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Spinal Cord Injury

Dont forget to go backover your notes from

Physical DisabilitiesConditions. The

assumption here is thatyou remember that

information.

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What is Spinal Cord Injury?Etiology

any injury to the neck or back thatinterrupts spinal cord function.

200,000-500,000 spinal cord injuredpersons in US

8,000-10,000 new injuries annually thatresult in paralysis

Average age- 16- 30(19 is most frequent)

Male:female ratio is 4:1

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Causes of Traumatic SCI

MVAapprox. 37%

Falls

Violence (i.e. gun shot, stabbing) Sports injuryof which 66% are

diving accidents

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Types of Spinal Cord Injuries

Complete- total paralysis and loss ofsensation by total destruction of theascending and descending pathways Zone of partial preservation (sparing)- areas

caudal to level of injury with intact sensation andor motor function= spinal cord completely severedor when spinal tissue deoxygenated,,swellig cnclose space and stop o2

Incomplete- partial preservation of sensoryand/or motor function

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Labeling SCI

The injury is labeled from the last (mostcaudal) level with INTACTsensoryand motor function bilaterally. Below

that level is impaired

So tell me about a person with a

C5 complete SCI

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Lets meet Elva

C5/c6 sc injury.

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Tetraplegia v Paraplegia

Tetraplegia (old termquadriplegia)- C

8

and higher

Paraplegia- below C8

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ACUTE SCI

Spinal Shock Occurs after trauma to spinal cord

Usually resolves within a few weeks, but

can take up to a few months Maintain (create airway)- tracheostomy

(well talk about respiratory function

later) Determine extent and type of injury

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Cervical Spinal Stabilization(internal)

Decompress spinal canal by removing allbony and soft tissue elements pressingagainst the cord (often anterior)

Wiring of spinous processes Graft using iliac crest, fibula or tibia

Rods

Sometimes plates and screws providesinternal stabalization to provide stability so itcan heal.

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Cervical Spinal Traction/Support(external)

Tongs or calipers (Somers, 41)

Supportive bedStryker Frame (Somers, 42)

Halo- rigid brace used later, after cervical

traction with tongsContraindications include severe respiratory problems,

chest injuries and burns on the trunk or abdomen

Semi-rigid cervical orthoses- later Cervical collar- later

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Assessment

Sensory Motor

Tone (spasticity- different than CVA)

Strength

Endurance

Posture- alignment and control

Soft tissue integrity- skin, joints

PsychosocialValues, interests, self concept, role performance,

coping

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TreatmentIntervention/Expectations

C 1-4

C 1 C 2-3 C 4 C 2-8

C 1-7

TEAM/Roles

Resp therapy

PT

Nutrition

OT

Psychology

ExpectationDependent some/all care; use of assistive technology

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C 5-6I (most tasks)with equipment

C 5 C6

Tenodesis- how do you maintain? Respiratory- no obliques/abdominals

Spasticity- may need meds

Positioning- maintain shortening in low back Medical complication- HO, OH, DVT

Too much biceps without triceps How do you compensate for lack of triceps?

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Case Study- WEAK C5injury(weak biceps)

Using mobile armsupportsecondary tolimited UEstrength; allowsflexion at elbowwith handmoving towardmouth andextension withhand movingtoward table

Write a long term goal (1 month)

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C 6-7I with equipmentC 8T 1

C 6-7

C 7-8

C8T 1 C 8

C 8T 1

C6 extensor carpi radialis longus and brevis

C7 triceps

C8 flexor digitorum profundus

T1 Interossei

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Thoracic, Lumbar and Sacral SCI

T 1-5 T 11and below- expect to walk

with/without braces

L 1-4 L 5S3

S 4-5 S2-5 bowel and bladder

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Other Considerations

Respiratory

Bowel and Bladder Function

Orthopedic Restrictions

Spasticity

Medical Complications

Spinal Cord Injury Syndromes

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Respiratory Considerations

Initially after injury- often requires intubation If the lesion is below C5, there is a good

chance that the person will eventually be ableto breath on his/her own

If the lesion is between C3and C5, may ormay not need mechanical ventilation

High injury (C3or higher) need ventilator

Incomplete injury? Difficult to predictoutcome of respiratory abilities

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Tracheostomywhat it is and how it works

Trach Placement

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Suctioning

Signs of need for suctioning

frightened look

flared nostrils

restlessness

paleness or bluishness around mouth

clammy skin

sinking in of the chest (retractions)

NOT dependent on presence of trach tube

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Other respiratory considerations

Assisted cough

Weaning from mechanicalventilation

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Bowel and Bladder Function

Spastic v. flaccid bladder (go backover old notes)

Bowel program

Equipment Bladder care and catheterization

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Orthopedic Considerations

Cervical injury- placement of halo-usually restricted to 90flexion/abduction at shoulders

Other?

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Spasticity

Explain the difference

between the spasticityseen following SCI v. CVA

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Med Complication:Autonomic Dysreflexia

Characterized by sudden severe headachesecondary to an uncontrolled elevation in BP

Caused by any variety of stimuli creating anexaggerated response of the sympathetic

nervous system Over-distended bladder, bowel impaction,

urinary infection, or other infection (likepressure sore, ingrown toe nail)

Occurs mainly when injury is T 4-6 or higher Treatmentis to remove the aversive stimuli

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Med. Complication:Orthostatic Hypotension

Also called postural hypotension

Dramatic fall in BP when upright

posture is assumed Disturbed vasomotor control with

decreased blood supply returning toheart

Occurs mainly with injury T4-6 orhigher, with increased incidence athigher levels.

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Med. Complications:Deep Vein Thrombosis

Development of a blood clotin the venous structures

Why? Tx?

Prevention

After occurrence

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Med. Complication:Heterotopic Ossification

occurs below the level of the injury

usually at major joints (esp. hips, alsoknees, shoulders, elbows)

may present w/ signs of localizedinflammation or pain, elevated skintemp, etc.

Tx- meds, radiation, operative resection(still risk recurrence)

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Incomplete SCI

Central Cord Syndrome

Caused by damage to the centralportion of the cervical cord

Corticospinal tract fibers are

organized with those controllingthe arms located most centrally,the trunk intermediately, and thelegs laterally

UE involvement with LE sparing

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Incomplete SCI

Brown Sequard Syndrome

Damage to one side of the cord Loss of function below the level of

injury of the portion of the cord

that controls voluntary motorpathways on the same side of thebody and pain and temperature onthe opposite side of the body

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Incomplete SCI

Conus Medularis andCauda Equina Injuries

Loss of motor function

Sensory function NOT markedly

impaired Extremely variable pattern withasymmetrical involvement

Nerve roots have some recoverypotential, so outlook is oftenfavorable

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Prevention