Spinal Cord Injury

Question 1

What is a Spinal cord injury?

Answer 1

Loss of motor and sensory function due to damage or disease to the spinal cord

Question 2

Demographics of SCI:

Answer 2

• Typically considered 16 – 30 but now rising to 40

- ~ 80% male

Question 3

Aetiology of SCI:

Answer 3

• Motor vehicle accidents, falls, violence, gunshot, and sports injuries
• Diseases such as infections, cancer

Question 4

Signs and symptoms:

Answer 4

Sensory and motor loss
Above T1: Tetraplegia (complete, incomplete)
Below T1: Paraplegia (complete, incomplete)

Question 5

How do you classify SCI:

Answer 5

By: 
- mechanism
- level
- degree of injury
- syndrome
ASIA scale

Question 6

What are the factors of mechanism in SCI?

Answer 6

Flexion
Hyperextension
Rotation (either flexion- or extension-rotation) or
Compression Injury

Question 7

What levels are affected in SCI?

Answer 7

• cervical
• thoracic
• lumbar

Question 8

Describe the degree of injuries in SCI:

Answer 8

• complete

* incomplete / partial

Question 9

What syndromes can cause SCI?

Answer 9

• Cauda equina syndrome
• Conus medullaris syndrome
• Brown-Séquard syndrome
• Anterior cord syndrome
• Central cord syndrome
• Posterior cord syndrome

Question 10

What level is the Central cord syndrome most likely to occur in?

Answer 10

Cervical

Question 11

What mechanism causes Anterior cord syndrome?

Answer 11

• Usually a flexion injury
• Sudden, complete motor paralysis at lesion and below
• Touch, position, vibration and motion sensation intact
• Decreased pain and temperature sensation below site

Question 12

What level is the Posterior cord syndrome (rare) most likely to occur in?

Answer 12

Cervical

Question 13

What are the consequences of Posterior cord syndrome ?

Answer 13

• Dorsal columns damaged resulting in loss of
proprioception
• Pain, temperature sensation and motor function remain
intact

Question 14

What is Brown-Séquard syndrome

Answer 14

• Damage to one half of the cord on either side
• Trauma, tumour, infection (Tb), MS
• Hemiparalysis
• Hemianaesthesia on opposite side

Question 15

Describe the ASIA Classification Scale:

Answer 15

A = Complete
No motor or sensory function in the sacral segments
B = Incomplete
No motor but sensory function below the neurological level and sacral segments (s4-s5)
C = Imcomplete
Motor function preserved below neuro level and more than half of key muscles below the neuro level have a muscle grade less than 3
D = Incompete
Motor function preserved below neuro level and more than half of key muscles below the neuro level have a muscle grade more than 3
E = Normal
Normal motor and sensory function

Question 16

Conventional therapies of SCI:

Answer 16

Surgical decompression
Spine stabilisation
Physical and occupational therapy
Treatment of co-morbidities

Question 17

Role of aerobic exercise in rehabilitation of SCI:

Answer 17

Improve circulation
Improved respiratory function
Re-conditioning

Question 18

Acute response to exercise:

Answer 18

• Tetraplegics’ blunted tachycardia
• Low V02 peak for tetraplegics and high-lesion paraplegia
• Inverse relationship between lesion level and peak power

Question 19

What is Autonomic dysreflexia?

Answer 19

• Severe paroxysmal hypertension (episodic high blood pressure)
• A medical emergency requiring immediate attention
• Occurs most often for lesions above T6
• It is a reaction of the autonomic (involuntary) nervous system to overstimulation associated with:
• throbbing headaches
• profuse sweating
• nasal stuffiness
• flushing of the skin above the level of the lesion
• bradycardia
• apprehension, anxiety
• sometimes accompanied by cognitive impairment

Question 20

Exercise Recommendations:

Answer 20

Aerobic 2 times a week, gradual progression to 20 minutes a session at a moderate to vigorous intensity
For example:
Arm crank ergometry (ACE)
Wheel chair ergometry (WErg)
Body weight supported treadmill
Resistance - 2 times a week, 1 set of 8-10 reps, gradually increase
Example: Dumbells, resistance bands