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Spinal Cord Injuries

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Spinal Cord Injuries Kristy Sandman Statistics 10,000 every year 183,000 230,000 current cases Avg. Age 31.7 years Highest incidence between 15 & 25 years ... – PowerPoint PPT presentation

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Title: Spinal Cord Injuries


1
  • Spinal Cord Injuries
  • Kristy Sandman

2
Statistics
  • 10,000 every year
  • 183,000 230,000 current cases
  • Avg. Age 31.7 years
  • Highest incidence between 15 25 years
  • Lifetime cost of treatment 500,000 2 million
  • Total cost of treatment in US 7 billion
  • Sport of Diving has highest incidence

3
Traumatic Causes
  • Car accidents (38)
  • Contact sports (7)
  • Violence (27)
  • Falls (21)
  • Other (7)
  • -- recreational activities
  • -- Diving into shallow water / diving
  • from high places
  • -- Blow to the head, neck, face

4
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5
Non-Traumatic Causes
  • Congenital / developmental
  • -- cerebral palsy
  • -- spina bifida
  • Degenerative disorders
  • -- spinal muscular atrophy
  • -- spondylolysis
  • -- disc disease
  • Infectious
  • -- bacterial, fungal, leukemia

6
  • Ischemic
  • -- cardiac arrest
  • -- atherosclerosis
  • -- thrombosis
  • Rheumatoligical
  • -- arthritis
  • Tumors

7
Physiology
  • The majority of SCI are the result of compression
    traction forces
  • Fracture of bones
  • Injury to discs
  • Ligament sprains
  • Broken blood vessels
  • Damaged cell membranes
  • Injured nerve axons

8
  • Primary Injuries
  • Hemorrhaging occurs in gray matter of spinal
    column and spreads outward.
  • Spinal cord swells, filling the spinal canal at
    the level of the injury.
  • Pressure of swelling exceeds venous return.
  • Ischemia affects circulation and leads to release
    of toxic chemicals from injured neural membranes,
    neurogenic shock, hypotension.

9
  • Secondary Injuries
  • Injured cells, axons, blood vessels release
    toxic chemical that attack surrounding healthy
    cells.
  • Glutamate is released in large amounts,
    overexciting neurons.
  • Overexcited cells, let in large amounts of
    calcium, causing the release of free radicals
    that attack healthy cells

10
Diagnoses
  • Assessment should always include entire CNS, 50
    of SCI include brain injuries.
  • Gait
  • Coordination
  • Cranial nerves
  • Motor function
  • Sensory perception
  • Autonomic systems

11
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12
  • American Spinal Injury Association (ASIA)
    Impairment Scale
  • 5 grades, A E
  • Pharmacology
  • Methylprednisolone
  • Given within 8 hours of injury
  • Reduces swelling
  • Controls glutamate release
  • Inhibits accumulation of free radicals

13
Complications
  • Osteoporosis and Muscular Atrophy
  • In persons who are immobile, calcium reabsorbed
    faster than its deposited.
  • Muscle spasms
  • Can cause injury to muscles, tendons, and
    ligaments.
  • Urinary infection / kidney failure
  • Loss of sensation, leads to incomplete emptying
    or overflow of bladder
  • Infection kidney stones result

14
  • Constipation
  • Caused by muscle atrophy lack of gravity
  • Respiratory dysfunction
  • Injury to C2, C3, C4 affects inervation of the
    diaphragm.
  • Impaired circulation
  • Heart atrophies leads to poor circulation
  • Phlebothrombosis
  • Movement of blood through veins is dependent on
    movement of muscle

15
  • Immobility leads to blood clots pooling of
    blood in legs abdomen
  • Pulmonary embolism
  • Blood clots dislodge land in the lungs
  • Often fatal
  • Hypotension
  • In persons who recline, blood pools in legs
    abdomen
  • Person sits or stand, BP drops

16
  • 10. Thermoregularity
  • Sitting/lying for long periods affects constant
    body temp.
  • Leads to rashes, fungi, dry skin, skin disorders
  • 11. Decubitus ulcers
  • Person in one position for extended periods of
    time.
  • Pressure of bones collapse blood vessels, cuts
    off circulation
  • Tissue dies

17
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18
Therapeutic Treatments
  • Tendon transfer
  • Restores limited function
  • Muscles must be voluntary, strong, have a
    secondary role
  • Electrical Stimulation
  • Strengthens muscles heart, relieves pain, paces
    the diaphragm
  • Phrenic nerve stimulation
  • Implanted electrode can keep diaphragm working

19
  • Abdominal trussing
  • Pushing the abdomen inward
  • Abdominal pressure increases, rib cage rises,
    expiratory muscles lengthen
  • Use of corsets, elastic wraps, belts, custom
    built devices
  • Increases vital capacity, tidal volume,
    inspiratory pressure, expiratory pressure

20
Mobility in Wheelchairs
  • Tipping chair backwards to a 35 or 65-degree
    angle
  • Flexing the trunk towards the knees
  • Leaning to either side
  • Push-ups in the chair

21
Exercise
  • Lack of exercise leads to
  • Reduced heart rate
  • Reduced stroke volume
  • Reduced cardiac output
  • Ventricular atrophy
  • Reduced vital capacity
  • Impaired thermoregulatory system
  • Decreased muscle mass

22
  • Ability to exercise is dependent on location and
    extent of injury.
  • Endurance exercises useful for cardiovascular
    benefits
  • Calisthenics
  • Weight lifting
  • Swimming
  • Wheelchair mobility exercises
  • Sitting, standing, walking

23
  • Aquatic Exercising
  • 90 reduction of body weight
  • Reduced forces on musculoskeletal system
  • Buoyancy can be used for assistance, support,
    resistance
  • Physiological benefits
  • Cardiorespiratory system
  • Muscular system
  • Coordination, balance
  • Respiratory system
  • mobility

24
  • Spatial awareness
  • Prevents osteoporosis
  • Psychological benefits
  • Self esteem
  • Decreases anxiety
  • Decreases depression

25
Spinal cord Repair
  • Neurons in CNS can grow when placed by axon
    bundles in PNS
  • Transplanted neurons maintain nerve activity in
    muscles
  • Injecting spinal cord cells from pig fetuses
  • Fetal cell transplants
  • Combination cell transplant muscle activity
  • Cord transplantation

26
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