Spinal Cord Injuries

Protection of the Central Nervous Protection of the Central Nervous System - understandSystem - understand Scalp and skin Skull and vertebral column Meninges

Protection of the Central Nervous Protection of the Central Nervous SystemSystem

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Cerebrospinal fluid Blood brain barrier

The 3 Meninges - understandThe 3 Meninges - understand1. Dura mater (most superficial)

Double-layered external covering Periosteum – attached to surface of the

skull Meningeal layer – outer covering of the

brain

Folds inward in several areas

Spinal Cord Anatomy - knowSpinal Cord Anatomy - know Exterior white mater – conduction tracts

VENTRAL

Spinal Cord Anatomy - knowSpinal Cord Anatomy - know Internal gray matter - mostly cell bodies

Dorsal (posterior) horns Anterior (ventral) horns

Spinal Cord Anatomy - knowSpinal Cord Anatomy - know Central canal filled with cerebrospinal

fluid

Spinal Cord - knowSpinal Cord - know

Slide 7.52

Extends from the medulla oblongata to the region of T12

Below T12 is the cauda equina (a collection of spinal nerves)

Enlargements occur in the cervical and lumbar regions

Traumatic Spinal Cord Injury

• Immediate loss of strength • Immediate numbness in legs

and arms• Level of injury can predict

symptoms

Non-Traumatic Spinal Cord Injury

• Most common type of SCI• Hard to predict the area

affected by the signs and symptoms

• Arthritis, cancer, inflammation, infections, or disk degeneration of the spine

Exams

• Need immediate medical attention

• General exam • Neurological exam

– American Spinal Injury Association test

• Tests sensory and motor skills

High level injuries, C1, C2, C3, lose involuntary functions.

– Breathing– Regulating of blood pressure

C1-C4 May need breathing assistance

C5- No wrist or hand control, some shoulder and bicep control

C6- Includes some wrist control, no hand control

C7 and T1- Can straighten arms, lacking in hand and finger control

T1-T8- Most often include hand control, lack of trunk control

T9-T12- Have most trunk control, can balance sitting up

Lumbar and Sacral- Loss includes hip flexor and leg control

Dermatomes – surface of body innervated by spinal nerves

Problems associated with SCI

» Bowel and bladder dysfunction, loss of sexual function

» Loss of autonomic control» Men’s fertility is affected and

women’s mostly is not» Low blood pressure and reduced

control of temperature» Inability to sweat below the injury» Chronic pain

Quadriplegia (cervical vertebrae)- » Cervical neck injuries that generally

cause paralysis of all arms and legs.

Paraplegia (below cervical vertebrae)- » SCI causing paralysis of the legs and

sometimes the trunk, but not the arms. Injury from T1 and below.

Extent of injury

Christopher Reeve(September 25, 1952 - October 10, 2004)

•American actor, most famous role was original “Superman” movie, 1978•After SCI, became advocate for Stem Cell Research for SCI victims and other SCI research•http://www.youtube.com/watch?v=tGiMKwIEVAI

Christopher ReeveChristopher Reeve shattered C1 and C2 vertebrae from a horse riding accident.

He survived because of immediate medical attention and surgery to reattach his head to his body.

Reeve relied on a ventilator to breathe for him and was unable to move anything below his shoulders.

Years after the injury, Reeve began to feel sensations in his left leg, left arm and his spine.

Reeve died from a reaction to an antibiotic he was given to treat a systemic infection from a pressure wound.

http://www.youtube.com/watch?v=Yiu41fE_vJ8From: www.chrisreeveshomepage.com

Totipotent Stem cellsMost versatile stem cells require destruction of a human embryo to harvest stem cells that can become any tissue when grown under correct conditions

Highly controversialhttp://www.youtube.com/watch?v=3Axkn8G18t8

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.

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 both 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

Spinal Cord Paralysis LevelsC1-C3 • All daily functions must be totally assisted• Breathing is dependant on a ventilator• Motorized wheelchair controlled by sip and puff or chin movements is

requiredC4• Same as C1-C3 except breathing can be done without a ventilatorC5• Good head, neck, shoulder movements, as well as elbow flexion• Electric wheelchair, or manual for short distancesC6• Wrist extension movements are good• Assistance needed for dressing, and transitions from bed to chair and car

may also need assistanceC7-C8• All hand movements• Ability to dress, eat, drive, do transfers, and do upper body washes

Spinal Cord Paralysis LevelsT1-T4 (paraplegia)• Normal communication skills• Help may only be needed for heavy household work or

loading wheelchair into carT5-T9• Manual wheelchair for everyday living• Independent for personal careT10-L1• Partial paralysis of lower bodyL2-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

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.

Kinesiologist’s 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

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.

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

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

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

SCI caregiver