Spinal Cord Injury Flashcards
Tetraplegia
Lesions in the cervical (C) region
Paraplegia
Lesions in the thoracic (T), lumbar (L) and sacral (S) regions
Spinal cord injury results in
- 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
SCI C4
artificial support for breathing
SCI C5-C8
Control of shoulder, elbow and wrist, decreased hand function
SCI T1-T6
- Autonomic dysreflexia (an uncoordinated, spinally mediated reflex response called the mass reflex)
- Poor thermoregulation
- Orthostatic hypotension
- Diminished breathing capacity
SCI T6-L2
Respiratory and motor control depends on abdominal muscles
SCI L2-S2
Lack of voluntary control
Normal upper extremities
SCI statistics
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
Secondary complications of SCI
shoulder pain, urinary tract infection, skin pressure ulcers, osteoporosis, chronic pain, problematic spasticity, depression, CVD, obesity, Type 2 DM
Causes of SCI
Motor vehicle accidents, falls, sports, violence, surgical complications, infection, tumor
Primary Injury
an acute SCI
Secondary Injury
- Systemic injury to neurons and cells nearby
- Cellular Injury 1
- Cellular Injury 2
Cellular Injury 1
Reperfusion of ischemic area leads to free radicals, excitotoxicity, neuronal malfunction, death
Cellular Injury 2
Neutrophils, macrophages, pro-inflammatory cytokines glial scars
(These are barriers to regeneration and recovery)
Systemic injury to neurons and cells nearby
hypotension, hypoxia
Pathophysiology of primary injury
Neuronal damage/disruption -spinal cord, axon, demyelination, cell death Cytokine release -pro-inflammatory -ATP -Potassium Hemorrhage
Primary Injury Processed
Inhibitory Proteolgycan scar
Limited Scwann cell remyelination
Restricted axonal regrowth
Restricted Cycle of Deconditioning
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
associated complications for management of SCI includes
skin, bones, orthopedic, stabilization, handgrip or foot placement, bladder and bowels, illness, hypotension or hypertension, pain
Exercise Response to SCI
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
Considerations for Exercise testing
Purposes of the exercise test
Level of the SCI
The physical fitness level
To optimize equipment and protocol selection
Initial Exercise Testing
A functional assessment should be taken like
trunk ROM, wheelchair mobility, transfer ability, upper and lower extremity involvement
Cardiorespiratory endurance training
arm ergometer, cycle ergometer, wheelchair ergometer, rowing
Voluntary arm ergometry
easiest way to perform
the reference method
may not be accurate
Stationary wheelchair roller system, motor-driven treadmill
allow for realistic stimulation of external condition
like slope and speed alterations
Treating post exercise hypotension and exhaustion with…
rest, recumbency, leg elevation, and fluid ingestion
happens mostly with max effort exercise with tetraplegia patients
Exercise Rx (wheelchair)
Develop Joint Contracture
Wheel chair positioning could lead to
muscle spasticity
tight hip flexors, hip adductors and knee flexors
Excessive wheelchair pushing and manual transfers can lead to
anterior chest and shoulder issues
Needed in Exercise Rx because of wheelchair
Upper Extremity stretching (prime movers) and strengthening (antagonists) program is needed to promote muscular balance around the joints
How to prevent upper extremity overuse
Vary excessive modes
Strengthen the muscles of the upper back and shoulder
Stretch muscles of anterior shoulder and chest
examples of exercise Rx
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)
Patients with SCI tend to have
depression, cognitive impairment and learning disability, osteopenia, osteoporosis, bradycardia, hypotension, small improvements, and they should have a thermally neutral environment
what is autonomic dysreflexia? and results?
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
SCIS above t6 specifically those with complete tetraplegia
are at risk of decreased cardiovascular performance
Why at T6 + tetraplegic patients at risk for decreased cardiovascular performance
no cardiac sympathetic innervation with their HR peak limited to 115-130bpm
High spinal lesions during exercise
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
Symptoms to watch for during exercise (medical attention symptoms)
headache, piloerection, flushing, gooseflesh, shivering, sweating above the lesion level, nasal congestion, and bradycardia
BP where athletes should not be able to compete/start the event
SBP > or equal to 180 mm Hg
Hemodynamic Effects (special considerations)
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
Beneficial hemodynamic effects
(during arm work to compensate for blood pooling below the lesion)
- maintenance of BP
- lower HR
- higher stroke volume
Proper exercise for patients with SCI
can reduce the prevalence of secondary complications and improve quality of life
before FITT principle is tested or exercise Rx
the level of SCI lesion must be taken into account
Individuals with SCI have…
compromised thermoregulatory responses to exercise
