Spinal Cord Injury

Question 1

Who gets spinal cord injuries? How?

Answer 1

Males, 15-30

MVAs

Question 2

How do you examine someone with a spinal cord injury?

Answer 2

Full neurological exam including PR

ASIA scale for assessing extent of injury

Question 3

What are the domains that must be addressed in rehab?

Answer 3

Psychological 
Pain
Skin
Post traumatic syrinx
Autonomic
Respiratory
Spasticity
Bowels
Bladder
Sexual function
Osteoporosis
Return to work

Question 4

What do you do for psychological? Why?

Answer 4

Refer to psychology and social work for an assessment

10% of spinal cord injuries get depression

Question 5

What do you do for pain?

Answer 5

They develop neuropathic pain so use

• Amitriptyline
• Pregabalin and gabapentin

Question 6

What do you do for skin?

Answer 6

Skin checks twice daily using mirror to see unreachable areas
Regular cleaning
Regular use of emollients
ROHO cushion and pressure relieving mattress

Question 7

Why do you worry about post traumatic syrinx?

Answer 7

They commonly occur at the sight of injury

Question 8

What do you do about spasticity?

Answer 8

Daily stretching
Resistance exercises 
Treat causes of irritation that exacerbate - eg UTI
Baclofen or diazepam 
Surgery or botulin toxin 

"SPPORT"
S: Splint
P: Positioning
P: Passive
O: Other arm
R: Resistance exercise
T: Task specific perfect practice

Question 9

What do you about bladder dysfunction?

Answer 9

Short term - IDC or SPC
Long term - Males: Condon catheter plus spincterotomy, females have less options, SPC is used

For retention methods to increase intraabdominal pressure are used

Cystoscopies every year after 10 years of IDC use due to bladder Ca risk
Always get cultures before treating UTI’s (no empirical abx) then one 48 hours after starting and one more after treatment course

Question 10

What do you get with autonomic dysfunction and what triggers it?

Answer 10

Spinal dysreflexia causing hypertension if the lesion is above T6
A noxious stimulus beyond the lesion triggers it