Spinal Cord Injury

Question 1

Tetraplegia

Answer 1

Lesions in the cervical (C) region

Question 2

Paraplegia

Answer 2

Lesions in the thoracic (T), lumbar (L) and sacral (S) regions

Question 3

Spinal cord injury results in

Answer 3

• tetraplegia
• paraplegia
• complete or incomplete loss of somatic, sensory, and autonomic functions below the lesion level
• spinal bifida
• physiologic impairment
• autonomic troubles
• segmental neuromuscular troubles

Question 4

SCI C4

Answer 4

artificial support for breathing

Question 5

SCI C5-C8

Answer 5

Control of shoulder, elbow and wrist, decreased hand function

Question 6

SCI T1-T6

Answer 6

• Autonomic dysreflexia (an uncoordinated, spinally mediated reflex response called the mass reflex)
• Poor thermoregulation
• Orthostatic hypotension
• Diminished breathing capacity

Question 7

SCI T6-L2

Answer 7

Respiratory and motor control depends on abdominal muscles

Question 8

SCI L2-S2

Answer 8

Lack of voluntary control

Normal upper extremities

Question 9

SCI statistics

Answer 9

50% of those with SCI have tetraplegia
80% are men
SCI’s that are traumatic often occur at an early age
Individuals with SCI have a high risk for the development of secondary complications

Question 10

Secondary complications of SCI

Answer 10

shoulder pain, urinary tract infection, skin pressure ulcers, osteoporosis, chronic pain, problematic spasticity, depression, CVD, obesity, Type 2 DM

Question 11

Causes of SCI

Answer 11

Motor vehicle accidents, falls, sports, violence, surgical complications, infection, tumor

Question 12

Primary Injury

Answer 12

an acute SCI

Question 13

Secondary Injury

Answer 13

• Systemic injury to neurons and cells nearby
• Cellular Injury 1
• Cellular Injury 2

Question 14

Cellular Injury 1

Answer 14

Reperfusion of ischemic area leads to free radicals, excitotoxicity, neuronal malfunction, death

Question 15

Cellular Injury 2

Answer 15

Neutrophils, macrophages, pro-inflammatory cytokines glial scars
(These are barriers to regeneration and recovery)

Question 16

Systemic injury to neurons and cells nearby

Answer 16

hypotension, hypoxia

Question 17

Pathophysiology of primary injury

Answer 17

Neuronal damage/disruption 
-spinal cord, axon, demyelination, cell death 
Cytokine release
-pro-inflammatory
-ATP
-Potassium 
Hemorrhage

Question 18

Primary Injury Processed

Answer 18

Inhibitory Proteolgycan scar
Limited Scwann cell remyelination
Restricted axonal regrowth

Question 19

Restricted Cycle of Deconditioning

Answer 19

SCI-Muscle paralysis-less physical activity-lower fitness/less mobile-change in body (more fat, less muscle)-high risk factors/chronic diseases

recurring arrow from high risk factors and then even less physical activity

Question 20

associated complications for management of SCI includes

Answer 20

skin, bones, orthopedic, stabilization, handgrip or foot placement, bladder and bowels, illness, hypotension or hypertension, pain

Question 21

Exercise Response to SCI

Answer 21

Limited mobility,
Restricted peak values (approx 1/2) of power output, oxygen consumption, cardiac output
Orthostatic and exercise hypotensive
peak HRs typically do not exceed 120 bpm

Question 22

Considerations for Exercise testing

Answer 22

Purposes of the exercise test
Level of the SCI
The physical fitness level
To optimize equipment and protocol selection

Question 23

Initial Exercise Testing

Answer 23

A functional assessment should be taken like

trunk ROM, wheelchair mobility, transfer ability, upper and lower extremity involvement

Question 24

Cardiorespiratory endurance training

Answer 24

arm ergometer, cycle ergometer, wheelchair ergometer, rowing

Question 25

Voluntary arm ergometry

Answer 25

easiest way to perform the reference method may not be accurate

Question 26

Stationary wheelchair roller system, motor-driven treadmill

Answer 26

allow for realistic stimulation of external condition | like slope and speed alterations

Question 27

Treating post exercise hypotension and exhaustion with...

Answer 27

rest, recumbency, leg elevation, and fluid ingestion happens mostly with max effort exercise with tetraplegia patients

Question 28

Exercise Rx (wheelchair)

Answer 28

Develop Joint Contracture

Question 29

Wheel chair positioning could lead to

Answer 29

muscle spasticity | tight hip flexors, hip adductors and knee flexors

Question 30

Excessive wheelchair pushing and manual transfers can lead to

Answer 30

anterior chest and shoulder issues

Question 31

Needed in Exercise Rx because of wheelchair

Answer 31

Upper Extremity stretching (prime movers) and strengthening (antagonists) program is needed to promote muscular balance around the joints

Question 32

How to prevent upper extremity overuse

Answer 32

Vary excessive modes Strengthen the muscles of the upper back and shoulder Stretch muscles of anterior shoulder and chest

Question 33

examples of exercise Rx

Answer 33

Arm cranking Wheelchair ergometry Wheelchair propulsion on treadmill or rollers Free-wheeling Swimming Wheelchair basketball, quad rugby and racing arm-powered cycling ambulation with crutches and braces seated aerobic exercises electrically stimulated leg exercise (ESLCE)

Question 34

Patients with SCI tend to have

Answer 34

depression, cognitive impairment and learning disability, osteopenia, osteoporosis, bradycardia, hypotension, small improvements, and they should have a thermally neutral environment

Question 35

what is autonomic dysreflexia? and results?

Answer 35

uncontrolled emptying of bladder or bowels autonomic dysreflexia results in an increased release of catecholamines Increases HR, VO2 BP and exercise capacity Excessively high levels of BP (SBP 250-300 mm HG and/or 200-220 mm HG) STOP EXERCISE, SIT UPRIGHT, IDENTIFY AND REMOVE THE IRRITATING STIMULUS like a catheter, leg bag, tight clothing, or braces

Question 36

SCIS above t6 specifically those with complete tetraplegia

Answer 36

are at risk of decreased cardiovascular performance

Question 37

Why at T6 + tetraplegic patients at risk for decreased cardiovascular performance

Answer 37

no cardiac sympathetic innervation with their HR peak limited to 115-130bpm

Question 38

High spinal lesions during exercise

Answer 38

patients with high spinal lesions may reach their peak HR, cardiac output, and VO2 at a lower exercise level than those with paraplegia with lesion levels below T5 to T6

Question 39

Symptoms to watch for during exercise (medical attention symptoms)

Answer 39

headache, piloerection, flushing, gooseflesh, shivering, sweating above the lesion level, nasal congestion, and bradycardia

Question 40

BP where athletes should not be able to compete/start the event

Answer 40

SBP > or equal to 180 mm Hg

Question 41

Hemodynamic Effects (special considerations)

Answer 41

Individuals with higher SCI levels (tetraplegia) -may benefit from use of lower body positive pressure through applying compressive stockings, an elastic abdominal binder, or electrical stimulation to leg muscles

Question 42

Beneficial hemodynamic effects

Answer 42

(during arm work to compensate for blood pooling below the lesion) - maintenance of BP - lower HR - higher stroke volume

Question 43

Proper exercise for patients with SCI

Answer 43

can reduce the prevalence of secondary complications and improve quality of life

Question 44

before FITT principle is tested or exercise Rx

Answer 44

the level of SCI lesion must be taken into account

Question 45

Individuals with SCI have...

Answer 45

compromised thermoregulatory responses to exercise