Spinal Cord Injury Flashcards
What is a Spinal cord injury?
Loss of motor and sensory function due to damage or disease to the spinal cord
Demographics of SCI:
- Typically considered 16 – 30 but now rising to 40
- ~ 80% male
Aetiology of SCI:
- Motor vehicle accidents, falls, violence, gunshot, and sports injuries
- Diseases such as infections, cancer
Signs and symptoms:
Sensory and motor loss
Above T1: Tetraplegia (complete, incomplete)
Below T1: Paraplegia (complete, incomplete)
How do you classify SCI:
By: - mechanism - level - degree of injury - syndrome ASIA scale
What are the factors of mechanism in SCI?
Flexion
Hyperextension
Rotation (either flexion- or extension-rotation) or
Compression Injury
What levels are affected in SCI?
- cervical
- thoracic
- lumbar
Describe the degree of injuries in SCI:
- complete
* incomplete / partial
What syndromes can cause SCI?
- Cauda equina syndrome
- Conus medullaris syndrome
- Brown-Séquard syndrome
- Anterior cord syndrome
- Central cord syndrome
- Posterior cord syndrome
What level is the Central cord syndrome most likely to occur in?
Cervical
What mechanism causes Anterior cord syndrome?
- 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
What level is the Posterior cord syndrome (rare) most likely to occur in?
Cervical
What are the consequences of Posterior cord syndrome ?
• Dorsal columns damaged resulting in loss of
proprioception
• Pain, temperature sensation and motor function remain
intact
What is Brown-Séquard syndrome
- Damage to one half of the cord on either side
- Trauma, tumour, infection (Tb), MS
- Hemiparalysis
- Hemianaesthesia on opposite side
Describe the ASIA Classification Scale:
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
Conventional therapies of SCI:
Surgical decompression
Spine stabilisation
Physical and occupational therapy
Treatment of co-morbidities
Role of aerobic exercise in rehabilitation of SCI:
Improve circulation
Improved respiratory function
Re-conditioning
Acute response to exercise:
- Tetraplegics’ blunted tachycardia
- Low V02 peak for tetraplegics and high-lesion paraplegia
- Inverse relationship between lesion level and peak power
What is Autonomic dysreflexia?
- 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
Exercise Recommendations:
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
