Neuromuscular condition 2: Spinal Cord Injury Flashcards
What is spinal cord injury
A complete or incomplete loss of somatic, sensory and autonomic functions below the lesion level
Lesions in the cervical region typically result in
Tetraplegia
Lesions in the thoracic, lumbar and sacral regions lead to
Paraplegia
C4 in the spine is
Artificial support for breathing
C5 - C8 in the spine is
Control of shoulder, elbow and wrist
Decreased hand function
T1 - T6 in the spine is
Autonomic dysreflexia
Poor thermoregulation
Orthostatic hypotension
Diminished breathing capacity
What is Autonomic dysreflexia
An uncoordinated spinally mediated reflex response called the mass reflex
T6 - L2 in the spine is
Respiratory and motor control depends on abdominal muscles
L2 - S2 in the spine is
Lack of voluntary control
Normal upper extremities
Approx how many spinal cord injury possess tetraplegia
How many in men
50%
80% are men
Spinal cord injury of traumatic origin usually occurs at
Early age
Individuals with spinal cord injury have ______ for developing secondary complications
High risk
What causes spinal cord injury
Accidents
Infection
Tumor
What injuries are result of spinal cord injury
Paraplegia
Tetraplegia
Segmental neuromuscular
Autonomic
physiologic impairment
Spinal bifida
Primary injury refers to
Acute spinal cord injury
Such as: Contusion Shear Compression Laceration Stretch
Secondary injury refers to
Systemic injury to neurons and cells nearby
Cellular injury 1
Cellular injury 2
Systemic injury to neurons and cells nearby involves
Hypotension
Hypoxia
Cellular injury 1 involves
Reperfusion of ischemic area
Leads to free radicals
Excitotoxicity
Neuronal malfunction
Death
Cellular injury 2 involves
Neutrophils
Macrophages
Pro inflammatory cytokines
Glial scars
What are the barrier to regeneration and recovery
Cell necrosis
Cell apoptosis
Myelin loss
Oligodendrocyte
Glial scar
Cyst formation
Myelin matrix inhibition
Primary injury acutely leads to
Which then leads to
Also causes
Neuronal damage/disruption
Spinal cord, axon, demyelination and cell death
Also:
Cytokine release
Hemorrhage
Primary injury processed leads to
Inhibitory proteoglycan scar
Limited schwann cell remyelination
Restricted axonal regrowth
What is the cycle of deconditioning
Spinal cord injury
Muscle paralysis
Less physical activity
Lower fitness
Change in body - more fat and less muscle
High risk factors/chronic disease
Causes more of cycle to occurs
Management and medication for spinal cord injury is
Complex due to associated complications
List is on slide 12
What is the exercise response to spinal cord injury
Limited mobility
Restricted peak values (around half)
Orthostatic and exercise hypotensive
Peak heart rate typically do not exceed 120 bpm
What is the exercise testing for spinal cord injury INITIALLY
Function assessment
Such as trunk ROM, wheelchar mobility
Allows to facilitate choice of exercise equipment etc
What should we consider when doing exercise testing for spinal cord injury
The purpose of the exercise test
The level of spinal cord injury
The physical fitness level
To optimise equipment and protocol selection
What cardioresipiratory exercise test can be done for spinal cord injury
Arm ergometer
Cycle ergometer
Wheelchair ergometer
Rowing
Arm ergometry is
The easiest way to perform
The reference method
May not be accurate
Stationary wheelchair roller system allows for
Realistic simulation of external condition
What is vital to do after exercise testing in patients with tetraplegia
To treat for post exercise hypotension and exhaustion with: Rest, Recumbency, Leg elevation Fluid ingestion
What should spinal cord injury patients exercise prescription consist of
Wheelchair mobility:
Develop joint contracture
Muscle spasticity and position in wheelchair
Excessive wheelchair pushing and manual transfers
Upper extremity stretching and strengthening program needed to promote muscular balance around joints
Prevent upper extremity overuse
Why do spinal cord patients who are prescribed exercise need to have upper extremity stretching and strengthening
To promote muscular balance around joints
What are the special considerations (conditions) for patients with spinal cord injury
Depression
Cognitive impairment and learning diability
Osteopenia
Osteoporosis
Bradycardia
Monitor blood pressure - due to hypotension
Spinal cord injury patients should do what before exercising
Why
Empty bowels and bladder
Due to autonomic dysreflexia can be triggered by a full bladder or bowel distension
Decreased cardiovascular performance be found in in individuals with
Why is this
Complete spinal cord injury above T6
Have tetraplegia
They have no cardiac sympathetic innervation with HRpeak limited to 115 - 130 bpm
Individuals with high spinal lesions may reach their ______, ________, and _______ at ________ than those with paraplegia with lesion levels below T5 to T6
Peak HR
CO
VO2
At lower exercise levels
During exercise what does autonomic dysreflexia result in
Increased release of catecholamines
Increases HR, VO2, BP and exercise capacity
Excessive BP elevation 250-300 mmHG SBP
If there has been an increase release of caecholamines from autonmoic dysreflexia, what is immediate emergency response
Stop exercise
Sit upright to decrease BP
Identify and remove the irritating stimulus
If serious symptoms persist what is required
Medical attention
In competition, athletes with a resting SBP of greater or equal to 180 mm HG should
Not be allowed to compete
Individuals who have higher spinal cord levels such as tetraplegia may benefit from
use of lower body positive pressure
Such as:
Compressive stockings
Electrical stimulation to leg muscles
What is the bottom line for spinal cord injury patients
Proper exercise and physical activity reduce the prevalence of secondary complications
Level of spinal cord lesion must be considered
Individuals with spinal cord injury have compromised thermoregulatory responses to exercise - problem with endurance exercise
