear the details of isolated incidents. And you never hear about them for days or weeks - they're a blip and then they're old news.

I imagine it's impossible to get an accurate account of how many people have been saved. You can't know how many people would have been killed/injured if those civilians hadn't stepped forward. It is noteworthy in this discussion to recognize we'll only ever have statistics to one side of this equation.

Jane Goude December 17, 2012 11:30 PM
Lexington SC

Lisa, it's time to remove semiautomatic weapons from civilian hands. Period. End of sentence. As a healthcare reporter for several years, I've heard from many trauma doctors, nurses and PTs and OTs. As healthcare professionals, you know more than anyone the terrible toll guns have on our society. Now following the horrific events in Newtown, we have to support a ban on all automatic and semiautomatic weapons.

Tom Kerr December 17, 2012 6:54 PM
Birdsboro PA


A tragedy occured and I am deeply moved, however, if not a gun then a knife (like that guy in China).  Do you intend to ban or control distribution of all sharp instruments.  How about a hammer because of the guy in Florida? Car bombs seem to be common in certain areas of the world, so why aren't they being banned? How about a crossbow

There are SCI's that happen in swimming pools and lakes so is society suppose to monitor that activity as well and where were you posturing about horse related injuries when Christopher Reeves was injuried? Did you ever suggest horses were dangerous to societies well being and safety?

I do hope you had a chance to read that link and think a bit more about injuries that can be prevented even more so than banning guns.

Karen December 16, 2012 10:57 PM

Karen, I responded directly to your question about "...why isn't there more scrutiny there?" I think there is more scrutiny there actually because automobile issues aren't such a hotly debated topic.

When one looks at rates of gun homicides between the US and the UK in 2009; 2.98/100,000 and 1.2/100,000 respectively (, it becomes clear that tougher regulation results in less intentional harm.

It is interesting to be having this discussion a day after a mall shooting in Oregon and the same day as an elementary school shooting in Connecticut. These were not irresponsible individuals, they had mal intent. Too many people will have to pay, in suffering and in monetary terms, for one person's actions. Actions that are at least partially preventable.

Dean Metz December 14, 2012 1:39 PM

Dean and Lisa,

Last year over 2000 people died in vehicle related accidents in the UK.  In America the average is approximately 90 people a day.  I would venture a guess that the reported injury rate is high in both countries where a nonlethal injury occured.  

Approximately 30,000 deaths from firearms occur every year in America.

So, about the same amount of people die from vehicles and firearms in the United States.  Which is more dangerous?

Even though laws have been enacted to protect us, irresponsible individuals drive cars and carry guns.

Please see

karen December 13, 2012 11:29 PM


In regard to your argument, there is great scrutiny about automotive safety which is why there are mandatory seat-belt laws, speed limits, laws against cell phone calls and texting. The automotive industry is filled with laws and restrictions designed to make the impact of driving safer to the whole public. Driving is also a privilege which is revocable should one fail to observe these laws.

I don't think your argument holds water here. I have lived and worked in the United Kingdom for 3 years where guns laws and ownership is very tightly restricted. I never saw a single gun shot wound there. The people are not up in arms about how difficult it is to own a gun because they don't want them in the hands of inexperienced, inattentive, or potentially dangerous individuals. Many farmers in the UK own guns to protect their livestock from predators, but beyond that, there is no need for them. If it seems strange to you that soldiers and police can have guns but not individuals, that is probably because it is simply habit.

I am reminded of the two recent cases in Florida where youths have been shot dead by individuals under the "Stand your ground" law. It just seems wrong to me that actually, we regulate automobiles, which are necessary in today's world, than we do guns, which are not necessary and can too easily fall into the hands of children, burglars, or the very people one is trying to protect themselves from.

Dean Metz December 13, 2012 9:27 PM


If motor vehicle accidents are the number one cause of spinal cord injury why isn't there more scrutiny there? Inexperience, poor safety awarenss and inattentiveness will contribute to an injury whether it is a vehicle, gun or ironing clothes.  

It is strange for our government to tell a certain group of people (soldiers, police) they are allowed to shoot a gun to kill or severely injury and for others (civilians) it is forbidden.

Karen December 13, 2012 6:16 PM

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