Spinal Cord Injury Reading Flashcards
What is meant by a “bimodal distribution” for ages of people that sustain a traumatic SCI? How does this distribution interact with the top three causes of traumatic SCI?
Bimodal distribution of ages of people with a traumatic SCI means there are two separate age ranges where traumatic SCI occurs most frequently.
The first peak is people between 15 and 29 years old, and the second peak, which is smaller but growing, is in people over 50 years old.
The interaction between the age distribution and the top three causes of traumatic SCI is seen in how the causes vary between the two age peaks.
Traffic accidents are the primary cause of traumatic SCIs in North America, and sports-related injuries are also more common in younger people.
Falls, on the other hand, are more common in people over 60.
This is likely due to the increased prevalence of underlying spinal degenerative changes, such as degenerative cervical myelopathy, in older people.
The pathophysiology at the site of injury changes across 3-4 phases. What are these phases and which one is most applicable to exercise scientists?
four phases:
Acute phase (<48 hours)
Subacute phase (48 hours to 14 days)
Intermediate phase (14 days to 6 months)
Chronic phase (>6 months)
While all phases are important, the acute and subacute phases are particularly important for exercise scientists because they involve the most significant changes in cellular and physiological function.
Understanding these changes is crucial for developing appropriate exercise interventions for individuals with SCI
At what levels of the spinal cord and vertebra does it become important to distinguish between vertebral level and neurological level of the injury? Which of these levels is more relevant for thinking of neurologic impairments?
It becomes important to distinguish between vertebral level and neurological level of injury in the mid-to-low regions of the thoracic spinal cord.
This is because the spinal cord ends at approximately the L1 vertebra, and the remaining spinal nerves continue as the cauda equina.
Therefore, a fracture at T8 might cause a neurological SCI at T12, and a fracture at T12 might cause a SCI at S1.
The neurological level is more relevant for thinking about neurologic impairments, as it determines which nerve roots are affected and what functional deficits will be present.
Injury between T1 and L2 can disrupt sympathetic nervous system outflow to which tissues that are important for physiological responses to exercise?
SCI between T1 and L2 can disrupt sympathetic nervous system outflow to tissues below the level of injury. [7] This is significant because sympathetic nervous system activity is crucial for regulating several physiological responses to exercise, including:
Blood pressure: Loss of sympathetic outflow can lead to hypotension.
Heart rate: Disruption of sympathetic outflow to the cardiac pacemaker can cause bradycardia.
Blood vessel tone: Loss of sympathetic tone results in vasodilation, which affects blood flow distribution.
Thermoregulation: Sympathetic activity is essential for sweating and regulating body temperature.
What is the difference between spinal and neurogenic shock? Which one of these is most relevant to KIN 372 and what neurologic level is important and why?
Spinal shock is a temporary state of flaccid paralysis that occurs immediately following SCI.It involves the loss of motor, sensory, autonomic, and reflex function below the level of the injury.
Neurogenic shock, on the other hand, is a hypotensive state caused by the loss of sympathetic outflow to the peripheral vascular system.It is characterized by hypotension, bradycardia, wide pulse pressure, and warm pink extremities.
Neurogenic shock is more relevant to KIN 372 because it has significant implications for exercise prescription and management in individuals with SCI.
Neurological level of injury above T6 is particularly important because these injuries prevent central impulses from reaching the sympathetic splanchnic nerves, which are essential for maintaining vascular tone.
To evaluate potential vertebral fractures what imaging modality is recommended? It this the same modality that would be used to evaluate injury-induced swelling?
CT imaging is recommended to evaluate potential vertebral fractures.
CT scans are highly sensitive for detecting bone injuries, including fractures and dislocations of the spine.
MRI, on the other hand, is the preferred modality to evaluate injury-induced swelling.
MRI is more effective at assessing soft tissue structures like intervertebral discs, ligaments, the spinal cord, and nerve roots.
The T2-weighted STIR sequence in MRI allows for the identification of edema and tissue disruption, which are indicators of swelling.
Why do individuals with a Brown-Sequard type SCI have impaired motor and light touch/proprioception on one side but temperature and pain impairments on the other side of the body?
In Brown-Séquard syndrome, individuals experience impaired motor function, light touch, proprioception, and vibration sensation on the same side (ipsilateral) as the spinal cord injury.
On the opposite side (contralateral) of the body, they experience impaired pain and temperature sensation.
This distinct pattern of neurological deficits can be explained by the anatomy of the spinal cord.
The descending motor tracts (lateral corticospinal tract), responsible for voluntary movement, and the ascending tracts carrying light touch and proprioceptive information (dorsal columns) cross over to the opposite side of the brain at the brainstem.Thus, damage to these tracts on one side of the spinal cord results in deficits on the same side of the body.
The ascending tracts carrying pain and temperature information (lateral spinothalamic tract), however, cross over to the opposite side of the spinal cord shortly after entering. Therefore, damage to the lateral spinothalamic tract on one side of the spinal cord leads to deficits on the opposite side of the body.
This explanation of Brown-Séquard syndrome illustrates how specific neurological impairments can help localize the site of injury within the spinal cord.
What are the three most common secondary health conditions in individuals living with spinal cord injury (SCI) according to the review?
Three Most Common Conditions: The three most common secondary health conditions affecting individuals with SCI are pain, bowel and bladder regulation issues, and muscle spasms
These conditions are often reported with a prevalence exceeding 50%
How does the prevalence of cardiovascular disease in individuals living with SCI change with age?
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Cardiovascular Disease and Age: The prevalence of cardiovascular disease in individuals with SCI escalates with age. The sources suggest this might be part of a broader trend of “premature aging” in the SCI population, where they experience age-related health conditions earlier and at a faster rate compared to individuals without SCI
What did the review find regarding the association between age/duration of injury and the prevalence of bladder problems?
Bladder Problems and Age/Duration of Injury: Contrary to expectations, the review revealed no significant association between the prevalence of bladder problems and age or duration of the SCI. This finding challenges the assumption that bladder issues automatically worsen over time or with age in this population.
According to the review, which secondary health conditions were most important to patients living with SCI?
Patient-Prioritized Conditions: The review indicated that individuals with SCI consider bowel and bladder regulation problems, spasms, and pain to be the most impactful secondary conditions affecting their lives. This highlights the importance of prioritizing effective management and treatment of these conditions for improved quality of life.
What does the review suggest about the relationship between sedentary lifestyle, obesity, and secondary health conditions in SCI?
Lifestyle and Secondary Conditions: The review underscores a robust connection between a sedentary lifestyle, obesity, and the emergence of secondary health conditions in individuals with SCI. It advocates for interventions focused on enhancing weight-bearing exercises and cardiovascular fitness, along with strategies for weight management, to potentially decrease the occurrence and severity of secondary health issues in the SCI population.
CSEP Guidelines
Two levels
The guidelines have two levels: a starting level and an advanced level. Which level you choose depends on your goals, abilities and current fitness level. If you’re just starting a physical activity program, consider working up to the starting level and ideally work up to the advanced level. If you’re already physically active, you might want to begin with the advanced level.
UBC Okanagan Guidelines/ CSEP Guidelines
Starting Level
Advanced Level
The starting level is the minimum level of activity needed to achieve fitness benefits:
Aerobic activity: 20minute /2x a week
Strength training Activity:
3sets / 10 reps / 2x a week
The advanced level will give you additional fitness and health benefits, such as lowering your risk of developing Type 2 diabetes and heart disease:
Aerobic activity: 30minute /3x a week
Strength training Activity:
3sets / 10 reps / 2x a week
The way the guidelines are presented is to work from fitness towards cardiometabolic health (aka the Advanced Level).
Dr Amy E. Latimer-Cheung developed some guidelines for home-based strength training for people that have had a SCI
These manuals were developed as part of a research study to try and find ways to reduce barriers to meeting the guidelines for strength training:
2 times a week
3 sets of 10 reps
for each major muscle group
Importantly, this work found that effective strength training in this population to meet the guidelines (for fitness) can happen at home and need not be in a gym. Adherence to the program was facilitated by home visits with an: 1) exercise professional, and 2) someone with SCI familiar with the exercises.
