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Spinal Cord Injury Lecture

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by

Iman Khowailed

on 26 November 2014

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Transcript of Spinal Cord Injury Lecture

C1: Little or no sensation of head and neck, no diaphragm control. Dependent on Mechanical ventilation. Requires electric wheelchair.
C2-C3: Little head & neck sensation; independent of mechanical ventilation for short periods
C4: Good head & neck sensation
and motor control; some shoulder
elevation; diaphragm movement.
C5: Full head and neck control; shoulder strength; elbow flexion.
C6: Fully innervated shoulder; wrist extension
C7-C8: Full elbow extension; wrist plantar flexion; some finger control.
S1-S5: Full leg, foot, and ankle control; innervation or perineal muscles for bowel, bladder, and sexual function (S2-S4)
T11
-L5: Hip flexors, hip abductors (L1-L3); knee extension (L1-L4); knee flexion and ankle dorsiflexion (L4-L5).
T6-10: Abdominal muscle control, partial good balance with trunk muscles.
T1-T5: Full hand and finger control; use of intercostals and thoracic muscles.
Spinal Injury C1-C8
In 2014 ,almost 276,000 people in the US live each day with a disability from SCI.
Estimated 12,500 new injuries occur each year.
Primarily an injury of young adult males and
50% of those injured are between 16-30 years of
age.
-MVA 48%
-Gunshot Wounds 23%
-Falls 23%
-Recreational Activities 9%
Improving Bladder Management

Establishing Bowel Control
Insult to the spinal cord
Temporary or permanent Damage , in the cord’s normal motor, sensory, or autonomic function.

Cyclical process that includes assessment, establishment of goals and collaborative plan to work towards:
High dose IV corticosteroid
Respiratory Management

ROM & Positioning
Selective Strengthening
Spinal Immoblization
Acute Phase
Rehabilitation Phase
NCLEX question #2
Goals:
Spinal Cord Injury
The program focuses on understanding the effects and complications of spinal cord injury:
Neurogenic Bowel & Bladder
Sexuality & Fertility enhancement
Self-Care: prevent skin breakdown, bed mobility, transfers, driving with adaptive equipment.
Other areas of focus include vocational assessment, training, and re-entry into employment and the community
Spinal Cord Injury Rehab
Long Term needs depend on the severity of the injury and the degree of the affected areas.
GOAL: Enhance Quality of Life, and provide maximal independence.
Long Term needs of the SCI patient
SCI Center: "PROJECT WALK"
HUB
Ambulatory Devices:
Wheelchair
Canes, Crutches, Walkers
Ramps in the entrance
Accessible Shower
Bionic Legs
The Home Setting

"Project Walk" Spinal Cord Injury and Recovery
http://www.projectwalk.org/current-research-projects/
long term complications:
Infection
Sepsis
DVT
Pressure Sore
Contractures
Prevent secondary injury, observe for symptoms of progressive neurologic deficits, and prevent complications.
Treatments:
Maximize Independence
Preventing long term complication
Spinal Cord Injury
Clinical Manifestation

Ascending & Descending tracts
Clinical Syndromes
1. Posterior Cord Syndrome

Damage of Dorsal Column


Preservation of motor function
Preservation of sense of pain, temperature and light touch

Loss of proprioception, pressure, vibration sense, kinesthesia, stereognosis, two point discrimination below the level of the lesion.

2. Anterior Cord Syndrome
A wide Steppage Gait Pattern
Damage to the Anterior portion of the spinal cord
Loss of motor function (Corticospinal tract damage)
Loss of sense of pain and temperature (spinothalamic tract damage)
Deep sensation are preserved
3. Central Cord Syndrome
More severe neurological involvement of the UE than the LE

4. Brown Sequard Syndrome
Ipsilateral Hemiplegia
Ipsilateral Deep sensory loss
Contralateral Loss of Pain & temperature
Hyper extension injury

Immediately after SCI, there is a period of areflexia.
Absence of all reflex activity
Flaccidity
Loss of all sensory function below level off the lesion
Loss of all motor function below the level oft the lesion

1. Spinal Shock
2. Motor and Sensory Manifestation
Complete or partial loss of muscle function below the level of the lesion
Impaired or absent sensation below the level of the lesion
3. Autonomic Dysreflexia
Pathological Autonomic Reflex
Noxious cutaneous stimuli
Urethral irritation
Bladder retention
Rectal distention
Pressure sore
Urinary stones
Bladder infection
Kidney malfunction
Passive Stretching of the Hip

Initiating Stimuli
Symptoms of autonomic dysreflexia
Below the level of the lesion Sympathetic
Hypertension
Bradycardia
Headache
Increased spasticity
Profuse sweating
Above the level of the lesion Parasympathetic
Vasodilatation
Constricted pupils
Nasal congestion
Piloerection
Medical Emergency
Intervention
If lying flat, the patient should be brought to a siting position
The Drainage system should be examine immediately
If source of irritation cant be identified, medical assistance should be called immediately
Anti hypertensive medication should be addressed
Postrual Hypotension
Decrease in Blood pressure that occurs when assuming an erect position
Impaired Temperature Control
After damage to the spinal cord, the thalamus can no longer control cutaneous blood flow or level of sweating.
Respiratory Impairment
High SCI C1 -C3 Phrenic nerve innervation is impaired or lost . An artificial ventilator is required to sustain life
Spasticity
Typically occurs after spinal shock subsides.
Hypertonicity
Hypereflexia
Clonus
Bladder & Bowel Dysfunction

1
. Spastic Bladder (above cauda equina)
Bladder Contracts and reflexively empties at certain level of filling pressure.
2. Flaccid Bladder (Cauda Equina)
Bladder is flaccid because there is no reflex action of the detrusor muscle
Sexual Dysfunction
Caused by a loss of sympathetic vasoconstriction control
VD does not occur in response to heat nor does VC occur in response to cold
Pts rely on their sensory inputs from head and neck
Muscles Relaxant
Peripheral nerve Block
Intrathecal Injection
Myotomy
Classification of the Spinal Cord Injuries
1. Designation of lesion level

Key Sensory Points
Dermatomes
International Standards for the Classification of SCI

2. Complete injuries & Incomplete Injuries
a. Quadriplegic
b. Paraplegic
To determine the extent of neurological impairment in terms of motor and sensory loss
Complete Injury : Bilateral sensory & motor loss below the level of the lesion
Incomplete Injury : Motor & sensory function below the level of the lesion
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