Spinal Cord InjurySpinal Cord InjuryKirsten Kirsten

Natasha Natasha

LindseyLindsey

VickieVickie

LauraLaura

General OverviewGeneral Overview

Spinal Cord Injury is damage to the spinal cord Spinal Cord Injury is damage to the spinal cord that results in a loss of function such as mobility that results in a loss of function such as mobility or feeling. Frequent causes of damage are or feeling. Frequent causes of damage are trauma and disease.trauma and disease.

Spinal Cord is the major bundle of nerves that Spinal Cord is the major bundle of nerves that carry impulses to/from the brain to the rest of the carry impulses to/from the brain to the rest of the body. body.

Spinal Cord is surrounded by rings of bone-Spinal Cord is surrounded by rings of bone-vertebra. They function to protect the spinal vertebra. They function to protect the spinal cord.cord.

PrognosisPrognosis

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

Scale of Motor Strength in SCIScale of Motor Strength in SCI

The American Spinal Injury Association: The American Spinal Injury Association: 0 - No contraction or movement 0 - No contraction or movement 1 - Minimal movement 1 - Minimal movement 2 - Active movement, but not against gravity 2 - Active movement, but not against gravity 3 - Active movement against gravity 3 - Active movement against gravity 4 - Active movement against resistance 4 - Active movement against resistance 5 - Active movement against full resistance5 - Active movement against full resistance

Assessment of sensory function helps to identify Assessment of sensory function helps to identify the different pathways for light touch, the different pathways for light touch, proprioception, vibration, and pain. Use a proprioception, vibration, and pain. Use a pinprick to evaluate pain sensation. pinprick to evaluate pain sensation.

Types of Spinal Cord ParalysisTypes of Spinal Cord Paralysis

Depending on the location and the extent of the Depending on the location and the extent of the injury different forms of paralysis can occur.injury different forms of paralysis can occur.

Monoplegia- paralysis of one limbMonoplegia- paralysis of one limb

Diplegia- paralysis of both upper or lower limbsDiplegia- paralysis of both upper or lower limbs

Paraplegia- paralysis of both lower limbsParaplegia- paralysis of both lower limbs

Hemiplegia- paralysis of upper limb, torso and Hemiplegia- paralysis of upper limb, torso and lower leg on one side of the bodylower leg on one side of the body

Quadraplegia- paralysis of all four limbsQuadraplegia- paralysis of all four limbs

Spinal Cord Paralysis LevelsSpinal Cord Paralysis LevelsC1-C3 C1-C3

All daily functions must be totally assistedAll daily functions must be totally assistedBreathing is dependant on a ventilatorBreathing is dependant on a ventilatorMotorised wheelchair controlled by sip and puff or chin movements Motorised wheelchair controlled by sip and puff or chin movements is requiredis required

C4C4Same as C1-C3 except breathing can be done without a ventilatorSame as C1-C3 except breathing can be done without a ventilator

C5C5Good head, neck, shoulder movements, as well as elbow flexionGood head, neck, shoulder movements, as well as elbow flexionElectric wheelchair, or manual for short distancesElectric wheelchair, or manual for short distances

C6C6Wrist extension movements are goodWrist extension movements are goodAssistance needed for dressing, and transitions from bed to chair Assistance needed for dressing, and transitions from bed to chair and car may also need assistanceand car may also need assistance

C7-C8C7-C8All hand movementsAll hand movementsAbility to dress, eat, drive, do transfers, and do upper body washesAbility to dress, eat, drive, do transfers, and do upper body washes

Spinal Cord Paralysis LevelsSpinal Cord Paralysis LevelsT1-T4 (paraplegia)T1-T4 (paraplegia)

Normal communication skillsNormal communication skillsHelp may only be needed for heavy household work or Help may only be needed for heavy household work or loading wheelchair into carloading wheelchair into car

T5-T9T5-T9Manual wheelchair for everyday livingManual wheelchair for everyday livingIndependent for personal careIndependent for personal care

T10-L1T10-L1Partial paralysis of lower bodyPartial paralysis of lower body

L2-S5L2-S5Some knee, hip and foot movements with possible slow Some knee, hip and foot movements with possible slow difficult walking with assistance or aidsdifficult walking with assistance or aidsOnly heavy home maintenance and hard cleaning will Only heavy home maintenance and hard cleaning will need assistanceneed assistance

Complete and IncompleteComplete and Incomplete

Spinal Cord Syndromes can be classified into Spinal Cord Syndromes can be classified into either complete or incomplete categorieseither complete or incomplete categoriesComplete – characterized as complete loss of Complete – characterized as complete loss of motor and sensory function below the level of motor and sensory function below the level of the traumatic lesionthe traumatic lesion

Incomplete – characterized by variable Incomplete – characterized by variable neurological findings with partial loss of sensory neurological findings with partial loss of sensory and/or motor function below the lesionand/or motor function below the lesion

Spinal ShockSpinal Shock

An immediate loss of reflex function, called An immediate loss of reflex function, called areflexia, below the level of injuryareflexia, below the level of injurySigns: Signs: Slow heart rateSlow heart rate Low blood pressureLow blood pressure Flaccid paralysis of skeletal musclesFlaccid paralysis of skeletal muscles Loss of somatic sensationsLoss of somatic sensations Urinary bladder dysfunctionUrinary bladder dysfunction

Spinal shock may begin within an hour after Spinal shock may begin within an hour after injury and last from several minutes to several injury and last from several minutes to several months, after which reflex activity gradually months, after which reflex activity gradually returnsreturns

Central Cord SyndromeCentral Cord Syndrome

Usually involves a cervical lesionUsually involves a cervical lesionMay result from cervical hyperextension causing May result from cervical hyperextension causing ischemic injury to the central part of the cordischemic injury to the central part of the cordMotor weakness is more present in the upper Motor weakness is more present in the upper limbs then the lower limbslimbs then the lower limbsPatient is more likely to lose pain and Patient is more likely to lose pain and temperature sensation than proprioception temperature sensation than proprioception Patient may complain of a burning feeling in the Patient may complain of a burning feeling in the upper limbs upper limbs More commonly seen in older patients with More commonly seen in older patients with cervical arthritis or narrowing of the spinal cordcervical arthritis or narrowing of the spinal cord

Brown-Sequard SyndromeBrown-Sequard Syndrome

Results from an injury to only half of the Results from an injury to only half of the spinal cord and is most noticed in the spinal cord and is most noticed in the cervical regioncervical regionOften caused by spinal cord tumours, Often caused by spinal cord tumours, trauma, or inflammation trauma, or inflammation Motor loss is evident on the same side as Motor loss is evident on the same side as the injury to the spinal cordthe injury to the spinal cordSensory loss is evident on the opposite Sensory loss is evident on the opposite side of the injury location (pain and side of the injury location (pain and temperature loss)temperature loss)Bowel and bladder functions are usually Bowel and bladder functions are usually normalnormalPerson is normally able to walk although Person is normally able to walk although some bracing or stability devices may be some bracing or stability devices may be requiredrequired

Anterior Spinal Cord SyndromeAnterior Spinal Cord Syndrome

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

Pre-hospital CarePre-hospital Care

Most pre-hospital care providers recognize the Most pre-hospital care providers recognize the need to stabilize and immobilize the spine on the need to stabilize and immobilize the spine on the basis of mechanism of injury, pain in the basis of mechanism of injury, pain in the vertebral column or neurological symptoms.vertebral column or neurological symptoms.Patients are usually transported to the hospital Patients are usually transported to the hospital with a cervical hard collar on a hard backboard.with a cervical hard collar on a hard backboard. Commercial devices are available to secure the Commercial devices are available to secure the

patient to the board.patient to the board. The patient should be secured so that in the event of The patient should be secured so that in the event of

vomiting, the backboard may be rapidly rotated 90 vomiting, the backboard may be rapidly rotated 90 degrees while the patient remains fully immobilized in degrees while the patient remains fully immobilized in neutral position. Spinal immobilization protocols neutral position. Spinal immobilization protocols should be standard in all pre-hospital care systems.should be standard in all pre-hospital care systems.

Kinesiologist’s RoleKinesiologist’s Role

Perform Subjective and Perform Subjective and Objective AssessmentObjective Assessment

Analyse the situation Analyse the situation and determine your and determine your diagnosisdiagnosis

Plan how you will treat Plan how you will treat the condition. Includes the condition. Includes consultation with or consultation with or referral to other areas of referral to other areas of the medical communitythe medical community

What can a Kinesiologist DoWhat can a Kinesiologist Do

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

Basic Life ChangesBasic Life Changes

The Kinesiologist will need to determine through The Kinesiologist will need to determine through conversation with the client, as well as subjective and conversation with the client, as well as subjective and objective assessment:objective assessment:EatingEatingDressingDressingBowel/Bladder functionBowel/Bladder functionWeight Management- nutrition and fitnessWeight Management- nutrition and fitnessRespiratory IssuesRespiratory IssuesPainPainPsychosocial IssuesPsychosocial IssuesSex and PregnancySex and PregnancyIndependence Independence

Equipment / AccessibilityEquipment / Accessibility

Kinesiologist should plan Kinesiologist should plan with client ways to with client ways to improve personal improve personal mobility:mobility:

HomesHomes

VehiclesVehicles

Public AccessPublic Access

Types of wheelchairs, Types of wheelchairs, mobility devices, splinting mobility devices, splinting and seating availableand seating available

Psychosocial IssuesPsychosocial Issues

These topics should be covered with the client, These topics should be covered with the client, but will most likely be referred to another but will most likely be referred to another professional for:professional for:Aging Aging Education/EmploymentEducation/EmploymentFamily/RelationshipsFamily/RelationshipsPsychosocial AdjustmentsPsychosocial AdjustmentsRehabilitationRehabilitationSexSexSubstance AbuseSubstance Abuse

Treatment FieldsTreatment Fields

Occupational TherapyOccupational TherapyPhysiotherapyPhysiotherapyPhysicians Physicians Social WorkersSocial WorkersTherapeutic RecreationTherapeutic RecreationRehabilitationRehabilitationPsychologists Psychologists Vocational CounsellorsVocational CounsellorsNutrition AssistanceNutrition AssistanceTelemedicine-employing Telemedicine-employing a SCI caregivera SCI caregiver

Partners to ConsultPartners to Consult

NeurosurgeryNeurosurgery

NeurologyNeurology

UrologyUrology

OrthopedicsOrthopedics

Plastic SurgeryPlastic Surgery

NeuropsychologyNeuropsychology

Internal MedicineInternal Medicine

GynecologyGynecology

Driver EducationDriver Education

Rehabilitation Rehabilitation EngineeringEngineering

ChaplaincyChaplaincy

Pulmonary MedicinePulmonary Medicine

General SurgeryGeneral Surgery

PsychiatryPsychiatry

Speech PathologySpeech Pathology

Treatment FocusTreatment Focus

The treatment team must specialize in treating The treatment team must specialize in treating SCISCI

The focus should be on family and patient The focus should be on family and patient participation where the clients personal abilities participation where the clients personal abilities are maximized towards independenceare maximized towards independence

Client should be a principal contributor to Client should be a principal contributor to treatment decisions and goal makingtreatment decisions and goal making

Treatment should be on a regular scheduled Treatment should be on a regular scheduled basis for at least three hours per daybasis for at least three hours per day

QuestionsQuestionsCan a person break their back/neck, but not sustain a spinal cord Can a person break their back/neck, but not sustain a spinal cord injury?injury?

A) A) YesYesB) NoB) NoC) MaybeC) MaybeD) Only in a MVAD) Only in a MVA

Christopher Reeve used a what to get around?Christopher Reeve used a what to get around?A) Suck and blow A) Suck and blow B) Ski’sB) Ski’sC) Sip and PuffC) Sip and PuffD) WagonD) Wagon

What are 4 types of Paralysis?What are 4 types of Paralysis?A) A) hemiplegia, diplegia, quadraplegia, paraplegiahemiplegia, diplegia, quadraplegia, paraplegiaB) hemiplegia, hyperplegia, biplegia, triplegiaB) hemiplegia, hyperplegia, biplegia, triplegiaC) hemiplegia, tetraplegia, homoplegia, heteroplegiaC) hemiplegia, tetraplegia, homoplegia, heteroplegiaD) hemiplegia, preplegia, sensiplegia, motorplegiaD) hemiplegia, preplegia, sensiplegia, motorplegia

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