5] SCI Part 1 Flashcards
Traumatic causes of SCI
MVA Falls Violence Other Sports
Average age of spinal cord injured person is
41
56% of injuries occur ?
Between ages of 16-30 (very young)
Cause of death with SCI
Pneumonia and septicemia
41%
Incomplete tetra
Around 22%
Complete para
Around 21%
Incomplete para
Around 16%
Complete tetra
Ethnicity for SCI
Caucasian
1 year post SCI, how many are employed
12%
20 years post SCI, how many are employed?
35%
Primary patho of SCI
Mechanical damage due to deformation of spine
Secondary patho of SCI
Cascade of biochemical and cellular processes
2 corticosteroids for medical management of acute SCI
Methylprednisone (naloxone)
Tirilazad mesylate
In animal studies: (Geisler et al, 1991)
Promotes growth of nerve cells
Regeneration of damaged nervous tissues
GM-1 ganglioside
Methylprednisolone prevents (3)?
Lipid peroxidation
Post-traumatic ischemia
Destruction of neuronal and microvascular membranes
Lipid peroxidation results in
Preservation of: spinal blood flow, metabolism, Na and K homeostasis
Reduction of lipid peroxidation
Damage from high levels of extracellular calcium, excitotoxicity, protease-mediated to neuro-filament proteins
Available medical evidence does not
support a significant clinical benefit from
the administration of THIS in
the treatment of patients after acute SCI
GM-1 ganglioside
For neuropathic pain
Pregablin (lyrica)
Mechanism of action for pregabalin (lyrica)
◦ Works similar to gabapentin
◦ reduces the synaptic release of several neurotransmitters
MOA for pregabalin is that it reduced the synaptic release of several neurotransmitters by: (2)
binding to alpha2-delta subunits
Reduce neuronal excitability and seizures
Medical complications of SCI
Autonomic dysfunction
Autonomic dysreflexia
Autonomic dysfunction is a ?
Medical emergency
sensory loss, motor
paralysis, loss of bowel and
bladder control
Autonomic dysfunction
Increased BP Bradycardia Nasal congestion Pounding headache Anxiety Flushing Profuse sweating
Autonomic dysreflexia (T6 and above)
Cause of autnomic dysreflexia
Anything that can be perceived as a noxious stimulation
Treatment of autonomic dysreflexia
Immediately sit person upright
Fix problem
Medical complications of SCI
Skin breakdown DVT UTI Osteoporosis GI issues HO Pain Spasticity
Factors predisposing individuals to WHAT?
peripheral vasodilation
absent/reduced LE muscle function
immobility
hypercoagulability
trauma
sepsis
DVT
◦ Urinary Retension ◦ Reflux ◦ Kidney and bladder stones ◦ Kidney failure ◦ Septicemia
UTI complications
usually stabilizes 16 months after injury with 2/3 of original bone mass
Osteoporosis
Rapid loss in 1st 6 months
Osteoporosis
Bleeds (steroids) paralytic ileus ◦ gastric dilation - affects respiration ◦ fecal impaction ◦ bowel obstruction
GI issues
◦ Swelling, pain & local increase in temperature
◦ bone formation at a joint
Hips & knees,
Shoulders & elbows (tetraplegia only)
HO
Chronic pain, spinal cord/brain changes in makeup
Nerve root pain
Broken, bruised
Traumatic pain
Young ppl, sing arms like legs, everything is flexed forward and puts shoulders at disadvantage, impingement
MSK pain
Initial period around 2 months of areflexia
Spasticity
