23. SCI (spinal cord injury)

Question 1

Aetiology

Answer 1

80% traumatic injury (motor vehicle accidents, falls, hit by object, water related, other)
21% non-traumatic (tumour)

Question 2

Diagnosis

Answer 2

X-ray, CT scan, MRI, physical observation (movement, sensation)

Question 3

Symptomology of paraplegia

Answer 3

Damage to: spinal cord at/below T1
Affects: Lower portion of the body, legs and some/all of trunk
Results in: Partial or complete motor/sensory loss

Question 4

Symptomology of tetra/quadriplegia

Answer 4

Damage to: Spinal cord above C7
Affects: Upper and lower portion of the body (legs, trunk, arms and hands)
Results in: Partial or complete motor/sensory loss

Question 5

Symptomology of complete SCI

Answer 5

No neural messages can travel past the level of cord lesion

Results in: Total loss of movement and sensation below the level of lesion

Question 6

Symptomology of incomplete SCI

Answer 6

Some parts of the spinal cord are spared at the level of lesion, allowing some neural messages through
Some movement and sensation below level of lesion. Amount of resultant function can be minimal (toe flickers) or substantial (ambulation)

Question 7

Level of injury

Answer 7

Relates to lowest functioning level of spinal nerves (T8 level complete, T8 still functioning)
Level of injury can differ from level of bony damage (fracture at T8 but damage at T6 of spinal cord).

Question 8

C1-C4 Tetraplegia

Answer 8

C1-C3: Allows head and neck movements
C4: Allows shoulder shrug.
Fully dependent in self-care, transfers and mobility.

Question 9

C5 Tetraplegia

Answer 9

Allows shoulder control, elbow flexion, supination

Question 10

C6 Tetraplegia

Answer 10

Allows wrist extension, pronation

Tenodesis action: Wrist extension and flexion is used to grab things. Encourage stronger grip, grasp and release

Question 11

C7 Tetraplegia

Answer 11

Allows elbow extension, finger flexion/extension, wrist flexion

Question 12

C8-T1 Tetraplegia/paraplegia

Answer 12

Allows MCP flexion, finger abduction and adduction, thumb movements.
Fully independent in self-care, transfers and mobility.

Question 13

T1-T12: Thoracic paraplegia

Answer 13

Have: Innervation and function of all upper extremity muscles, including hand function
T2-T9: Variable trunk control
T10-T12: Have better trunk control

Question 14

Lumbar/sacral paraplegia

Answer 14

Can achieve functioning independence for all mobility, self-care, bladder and bowel skills

Question 15

Injury above T6:

Answer 15

Difficulties with: Temp. regulation, blood pressure, heart rate, circulation, breathing and coughing.
Have autonomic dysreflexia: If baller is too full, messages don’t travel all the way up to spinal cord. Reflex arc increases blood pressure. Bladder incontinence.

Question 16

Factors impacting independence:

Answer 16

Physical: Level of injury, completeness, age, co-morbidities, pain, UTI, pressure areas, spasm
Pscyhosocial: Mental health, motivation, socioeconomic background, social supports, problem solving, perception of disability

Question 17

Risk factors:

Answer 17

Male, aged between 16-30 (risky behaviour) or 65+. Having bone or joint disorder.

Question 18

Treatment

Answer 18

Rehab to gain independent. Using what muscles and function they do have to maximise potential independence.
Medication to assist with pain and muscle relaxation.
Assistive aids (wheelchair, etc.)
Spinal shock and immobilisation to prevent further injury,.

Question 19

Co-occurring conditions

Answer 19

Depression, diabetes, heart disease, hypertension, respiratory conditions, pressure sores