Spinal Cord Injury

Question 1

What spinal paralysis?

Answer 1

• broad term for conditions caused by injury or disease to the spinal cord and/or spinal nerves
• paralysis can be complete (total) or incomplete (partial)

Question 2

What are the two criteria assessed that determines the severity of the condition?

Answer 2

• level of lesion

- is it complete or incomplete

Question 3

What is quadriplegia?

Answer 3

• involvement of all four limbs and the trunk

- 50% of persons with quadriplegia have incomplete lesions

Question 4

Spinal paralysis involves what systems?

Answer 4

• central and autonomic nervous systems

Question 5

What parts of the body are controlled by the cervical spine?

Answer 5

• arms, hands, breathing

Question 6

What parts of the body are controlled by the thoracic?

Answer 6

• balance, trunk control, forceful breathing

Question 7

What parts of the body are controlled by the lumbar?

Answer 7

• leg and foot movements

Question 8

What parts of the body are controlled by the sacral?

Answer 8

• bowel, bladder, sexual function

Question 9

What is high level quadriplegia?

Answer 9

• complete C1 to C4 lesions
• use motorized chairs for mobility
• powerchair sports

Question 10

What is low level quadriplegia?

Answer 10

• complete C5 to C8 lesions
• use manual chairs and participate in many wheelchair sports
• wheelchair rugby

Question 11

What is paraplegia?

Answer 11

• effects the legs but often includes trunk balance as well

Question 12

Why is trunk balance so important in sport?

Answer 12

• trunk balance is the most useful criterion in determining the level of participation

Question 13

What is spina bifida?

Answer 13

• congenital defect of spinal column caused by

failure of neural arch of a vertebra to properly develop and enclose spinal cord

Question 14

Which demographics are most effected by spina bifida?

Answer 14

• girls
• caucasians
• most common in GB and Ireland

Question 15

When does spina bifida occur?

Answer 15

• occurs between the 19th and 32nd day of gestations (normally this is when the neural tube develops and closes)

Question 16

What is spina bifida Meningomyelocele/ Myelomeningcele?

Answer 16

• spinal cord and meninges protrude into sac

- surgery is required to close wound but it does not lessen disability

Question 17

What is hydrocephalus?

Answer 17

• 80% of myelomeningocele develop hydrocephalus
• present at birth or develop within first 6 weeks
• results in enlarged head, pressure on brain which
  can cause brain damage and/or death

Question 18

How is hydrocephalus treated?

Answer 18

• problem is treated with a shunt (a tube to drain off the fluid into the abdominal cavity)
• person should not hang upside down for extended periods as shunt may become blocked
• avoid different types of head trauma that may damage shunt/placement

Question 19

What are the two main functions of a shunt insertion for hydrocephalus?

Answer 19

• it allows fluid to go only in
  one direction
• the valve allows fluid to flow out only when the pressure in the head has exceeded some value

Question 20

What is spina bifida meningocele?

Answer 20

• meninges protrude (outpouching of the coverings of the spinal cord but the cord and nerves remain within vertebral column)
• paralysis is rare

Question 21

What is spina bifida occult?

Answer 21

• Posterior arches of vertebrae fail to form
• no outpouching
• does not cause paralysis or muscle weakness
• associated with back problems

Question 22

What is the different between congenital and acquired paralysis?

Answer 22

• congenital: less experience and socialization into sport

- acquired: more experience and socialization into sport

Question 23

What are some things to focus on for congenital SCI?

Answer 23

• focus on developmental activities
• development of upper body and core strength are essential
• push and pull toys, scooter boards, parachute activities, climbing/hanging, weight lifting are high priority

Question 24

What are some general considerations for physical activity with spina bifida?

Answer 24

• latex sensitivity
• cognitive functioning: perceptual-motor deficits, specific learning disabilities, and attention deficits
• Strabismus (cross eyes)
• posture and orthopaedic concerns
• atrophy of limbs

Question 25

What are some risks associated with posture and orthopaedic concerns?

Answer 25

- paralysis can cause plantar flexion, hip dislocation, toeing inward, scoliosis, hyperlordosis, gluteus medius lurch, crouched gait

Question 26

For those in wheel chairs, what are some risk factors of extended sitting?

Answer 26

- tendency for the hip, knee and ankle flexors to become too tight. This can result in contractures - ulcers or pressure sores - bruises and friction burns - obesity because of low energy expenditure

Question 27

What are some risk factors associated with the possibility of sensation and skin break down?

Answer 27

- inability to feel sensation makes persons vulnerable to injury and skin breakdown - Ex. wrinkles in socks and poorly fitted shoes or braces cause blisters that become infected –- persons with spinal paralysis should be taught to inspect their body regularly to see that all sores are cared for

Question 28

What are some issues with temperature control that people with spinal cord injuries might face?

Answer 28

- spinal paralysis above T8 renders the body incapable of adapting to temperature changes - body assumes the same temperature as the environment - special attention needs to be given to appropriate clothing, heating and air conditioning - fluid intake is related to temp control

Question 29

How can a person experiencing a spinal cord injury avoid contractors?

Answer 29

- range of motion exercises

Question 30

What are some concerns regarding spams in people who are experiencing spinal cord injuries?

Answer 30

- paralyzed muscles in people with lesions above L1 often jerk involuntary - occasional spams can actually help with circulation - when spasms are too severe several treatment options are available (physical therapy, drug therapy, nerve blocks and surgery)

Question 31

Why is it important to consider things like using the bathroom in regards to people with a spinal cord injury?

Answer 31

- Catheterization, timing of bathroom breaks - all persons with spinal paralysis above S2 have some kind of bladder dysfunction, requiring that they urinate in different ways - retention of urine leads to urinary and kidney infections which is a major cause of illness and death among persons with spinal paralysis - defecation is managed by scheduling time and amount of eating as well as by regulating time of bowel movements –- surgical procedures create an opening in the abdomen and a tube is inserted that connects to the intestine and an external bag

Question 32

Why is sexual function a concern for those who experience spina bifida?

Answer 32

- innervated by the same nerves as urinary function (S2 to S4) - lesions above the sacral region may make it necessary to alter roles, methods, and positioning for sex depending on weather the lesions are complete or incomplete - capacity for erection, ejaculation and orgasm must be evaluated individually - menstruation is not affected

Question 33

Why is the heart and circulation function an important consideration for someone with spina bifida?

Answer 33

- low resting heart rates - maximum heart rates and target zones used in aerobic exercise programs for AB persons are not appropriate in high level spinal paralysis - pooling of blood in the veins of paralyzed limbs

Question 34

Why is blood pressure a concern for someone with a spinal cord injury?

Answer 34

- baseline blood pressure with lesions above T6 is typically low - autonomic dysreflexia: sudden onset of excessively high blood pressure, slowed heartbeat, sweating, & sever headache