Spinal Cord Injuries

A spinal cord injury (SCI) is an incomplete to

a complete loss of somatic, sensory, and

autonomic functions below the lesion level.

Cervical lesions typically result in

quadriplegia, also known as tetraplegia

Thoracic and lumbar lesions typically result

in paraplegia

Roughly 250,000 to 400,000 U.S. citizens

have an SCI.

Reportedly 52 new injuries per million per

year.

40% die before reaching a hospital.

Men suffer from SCI injuries 4 times as

frequently as women.

77% of SCI injuries occur in individuals

between 16 and 45 years old.

Most SCI injuries occur in young men involved

in motor vehicle collisions

Acts of violence

Falls (mostly in the elderly population)

Sports injuries (mostly diving)

Motor paralysis

Sensory loss

Hyperflexia

Flaccidity

Hypotension

Pulmonary dysfunction

Neurogenic bladder

Neurogenic bowel

Impaired or absent voluntary motor function

Impaired or absent sensation

Brisk deep tendon reflexes, spasticity, clonus

Flaccid paralysis with absent deep tendon

reflexes

Dizziness or loss of consciousness

Require accessory muscles of respiration

Urinary incontinence, urinary tract infection

Fecal incontinence, constipation

SCI injuries are largely diagnosed based on

the physical examination according to the

American Spinal Injury Association’s criteria.

Motor function sensory levels are assessed by

pinprick and light touch tests.

Electrodiagnostic studies are used, most

notably somatosensory evoked potentials.

Spine is considered unstable when two or

more of the spinal columns are damaged.

Syndrome Cause Physiological deficits

Central cord

syndrome

Incomplete cervical spinal cord

injury with cord damage

Weakness, sensory deficits in upper extremities (less in

lower)

Brown-Sequard

syndrome

Unilateral cord lesion Ipsilateral proprioceptive and motor deficit;

contralateral pain impairment and temperature deficit

below level of injury

Anterior cord

syndrome

Anterior cord ischemia

(T10-L2)

Below level of injury, pain impairment and temperature

deficit

Conus medullaris

syndrome

Upper and lower motor

neuron damage

Bowel, bladder, lower-extremity areflexia, and

flaccidity; preserved or facilitated reflexes

Cauda equia

syndrome

Lumbsacral nerve root injury Bowel, bladder, and lower-extremity areflexia and

severe dysesthetic pain

American Spinal Injury Association’s criteria

Can be used to establish a relationship

between fitness and posttraumatic return to

gainful employment.

Determine how the fitness level of a person

with SCI changes over time.

Arm crank ergometry is the most often used

test mode with SCI.

Protocols should employ incremental graded

advances.

Wheelchair ergometry results in similar or

greater VO2peak responses.

The arm crank or wheelchair ergometer

should be adjusted appropriately.

Straps applied to torso improve trunk

stability.

Wheelchair gloves may be worn to prevent

blisters, lacerations, and abrasions.

Autonomic dysreflexia resulting from recent

fracture

Orthostatic hypotension, with the risk of

syncope

Recent deep vein thrombosis or pulmonary

embolism

Pressure ulcers

Active tendinitis

Chronic heterotopic ossification

Peripheral neuropathy

Pressure ulcers of grade 2 or less

Spasticity

Should focus on the typical parameters.

Developed by a team composed of an

exercise physiologist, a physical therapist,

and a physician.

Begin exercise under the supervision of

either a physical therapist or a clinical

exercise physiologist.

Aerobic training:

F: 3-7 days per week

I: RPE 11-14; 50% to 85% VO2 peak or peak power

output; 30% to 80% HR reserve; 60% to 90% HR

peak; Talk test

T: 20-60 minutes, continuous or interval

T: Wheelchair ergomentry, Arm crank cycling,

seated aerobics, aquatics, and community

wheeling.

Resistance training:

F: One to three sets on 2-3 days per week

I: 8-12 reps at 60-75% 1 RM

T: 30-60 min.

T: Elastic bands, wrist weights, body weight,

body weight, dumbbells, free weights.

Patients should empty their urinary bag

before exercising because autonomic

dysreflexia can be triggered

Decreased cardiovascular performance may

be found in individuals with complete spinal

cord lesions above T6.

Novice and unfit participants will suffer from

peripheral fatigue before any central training

effect is achieved.

Thompson, W.R., Gordon, N.F., & Pescatello,

L.S.(Eds.). (2009). ACSM’s guidelines for

exercise testing and prescription. New

York, NY: Wolters Kluwer