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P410-SCI

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by

Kathleen Stanton

on 2 December 2016

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Transcript of P410-SCI

Spinal Cord Injury
Damage to the soft neural tissue of the spinal cord

Damage so severe that repair or regeneration is not possible (to date...)

Damage effects function of the motor, sensory and autonomic tract of the spinal cord

Life-altering injury
60-70% of all SCI are due to traumatic injury (e.g., accident, violence, sports related)

30-40% result of infection, disease or degeneration (e.g., stenosis, encephalitis)

55% of SCI occur between 16-30 years of age (median age ~ 28)

80% occur in males

Tremendous variation in incident rates per state because of demographics

Approximately 12,000 new cases/year in the US
Etiology
Demographic Trends
On average, first year medical costs will range from $23,000-$300,000

Emergency medical services, physician and outpatient services, nursing home, household assistance, voc. Rehab

Range will differ depending upon cause:

Vehicle crash ~ $233,947
Violence ~ $217, 000
Sport related ~ $295,643

Lifetime costs are expected to exceed a million dollars per individual
Costs of SCI (DeVivo, 1997)
Neurologic examination

Initially done in ER to diagnose
Localize neurological deficits asap
Treatments may include methylprednisolone; “ice”
Complete, incomplete, ASIA grade

Monitor progress
Examination of muscles innervated by root levels
MMT

Prognosis (72 hours post-injury)
Concomitant injuries can make this difficult (sedation; head injury; intubation)
Treatment after injury
After a period of immobilization, therapies will resume quite aggressively to maximize remaining function

Generally speaking, what function isn’t regained after 1 year, won’t come back

Acute Phase: 30-60 days post injury
medical management

Rehab period: 3-6 months following release
counseling, training, etc.
Cervical
C4-head, neck diaphragm
C5-elbow flexors
C6-triceps
C8-T2-hands

Thoracic
T4-T7-chest
T8-T12-abdminals

Lumbar
legs

Sacral
Bowel, bladder, sexual function, feet
SCI Configuration
Parasympathetic

“vegetative” responsibilities (digestion)






Sympathetic

fight/flight responses (increased HR, sweating, etc.)
Understanding Level of Injury
Cervical Injury
most limiting in function
can significantly impair autonomic regulatory function
most individuals will require significant assistance w/activity such as adapted gloves or wrist cuffs
exercise and activity will focus on fine motor movements, stability, and ADL function
independent transfers, eating, bathing, etc. are important functional skills
Pressure Sores
Poor Thermoregulation
Venous Pooling
Orthostatic Hypotension
Carpel Tunnel Syndrome
Autonomic Dysreflexia
Deep vein thrombosis
Stomach ileus (NG Tube/medication)
Thoracic Injuries
function highly dependent upon level of injury

ability to use hands, shoulders, and arms allowing for independent function

ability to regulate exercise will also depend on injury level ....concern for thermoregulation and cardiovascular capacity
Lumbar/sacral Injuries
highest degree of function
independent
able to regulate & tolerate exercise activity very well
Track Damage
Regulation is primarily a function of the sympathetic division concerned with:
vasoconstriction
Temperature regulation
cardiac musculature
pulmonary musculature
Neurogenic shock (low HR/BP)

Loss of sympathetic stimulation can mean….
decreased blood flow to exercising muscle
decreased delivery of O2
decreased ability to remove metabolic end products
greater dependence on anaerobic E

accumulation of lactic acid

early onset of fatigue

diminishes thermoregulation capability decreasing capability to dissipate heat, increasing risk for heat prostration
medical emergency

occurs in individuals with SCI at T6 or above

“uninhibited reflex to a noxious stimulus resulting in total body vasoconstriction”

symptoms include:

pounding headache
profuse sweating
goose bumps
splotching of skin
nasal obstruction
Exercise Suggestions & Modifications
body check, empty catheter
exercise should focus on functional activity (e.g., transfers, reaching)
differential between short bouts of exercise (function) & and endurance (travel)
vary CVE by travel ...grass, flat surfaces, inclines
upper body exercises
THR calculation 200-age
intermittent CVE depending upon tolerance & RPE
free weights vs. machines may be easier for transferring purposes
counter-balancing for homolateral exercises
active-passive finish
creativity!


Lateral spinothalamic
Pain and temperature


Fasciculus gracile
Touch, pressure and conscious muscle joint sense


Dorsal spinocerebellar
Proprioception


Lateral corticospinal
Voluntary skilled movement of trunk and hind limbs


Ventral corticospinal
Voluntary skilled movement of forelimb


Rubrospinal
Facilitate activity of flexor muscles and inhibits extensors


7 Cervical Vert. but 8 cervical nerves
Full transcript