Spinal Cord Injury Flashcards
What is a SCI?
Quadraplegia and Paraplegia acquired through some kind of trauma
Causes and % (5)
- 48% Motor vehicles
- 21% Falls
- 14% Violence
- 14% Sport injuries
- 3% other
Number 1 cause of SCI
Diving (pool, lake)
Incidence - new cases and number of Canadians
- 1100 new cases per year
- 44 000 Canadians live with SCI
Incidence - annual health care cost
3.6 billion
Incidence - lifetime health care cost/ person
between 1.6 and 3 million depending on the severity and the age.
Incidence - gender, age and why
- 80% male
- between 16 and 30 years
- takes more risks
Lesions - types and %
- Complete (50%)
- Incomplete (50%)
Lesions - most common type in the past
- more complete lesions vs incomplete
Lesions - why decrease in complete lessions (3)
- Meds
- Car safety belt + airbag
- Paramedics (spinal immobilization)
Organization of the nervous system - sensory information
somatosensory system (cutaneous & proprioceptive info) -> Ascending pathways (dorsal tracts)
Organization of the nervous system - motor commands
motor commands -> descending pathways (ventral tracts)
Severity of condition - depends on
- Level of lesion
- Whether it is complete or incomplete
Severity of condition - Quadriplegia
- also known as Tetraplegia
- involve all 4 limbs and trunk
- Cause : cervical segment
Quadriplegia - most common vertebrae and why
C5-C6 because of car accident
Quadriplegia - Vertebrae important for wheelchair users
C7 because it innervates the tricep = elbow extension
Severity of condition - Paraplegia
- involve lower limbs and trunk (if higher than lumbar)
- Cause damage to thoracic or lumbar spine
Paraplegia - complete lesions (3 types)
- T1 to T6 = no sitting balance
- T7 to L1 = some useful sitting
- L2 and lower = normal trunk control
- important for wheelchair sports
Health concerns in SCI (6)
- Sensation loss
- Contractures and injury prevention (Spasticity)
- Lower limb atrophy
- Osteoporosis
- Weight management
- ANS dysfunction
Sensation loss - complete lesion
total loss below lesion
Sensation loss - incomplete lesion
- partial loss below lesion
- Lose some sensations
- Vulnerable to injury
Contractures - spasticity
- Shortening and tightening of muscles
- Flexor in upper limbs
- Extensor in lower limbs
Injury prevention - spasticity
Stretching 2x / day (full ROM)
Lower limb atrophy, osteoporosis and weight management - why common (not in exam)
- decreased in muscles contraction (paralysis)
- decreased in mechanical loading
- decreased in energy expenditure
Weight management
more prone to hypokinetic diseases
What does ANS stands for?
Autonomic Nervous System
ANS - regulation
- Regulates involuntary function
ANS - sympathetic system during exercise
- Increase heart rate
- Increase blood pressure
- Constrict blood vessels
ANS - origin of cardiac sympathetic fibers
T1-T4 (partly T5)
ANS dysfunction- sympathetic system during exercise
- Decrease heart rate
- Decrease blood pressure
- Impairment of vasoconstrictor function = decrease blood to heart = decrease oxygen = early fatigue
- Sweating impairments
ANS dysfunction- In which condition can it be present
- Quadriplegics
- High paraplegics (T5 and above)
ANS signal origine
Brainstem
High intensity training in SCI, causes and symptoms
- May not be tolerated for quadriplegics and high paraplegics because of hypotensions
- Cause: sympathetic nervous system (ANS dysfunction)
- Symptoms : dizziness or nausea
Recommendations for Exercise programming (3)
- Decreased cardiovascular capacity
- Decreased endurance
- Decreased active muscle mass during exercise
Decreased % cardiovascular capacity and endurance - paraplegics
- decreased 50 %
Decreased % cardiovascular capacity and endurance - quadriplegics
- decreased 75%
Recommendations for Exercise programming - decreased muscle mass
- Lower limb muscle = 2/3 of muscle mass
- Quadriplegics = greater loss of cardiovascular capacity = greater loss than paraplegics
Recommendations for Exercise programming - When ANS dysfunction is present
- Decreased drive from sympathetic nervous system
- Max heart rate 110-120 beats/min
Cardiovascular training may include (3)
- Arm Ergometer
- Locomotor training with crutches or body weight support
- Wheelchair propulsion using rollers
Cardiovascular training - Arm Ergometer
- Suitable for use at home or center
- Workload can be adjust
- Grips cuffs used for quadriplegics
Cardiovascular training - Locomotor training with crutches or body weight support
- Increase muscle strength and bone mineral density
- Prevent pressure sore by increasing blood circulation
Cardiovascular training - Wheelchair propulsion using rollers
rollers are to wheelchair what treadmills are to ambulatory runners
Prevention upper extremity overuse syndromes
- Vary exercises from week to week
- Strengthen muscles of upper back and posterior shoulder
- Stretch muscles of ant. should and chest
Prevention contractures and injury
- Stretching exercises for both extremities
Seated flexibility exercises (4)
- Chest Stretch
- Shoulder Retraction
- Triceps Stretch
- Seated Chest Stretch in doorway
Why most spinal cord injured persons prefer wheelchair over crutches and braces ?
To save energy especially for long distance
Sports wheelchair common characteristics
- No push handle
- Not foldable = more solid
- Wheel camber
- Anti-tipping support
Which characteristics is common in all wheelchair except racing wheelchair?
Anti-tipping
Characteristics - basketball wheelchair (5)
- Fixed camber bars
- Anti-tipping support
- Quick release wheels
- Rollerblade casters
- Adjustable back and footplate height
Characteristics - rugby wheelchair (5)
- Fixed camber bars
- Anti-tipping support
- Cross spoked wheels + quick release
- Rollerblade casters
- Adjustable back and footplate height
Racing Wheelchair - camber angle
11 to 15 degree
Racing Wheelchair - cage
Build according to body dimensions
Racing Wheelchair - frame
Made of aluminum
Racing Wheelchair - Steering
Maneuver the front wheel during sharp turns
Racing Wheelchair - Tires
Preferably tubular tires
Racing Wheelchair - Hand ring
Used for propulsion (push from 12 to 9)
Racing Wheelchair - Fenders
Protection for torso and arms
Wheelchair propulsion - 2 types
- Short propulsion thrust
- Long-duration circular-propulsion thrust
Wheelchair propulsion - short propulsion
- ADL, most sport except racing
- Pushes forward and downward (noon to 3 o’clock) and trunk moves forward
- Handrims release at 3 o’clock and trunk return upright
Wheelchair propulsion - Long-duration circular-propulsion
- track and marathon racing
- Contact with handrims through 3/4 of the circle, applying force the entire time
- Trunk in flexion
- Final propulsion thrust is the shoulder extension
Wheelchair basketball - characteristics (7)
- 5 players / team
- Net 10 feet
- 3 sec in the key
- Dribble, shoot or pass after 2 pushes
- No double dribble rule
- Can’t raise butt off chair
- Open to able-bodied (no major comp)
Wheelchair basketball - classification for International Wheelchair Basketball Federation
- Have a permanent physical disability in lower limbs (can’t run, jump and pivot)
- Classification based on observed trunk mvt and stability during basketball competitions (not based on medical diagnosis )
Second most common condition after SCI in wheelchair basketball?
Amputation
Adapted Tennis - characteristics (6)
- Individuals or pairs
- **Ball may bounce once or twice **
- Scoring is the same
- Played by people w/ paraplegia and quadriplegia
- Created in 1976 (USA)
- More than 6000 players
Adapted Rugby - characteristics (7)
- Score points by carrying the ball over opponents’ goal line
- Very fast, contact team sport
- Play w/ volleyball for easier manipulation
- Played w/ hands or forearms
- Must dribble or pass at least every 10 sec
- Goal score when goal line touch with 2 wheels
- Violation includes charging, interference, etc
