Spinal Cord Injury and Rehabilitation Technologies Flashcards
How are spinal cord injuries classified?
American Spinal Injury Association
A - complete, no motor or sensory
B - incomplete, sensory but no motor function is preserved
C - incomplete, motor function is preserved, but muscles have grade <3/5
D - incomplete, motor function is preserved, but muscles have grade >3/5
E - normal
What are some types of incomplete SCI? (5) Hint: ACPBC
- Anterior Cord Syndrome: damage to the front of spinal cord, results in impaired movement and sensation
- Central Cord Syndrome: damage to the center of spinal cord, results in loss of function in arms but some leg movement is preserved
- Posterior Cord Syndrome: damage to the back of spinal cord, experience poor coordination
- Brown-Sequard Syndrome: damage to one side of spinal cord, loss of movement on one side, loss of sensation on the other
- Cauda Equina Syndrome: injury to nerve between 1st and 2nd lumbar region, results in partial/complete loss of sensation
What are the differences between upper vs lower motor neuron lesion?
Upper: increased reflexes, increased muscle tone, no atrophy, contralateral weakness
Lower: decreased reflexes, decreased muscle tone, yes atrophy, ipsilateral weakness
Functional consequences of the spinal cord (15)
Spinal cord reflexes, spinal shock, breathing, neurogenic shock, altered temp regulation, autonomic hyperreflexia, deep vein thrombosis, swallowing, bowel control, bladder control, skin, muscles and tendons, bones and joints, pain, sexuality
Stats on incidence rates of SCI
In Canada, 4300 new cases/year (86k total)
Highest rate occurs between ages 16-30
Less than 1% have complete neurological recovery
92% of sports injuries result in quadriplegia
Survival: 85% who survive first 24h will survive 10 years
Causes of death: pneumonia and septicemia
Costs: annually $3.6B in Canada
What do Quads vs Paras wish for?
Quads: Arm function, sex, trunk stability, bladder/bowel, walking
Paras: Sex, bladder/bowel, trunk stability, walking
What are the two stages of treatment for SCI?
Acute phase: begin at time of injury until stabilized, determine prognosis, maintain breathing, prevent shock
Rehabilitation: works towards patients’ independence
What technology is used in treatment for SCI?
Wheelchairs, computer adaptations, electronic aids, robot gait training, electrical stimulation
Epidural spine stimulation and robotic exoskeletons
What is body weight support locomotor retraining?
BWS locomotor retraining helps re-develop walking skills while unweighted; worked in improving locomotor activity in spastic paretic patients; with training they could take more of their body weight
How does BWS locomotor retraining work?
Training generates neuroplasticity within the spinal cord. Connections can be “strengthened” or “diminished” with training
Relevant afferent connections are load on the extensors and hip flexors stretch afferent
Effects of BWS locomotor retraining?
Independence of improvement in voluntary motor scores (ASIA standards /50 and Walking Index for SCI 0-19)
What robots are used for BWS retraining?
Lokomat and Lokohelp (holds you while you’re on a treadmill)
Driven gait orthosis (moves the legs)
What are some examples of exoskeletons?
- ReWalk
- EKSO
- Vanderbilt Indego
What are exoskeletons?
External skeleton that supports and protects an animal’s body, in contrast to the internal skeleton
What are design considerations of exoskeletons? (7)
- Power supply
- Strong but lightweight skeletal components
- Lightweight actuators
- Joint Flexibility
- Power control and modulation
- Detection of incorrect/unsafe motions
- Pinching/joint fouling
Comparison of exoskeletons
Slide 39
What is WalkAide?
FES for walking, prevent foot drop by stimulating peroneal nerve with surface electrodes
What is Parastep-1?
Only FES device for walking that has FDA approval. Elaborate system to be used by complete or incomplete paraplegics when they want to walk
Epidural Spinal Stimulation for regaining movement
Epidural stimulation involves implanting electrodes in the space between the dura mater and arachnoid, stimulation active neural networks; used to alleviate pain and help with bladder/bowel control
Results of man after epidural stimulation? (3)
- Able to achieve full weight-bearing standing with some assistance
- Locomotor patterns observed were optimized for stepping
- 7 months after implantation, subject recovered some supraspinal control of leg movements (only with electrical stim)
Explain how brain-spinal interface work
2 ECoG recording electrode grids in sensorimotor cortex and stimulating paddles electrodes epidurally in the spinal cord.
Mapped lower limb movements with electrodes in the brain.
After time, subject was able to get back to a natural walking pattern
