Spinal Cord Injury

Question 1

General Stats

Answer 1

Incidence 25 025/ million

Average age 31.7

82% male

Question 2

Etiology

Answer 2

MVC 37%

Violence 27%

Falls 21%

Sports 7.1%

Other 8%

Question 3

Tetraplegia

Answer 3

Due to injury to cervical segments of spinal cord

Sensory +/- motor function in arms, trunk, legs

Question 4

Paraplegia

Answer 4

Due to injury to thoracic, lumbar, or sacral segments of spinal cord

Sensory +/- motor function in trunk, legs

Both loss of bowel, bladder, sexual function

Question 5

Functional Outcome C1-C4

Answer 5

Supported ventilation

Dependent for transfers, self-care

Environmental control

Power chair with tilt/recline for pressure and hypotension relief

Question 6

Functional Outcome C5

Answer 6

Elbow flexion plus orthoses can allow self-care and mobility

Feeding, oral-facial hygiene, table top communication

Other ADL dependent

Manual chiar indoors, power wheelchair

Question 7

Functional Outcome C6

Answer 7

Radial wrist extension

Tenodesis orthosis

Feed, facial hygiene, dressing

Sliding board transfers

Manual wheelchair

Driving adapted van

Question 8

Functional Outcome C7-C8

Answer 8

Triceps, finger extension, wrist flexion at C7

Improves transfers and mobility

Independent bed mobility, dressing facial hygiene, transfers

Finger flexion at C8

Total independence with wheelchair

Can drive car

Question 9

Thoracic

Answer 9

Total independence at wheelchair level

Below T1 hand function is normal

Intercostals and abdominals present the lower the lesion

May do some standing and walking with KAFOs or RGOs

Question 10

Lumbar

Answer 10

Independent at wheelchair level

Community ambulators have control of pelvis, hip flexors, 1 quadriceps, proprioception in hips and ankles, usually T12 or below

Require KAFOs, AFOs plus canes or crutches

Question 11

Spasticity

Answer 11

Common

Develops in first few months, initially flexor then extensor

Treat if interfering with function, positioning, transfers, sleep, or causes pain or deformity

Physical

Pharmacologic: oral, injected, intrathecal

Question 12

Heterotropic Ossification

Answer 12

Abnormal bone formation in soft tissues around hips, knees, shoulders, and elbows

Occurs in 16-53% of SCI patients, but only 18-37% have a significant ROM limitation

Usually occurs within 1st 6 months after injury, rare after 1 year

Treatment: ROM, drugs, surgery

Question 13

Autonomic Dyreflexia

Answer 13

Acute syndrome of massive sympathetic discharge, occurs as a result of noxious stimuli, with spinal cord lesions above T6

Hypertension, headache, sweating, nasal congestion, flushing, reflex bradycardia

Occurs in 48-83% of tetraplegic and high paraplegic patients

Treatment: sit up, remove noxious stimulus, drugs

Question 14

Syringomyelia

Answer 14

Post-traumatic cystic myelopathy

Occurs in 0.3-3.2%, as early as 2 months

Pain and numbness, weakness, cranial nerve findings

Treatment: surgical

Question 15

Osteoporosis

Answer 15

Occurs below the level of the injury

Spine relatively spared

At risk for fractures

No good treatment

Question 16

Pain

Answer 16

Common

Peripheral nerve pain

Central spinal cord pain

Visceral pain

Muscle and mechanical pain

Psychogenic pain

Question 17

Tendon Transfers

Answer 17

Can be useful for C5 and C6 levels

Allow wrist flexion and elbow extension

Question 18

FNS

Answer 18

Implantable neuroprostheses

Walker systems