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Introduction to Spinal Cord Injury

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on 5 October 2016

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Transcript of Introduction to Spinal Cord Injury

Primary Clinical Manifestations
Spinal Shock
Motor and Sensory Impairments
Autonomic Dysreflexia
Postural Hypotension
Impaired Temperature Control
Respiratory Impairment
Spasticity
Bowel and Bladder Dysfunction
Sexual Dysfunction
Indirect Impairments and Complications
Respiratory Complications (i.e. pneumonia, atelectasis)
Skin issues, wounds
DVT
Contractures
Heterotrophic Ossification
Pain
Acute Medical Interventions
Anatomy Review
Classification of Spinal Cord Injuries
Tetraplegia versus Paraplegia
Cervical, Thoracic, and Lumbar injuries
Complete versus Incomplete Injuries
Sacral Sparing
Zones of Partial Preservation
Objectives
Review and understand the levels of the spinal cord and the ascending/descending tracts
Discuss the changing epidemiology of SCI
Understand the classification of spinal cord injury including cord level and complete v. incomplete
Understand the various Spinal Cord Syndromes
Describe the clinical manifestations and complications of SCI
Explain the acute medical management of SCI
Demonstrate an understanding of the PT evaluation of SCI
Develop an understanding of quality of life after SCI
Create examples of how to handle difficult conversations with patients with SCI
Introduction to Spinal Cord Injury
Brittany Kennedy, PT, DPT, NCS

Tracts
Spinal Cord Syndromes
Central Cord Syndrome
Anterior Cord Syndrome
Posterior Cord Syndrome
Brown Sequard Syndrome
Cauda Equina Syndrome
Emergency Care
Stabilization and Immobilization
Resources
Epidemiology
Changing demographics
Age
Males>Females
Never married/single
Cause of Injury
MVA
Falls
Violence
Sports
Surgical, other, etc
PT Evaluation
Quality of Life after SCI
In-Class Discussion
Tough discussions with SCI
Group 1: Walking after complete SCI
Group 2: Sex and family planning after SCI
Group 3: Caregiver planning
Group 4: Depression and Suicidal Ideation after SCI

ASIA Evaluation
Specific MMT
Muscle Length
Posture Assessment
Functional Evaluation
Respiratory Evaluation
Integumentary Evaluation
Tone Assessment
Seating Evaluation
Spinal Cord Specific Outcome Measures
Anterior Cord Syndrome
Posterior Cord Syndrome
Brown Sequard Syndrome
Cauda Equina Syndrome
Focus on Autonomic Dysreflexia
Flexion injury of the cervical region
Causes damage to the anterior or ventral aspects of the cord
Loss of...?
Keep...?
Very rare spinal cord syndrome
Loss of...?
Keep...?
Functionally see sensory ataxia in gait
Damage to hemisection of spinal cord
Ipsilateral side of lesion loses...
Contralateral side of lesion loses...
Peripheral Nerve Injury
Occurs with vertebral injuries below L2
Generally incomplete injuries
Common s/s: bowel and bladder dysfunction, saddle anesthesias, varying degree of motor
MEDICAL EMERGENCY
Pathologic autonomic reflex that generally occurs in complete and incomplete SCI at T6 or above
Acute onset of autonomic activity due to noxious stimuli
Immediate treatment
Follow up treatment
Functional Evaluation
Bed Mobility
Sit <> Supine
Rolling
Sitting balance
Transfers
Wheelchair propulsion
Gait and Balance
Spinal Cord Injury Specific Outcome Measures
*from the SCI EDGE Documents
Depression after Spinal Cord Injury
Studies have shown lower perceived quality of life in individuals with SCI though not as much as many expect
Bowel dysfunction, sexual dysfunction, pain, and then motor status impacted perceived health status
Other factors that influenced quality of life were self care ability, vocational status
Access to the community and recreation also impact quality of life
1) Fitzgerald M, et al. Clinical Neuroanatomy and Neuroscience. 5th Edition. “Descending Motor Pathways, Ascending Sensory Pathways”. 2008.
2)O'Sullivan K, et al. Physical Rehabilitation. 5th Edition. "Traumatic Spinal Cord Injury". 2007.
3) American Academy of Orthopedic Surgeons. "Cauda Equina Syndrome". 2014. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00362
4) Khan, J, et al. SCI EDGE Outcome Measures Recommendations for entry level education. 2013. Available at: http://www.neuropt.org/docs/sci-edge-/sci-edge-entry-level-recommendations.pdf?sfvrsn=2
5) University of Pittsburgh Medical Center. "Psychosocial Issues of Spinal Cord Injury. 2016. Available at: http://www.upmc.com/Services/rehab/rehab-institute/conditions/spinal-cord-injury/education-spinal-injury/Pages/psychological-issues.aspx
6) Parket S, Elliott S, et al. "Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community." The Journal of Spinal Cord Injury. 2016.
7) Chen Y, He Y, et al. "Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972-2014". Archives of Physical Medicine and Rehabilitation. 2016.
8) Post M, Noreau L. "Quality of Life after Spinal Cord Injury". Journal of Neurologic Physical Therapy". 2005; 29, 3: 139-146.
Corticospinal
Tract
Spinothalamic
Tract
DCML
Tract
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