The spinal cord injury (SCI)

Outline

DefinitionCauses of SCIDiagnosis/managementFixation and fusionPhysiotherapy goalsMobility and self careFunctional activities

What is spinal cord injury

SCI is damage to the spinal cord that results in loss of functions such as mobility or feeling. 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 and function to protect the spinal cord.

SCI is insult to spinal cord resulting in a change in the normal motor, sensory or autonomic function. This change is either temporary or permanent.

Causes of Spinal cord injury

Falls Gunshot Injuries Blunt Assault Diving Accidents Stab Wounds Sport Injuries Vascular disorders

Infectious conditionsDevelopment disordersengaging in sport while tired. Participating while on substance abuse like drugs, alcohol.

ManagementImmediate management at the scene is critical.Improper handling can cause further damage and loss of functioningAlways assume there is a spinal cord injury until it is ruled out

ImmobilizePrevent flexion, rotation

or extension of neckAvoid twisting patient

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Management consists of emergency treatment following an A-B-C-D-E sequence.AirwayBreathingCirculationDisabilityExpose

Medical management Patient receives a loading dose and then a continuous drip.High dose steroids.Neurological management includes methods a surgeon may use to treat unstable spinal cord injuries:

ReductionFixationFusion

Fixation and fusionFixation involves stabilizing vertebral fractures with wires, plates, and other types of hardware.

Fusion involves attaching injured vertebrae to uninjured vertebrae with bone grafts, and steel rods to help maintain structural integrity.

Physiotherapy GoalsRelieve painMaintain optimal level of wellnessMaintain optimal functioningMinimal or no complications of immobilityLearn new skills, self careReturn to home Integrate back into community

Physiotherapist teachesMobilitySelf careFunctional activities

Mobilitybed mobility (i.e. turning from side to side, moving from supine to sitting).sitting balance.wheelchair transfers (i.e. from wheelchair to bed, wheelchair to car, and wheelchair to floor).standing balance. ambulation (wheelchair or walking).

Self careAlong with increasing mobility, minimizing the need for assistance in self-care is a major step toward independence for those with SCI. Self-care includes feeding, bathing, dressing, grooming, and toileting. Those with motor-complete injuries at the C-7 level or below can usually achieve independence in all of these activities.

Functional activitiesLiving skills (e.g. meal preparation, shopping, housekeeping are necessary tasks of everyday life and must be relearned and adapted to a patient’s needs.These skills are often reacquired with the help of occupational therapists.

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