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Spinal Cord Injury

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Spinal Cord Injury Kirsten Natasha Lindsey Vickie Laura General Overview Spinal Cord Injury is damage to the spinal cord that results in a loss of function such as ... – PowerPoint PPT presentation

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Title: Spinal Cord Injury


1
Spinal Cord Injury
  • Kirsten
  • Natasha
  • Lindsey
  • Vickie
  • Laura

2
General Overview
  • Spinal Cord Injury is damage to the spinal cord
    that results in a loss of function such as
    mobility or feeling. Frequent causes of damage
    are trauma and disease.
  • Spinal Cord is the major bundle of nerves that
    carry impulses to/from the brain to the rest of
    the body.
  • Spinal Cord is surrounded by rings of
    bone-vertebra. They function to protect the
    spinal cord.

3
Prognosis
  • Patients with a complete cord injury have a less
    than 5 chance of recovery. If complete paralysis
    persists at 72 hours after injury, recovery is
    essentially zero.
  • The prognosis is much better for the incomplete
    cord syndromes.
  • If some sensory function is preserved, the chance
    that the patient will eventually be able walk is
    greater than 50.
  • Ultimately, 90 of patients with SCI return to
    their homes and regain independence.
  • In the early 1900s, the mortality rate 1 year
    after injury in patients with complete lesions
    approached 100. Much of the improvement since
    then can be attributed to the introduction of
    antibiotics to treat pneumonia and urinary tract
    infection.
  • Currently, the 5-year survival rate for patients
    with a traumatic quadriplegia exceeds 90. The
    hospital mortality rate for isolated acute SCI is
    low.

4
Scale of Motor Strength in SCI
  • The American Spinal Injury Association
  • 0 - No contraction or movement
  • 1 - Minimal movement
  • 2 - Active movement, but not against gravity
  • 3 - Active movement against gravity
  • 4 - Active movement against resistance
  • 5 - Active movement against full resistance
  • Assessment of sensory function helps to identify
    the different pathways for light touch,
    proprioception, vibration, and pain. Use a
    pinprick to evaluate pain sensation.

5
Types of Spinal Cord Paralysis
  • Depending on the location and the extent of the
    injury different forms of paralysis can occur.
  • Monoplegia- paralysis of one limb
  • Diplegia- paralysis of both upper or lower limbs
  • Paraplegia- paralysis of both lower limbs
  • Hemiplegia- paralysis of upper limb, torso and
    lower leg on one side of the body
  • Quadraplegia- paralysis of all four limbs

6
Spinal Cord Paralysis Levels
  • C1-C3
  • All daily functions must be totally assisted
  • Breathing is dependant on a ventilator
  • Motorised wheelchair controlled by sip and puff
    or chin movements is required
  • C4
  • Same as C1-C3 except breathing can be done
    without a ventilator
  • C5
  • Good head, neck, shoulder movements, as well as
    elbow flexion
  • Electric wheelchair, or manual for short
    distances
  • C6
  • Wrist extension movements are good
  • Assistance needed for dressing, and transitions
    from bed to chair and car may also need
    assistance
  • C7-C8
  • All hand movements
  • Ability to dress, eat, drive, do transfers, and
    do upper body washes

7
Spinal Cord Paralysis Levels
  • T1-T4 (paraplegia)
  • Normal communication skills
  • Help may only be needed for heavy household work
    or loading wheelchair into car
  • T5-T9
  • Manual wheelchair for everyday living
  • Independent for personal care
  • T10-L1
  • Partial paralysis of lower body
  • L2-S5
  • Some knee, hip and foot movements with possible
    slow difficult walking with assistance or aids
  • Only heavy home maintenance and hard cleaning
    will need assistance

8
Complete and Incomplete
  • Spinal Cord Syndromes can be classified into
    either complete or incomplete categories
  • Complete characterized as complete loss of
    motor and sensory function below the level of the
    traumatic lesion
  • Incomplete characterized by variable
    neurological findings with partial loss of
    sensory and/or motor function below the lesion

9
Spinal Shock
  • An immediate loss of reflex function, called
    areflexia, below the level of injury
  • Signs
  • Slow heart rate
  • Low blood pressure
  • Flaccid paralysis of skeletal muscles
  • Loss of somatic sensations
  • Urinary bladder dysfunction
  • Spinal shock may begin within an hour after
    injury and last from several minutes to several
    months, after which reflex activity gradually
    returns

10
Central Cord Syndrome
  • Usually involves a cervical lesion
  • May result from cervical hyperextension causing
    ischemic injury to the central part of the cord
  • Motor weakness is more present in the upper limbs
    then the lower limbs
  • Patient is more likely to lose pain and
    temperature sensation than proprioception
  • Patient may complain of a burning feeling in the
    upper limbs
  • More commonly seen in older patients with
    cervical arthritis or narrowing of the spinal cord

11
Brown-Sequard Syndrome
  • Results from an injury to only half of the spinal
    cord and is most noticed in the cervical region
  • Often caused by spinal cord tumours, trauma, or
    inflammation
  • Motor loss is evident on the same side as the
    injury to the spinal cord
  • Sensory loss is evident on the opposite side of
    the injury location (pain and temperature loss)
  • Bowel and bladder functions are usually normal
  • Person is normally able to walk although some
    bracing or stability devices may be required

12
Anterior Spinal Cord Syndrome
  • Usually results from compression of the artery
    that runs along the front of the spinal cord
  • Compression of SC may be from bone fragments or a
    large disc herniation
  • Patients with anterior spinal cord syndrome have
    a variable amount of motor function below the
    level of injury
  • Sensation to pain and temperature are lost while
    sensitivity to vibration and proprioception are
    preserved

13
Pre-hospital Care
  • Most pre-hospital care providers recognize the
    need to stabilize and immobilize the spine on the
    basis of mechanism of injury, pain in the
    vertebral column or neurological symptoms.
  • Patients are usually transported to the hospital
    with a cervical hard collar on a hard backboard.
  • Commercial devices are available to secure the
    patient to the board.
  • The patient should be secured so that in the
    event of vomiting, the backboard may be rapidly
    rotated 90 degrees while the patient remains
    fully immobilized in neutral position. Spinal
    immobilization protocols should be standard in
    all pre-hospital care systems.

14
Kinesiologists Role
  • Perform Subjective and Objective Assessment
  • Analyse the situation and determine your
    diagnosis
  • Plan how you will treat the condition. Includes
    consultation with or referral to other areas of
    the medical community

15
What can a Kinesiologist Do
  • Evaluate a person's ability and level of
    functioning in his or her home, at work, and
    while engaging in leisure activities and hobbies.
  • Determine how motivated a person is to
    participate in activities that he or she
    participated in prior to the injury.
  • Identify any changes in roles a person may
    experience as a result of SCI.
  • Provide individualized therapy to retrain people
    to perform daily living skills using adaptive
    techniques.
  • Facilitate coping skills that could help a person
    overcome the effects of SCI.
  • Implement exercises and routines that strengthen
    muscles that may have been affected that are
    necessary in daily activities, such as dressing,
    eating, and taking care of a home.
  • Determine the type of assistive devices that
    could help a person become more independent with
    daily living skills.

16
Basic Life Changes
  • The Kinesiologist will need to determine through
    conversation with the client, as well as
    subjective and objective assessment
  • Eating
  • Dressing
  • Bowel/Bladder function
  • Weight Management- nutrition and fitness
  • Respiratory Issues
  • Pain
  • Psychosocial Issues
  • Sex and Pregnancy
  • Independence

17
Equipment / Accessibility
  • Kinesiologist should plan with client ways to
    improve personal mobility
  • Homes
  • Vehicles
  • Public Access
  • Types of wheelchairs, mobility devices, splinting
    and seating available

18
Psychosocial Issues
  • These topics should be covered with the client,
    but will most likely be referred to another
    professional for
  • Aging
  • Education/Employment
  • Family/Relationships
  • Psychosocial Adjustments
  • Rehabilitation
  • Sex
  • Substance Abuse

19
Treatment Fields
  • Occupational Therapy
  • Physiotherapy
  • Physicians
  • Social Workers
  • Therapeutic Recreation
  • Rehabilitation
  • Psychologists
  • Vocational Counsellors
  • Nutrition Assistance
  • Telemedicine-employing a SCI caregiver

20
(No Transcript)
21
Partners to Consult
  • Neurosurgery
  • Neurology
  • Urology
  • Orthopedics
  • Plastic Surgery
  • Neuropsychology
  • Internal Medicine
  • Gynecology
  • Driver Education
  • Rehabilitation Engineering
  • Chaplaincy
  • Pulmonary Medicine
  • General Surgery
  • Psychiatry
  • Speech Pathology

22
Treatment Focus
  • The treatment team must specialize in treating
    SCI
  • The focus should be on family and patient
    participation where the clients personal
    abilities are maximized towards independence
  • Client should be a principal contributor to
    treatment decisions and goal making
  • Treatment should be on a regular scheduled basis
    for at least three hours per day

23
Questions
  • Can a person break their back/neck, but not
    sustain a spinal cord injury?
  • A) Yes
  • B) No
  • C) Maybe
  • D) Only in a MVA
  • Christopher Reeve used a what to get around?
  • A) Suck and blow
  • B) Skis
  • C) Sip and Puff
  • D) Wagon
  • What are 4 types of Paralysis?
  • A) hemiplegia, diplegia, quadraplegia, paraplegia
  • B) hemiplegia, hyperplegia, biplegia, triplegia
  • C) hemiplegia, tetraplegia, homoplegia,
    heteroplegia
  • D) hemiplegia, preplegia, sensiplegia,
    motorplegia

24
References
  • http//www.spinalinjury.net/html/_spinal_cord_101.
    html
  • http//www.spinalcord.org/
  • http//www.spinalcord.uab.edu/show.asp?durki19679
  • http//www.wheelessonline.com/ortho/central_cord_s
    yndrome_1
  • http//www.ninds.nih.gov/disorders/central_cord/ce
    ntral_cord.htm
  • http//orthoinfo.assos.org/fact//thr_report.cfm?TH
    read_ID285topcategorySpine
  • http//www.emedicine.com/orthoped/topic39.htm
  • http//www.emedicine.com/emerg/topic70.htm
  • http//www.emedicinehealth.com/Articles/64223-1.as
    p
  • http//www.neuro.wustl.edu/sci/physiolo.htmCentra
    l20Cord20Syndrome
  • http//www.emedicine.com/emerg/topic553.htm
  • http//www.apparelyzed.com/paralysis.html
  • http//www.spinalcord.uab.edu/show.asp?durki22408
  • http//www.spinalcord.org/html/newinjury/basic.php
  • http//images.main.uab.edu/spinalcord/html/Spas_Hy
    _files/frame.htm
  • http//www.spinalcord.org/html/injury.php
  • http//www.spinalinjury.net/index.html
  • http//www.spinalcord.uab.edu/
  • http//canparaplegic.org/national/level2.tpl?var1
    storyvar220001027122552
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