Spinal cord injuries can be either traumatic, from events like car accidents or falls, or non-traumatic, from conditions that damage the spinal cord. They are classified as either tetraplegia or paraplegia depending on whether the arms or legs are affected. Physiotherapy focuses on managing symptoms, preventing complications, and improving function through exercises for mobility, transfers, wheelchair skills, and more. The goal is to maximize independence and allow patients to safely perform daily living activities. Prognosis depends on the completeness of the injury and potential for recovery decreases over time as improvement plateaus.

1. Spinal Cord Injury
(SCI)
[Part 1: Brief Overview]
By: Gan Quan Fu, PT

2. Contents
1. Introduction
2. Overview of Spinal Cord
3. Classification and Symptoms in
Patient’s with Spinal Cord Lesion
4. Clinical Manifestations
5. Physiotherapy Examination
6. Physiotherapy Intervention
7. Summary
8. References
By: Gan Quan Fu, PT

3. Introduction
• Low incidence, high-cost disability requiring
tremendous changes in an individual
lifestyle
• Divided into 2 categories:
o Traumatic injuries (MVA, Fall, Gunshot etc.)
o Nontraumatic damage (Thrombosis, embolus
etc.)
• Typically divided into 2 broad functional
categories:
o Tetraplegia
o Paraplegia
By: Gan Quan Fu, PT

4. Overview of Spinal Cord
By: Gan Quan Fu, PT

5. Anatomy
• 31 pairs spinal nerve
o 8 Cervical
o 12 Thoracic
o 5 Lumbar
o 5 Sacral
o 1 Coccygeal
• Spinal Tracts
o Ascending Tracts (Sensory)
• Spinothalamic
• Dorsal Column Tract
• Spinocerebellar Tract
o Descending Tracts (Motor)
• Lateral Corticospinal
• Anterior Corticospinal
By: Gan Quan Fu, PT

6. Spinal Tracts
By: Gan Quan Fu, PT

7. Spinal Tracts
By: Gan Quan Fu, PT

8. Spinal Tracts
By: Gan Quan Fu, PT

9. Ascending Tracts
Tracts Function
Spinothalamic Tracts (Lateral) Pain & Temperature
Spinothalamic Tracts (Anterior) Light Touch & Pressure
Posterior Column Pathway 1. Deep touch & pressure
2. Proprioception
3. Vibration sensation
Spinocerebellar Tracts Posture and Coordination
By: Gan Quan Fu, PT

10. Ascending Tracts
By: Gan Quan Fu, PT

11. Descending Tracts
By: Gan Quan Fu, PT

12. Classification and
Symptoms in Patient’s
with Spinal Cord Lesion
By: Gan Quan Fu, PT

13. Designation of Lesion Level
• Important for clinician to accurately determine the
extent of neurological impairment in terms of motor
and sensory loss.
• American Spinal Injury Association (ASIA) had
created the International Standards of Neurological
Classification of Spinal Cord Injury.
o Standardize the way in which severity is
determined and documented.
• Better communication between and among
professionals
• Provide guidance for establishing prognosis
• Important tools for clinical research trials
By: Gan Quan Fu, PT

14. Dermatome
By: Gan Quan Fu, PT

15. Myotome
By: Gan Quan Fu, PT

16. Myotome
By: Gan Quan Fu, PT

17. Complete Injury, Incomplete Injury
and Zone of Partial Preservation
• Complete Injury
No sensory or motor function in lowest sacral segments
(Determine by Anal Sensation and Voluntary External Anal
Sphincter).
• Incomplete Injury
Having motor and /or sensory function below the
neurological level including S4 & S5.
• Zones of Partial Preservation
Having motor and /or sensory function below the
neurological level but no function at S4 & S5.
By: Gan Quan Fu, PT

18. ASIA Impairment Scale
By: Gan Quan Fu, PT

19. Clinical Syndromes
• Central Cord
• Brown-Sequard
• Anterior Cord
By: Gan Quan Fu, PT

20. Central Cord Syndrome
• Result of compressive forces
which give rise to hemorrhage
and edema in central aspect of
cord.
• More severe neurological
involvement of upper extremities
than lower extremities.
• Varying degrees of sensory
impairment but less severe than
motor deficits.
• Normal sexual, bowel and
bladder function
• Typically recover the ability to
ambulate with some remaining
distal upper extremities weakness
By: Gan Quan Fu, PT

21. Brown-Sequard
Syndrome
• Damage to one side (causes:
Penetration wound)
• Asymmetrical clinical features.
• Ipsilateral side of lesion Loss
of sensation in dermatome
segment in the level of lesion
(depending on area involve)
• Contralateral side of lesion 
Loss of pain and temperature
if damage to spinothalamic
tracts, loss begins several
dermatome segments below.
By: Gan Quan Fu, PT

22. Anterior Cord
• Loss of motor function
(corticospinal tract); Loss of
sense of pain and
temperature (spinothalamic
tract)
• Proprioception, Kinesthesia
and vibratory sense are
generally preserved
By: Gan Quan Fu, PT

23. Clinical Manisfestation
By: Gan Quan Fu, PT

24. Spinal Shock
• Period of areflexia after SCI
• Relates to the loss of all neurological activity below the
level of injury. This loss of neurological activity include loss
of motor, sensory, reflex and autonomic function.
• The mechanism for spinal shock involves the sudden loss
of conduction in the spinal cord as a result of the
migration of potassium ions from the intracellular to
extracellular spaces.
• Return of reflexes between 1-12 months post injury are
characterised by hyper-reflexia, or abnormally strong
reflexes usually produced with minimal stimulation. Inter
neurons and lower motor neurons below the SCI begin
sprouting, attempting to re-establish synapses.
By: Gan Quan Fu, PT

25. Autonomic Dysreflexia
• Also known as
hyperreflexia,
• Over-active Autonomic
Nervous System, which
causes an abrupt onset
of excessively high
blood pressure.
• Usually due to
compression of anterior
cord
By: Gan Quan Fu, PT

26. Other Direct Clinical
Manisfestation
• Postural Hypotension
• Impaired Temperature Control
• Respiratory Impairment
• Spasticity
• Bladder and Bowel Dysfunction
• Sexual Dysfunction
By: Gan Quan Fu, PT

27. Indirect Impairments and
Complications
• Respiratory complication (such as pneumonia)
• Pressure sores
• Deep Vein Thrombosis
• Contractures
By: Gan Quan Fu, PT

28. Prognosis
By: Gan Quan Fu, PT

29. Prognosis
• Influences on potential for recovery:
o Degree of pathological changes imposed by trauma
o Precaution taken to prevent further damage (eg during rescue)
o Prevention of additional compromise of neural tissue from hypoxia and
hypertension during acute management.
• Formulation of prognosis is initiated after spinal
shock has subside and is guided by whether or not
the lesion is complete (in complete lesion, no motor
improvement is expected other than which may
occur from nerve root return.)
• Good prognosis for incomplete lesion. Improvement
usually begins after the cessation of spinal shock.
• In time, rate of recovery will decrease and plateau
will be reached. When no new muscle activity is
observed for several weeks or months, no additional
recovery can be expected.
By: Gan Quan Fu, PT

30. Physiotherapy
Examination
By: Gan Quan Fu, PT

31. Physiotherapy
Examination
• Respiratory Examination
o Function of respiratory muscles
o Chest Expansion
o Breathing Pattern
o Cough
o Vital Capacity
• Integument
• Sensation
• Tone and Deep Tendon Reflex
• Manual Muscle Test and Range of Motion
• Functional Status
By: Gan Quan Fu, PT

32. Physiotherapy
Intervention
By: Gan Quan Fu, PT

33. Physiotherapy
Intervention(Acute Phase)
• Emphasis on respiratory management
• Prevention of indirect impairments and
complications
• Maintaining ROM
• Facilitate active movement in available
musculature
By: Gan Quan Fu, PT

34. Physiotherapy
Intervention(Acute Phase)
• Respiratory Management
o Deep Breathing
o Glossopharyngeal Breathing
o Airshift Maneuver
o Strengthening Exercise
o Assisted Cough
o Abdominal Support
o Stretching, chest physiotherapy etc.
• Range of Motion and Positioning
• Selective Strengthening
• Orientation to the Vertical Position
By: Gan Quan Fu, PT

35. Physiotherapy Intervention
(Active Phase)
• Emphasis of treatment on maximizing functional
independence
• Initially includes basic skills eg: bed mobility, transfer
and wheelchair mobility
• Progress to skills necessary for work, home and
community reentry.
• Individuals who are not able to accomplish specific
functional task should be educated on how to
instruct another person to perform task for them
(eg: those with high cervical lesion)
By: Gan Quan Fu, PT

36. Physiotherapy Intervention
(Active Phase)
• Continue Rx as in acute phase
• Educate patient on self skin inspection (with mirror)
• Mat Activities
o Rolling
o Prone on elbows
o Sitting
o Transfers, etc.
• Prescriptive wheelchair
o Wheelchair Skills
• Ambulation
• Functional Electrical Stimulation
• Educate on prevention, health promotion, fitness
and wellness.
By: Gan Quan Fu, PT

37. Take Home Message
• There is no specific recipe of treatment for SCI
patients. ‘All intervention planned comes with
appropriate reasoning and justification base on
your assessment/examination’
By: Gan Quan Fu, PT

38. References
• O’Sullivan. S.B. and Schmitz. T.J. (2008) ‘Physical
Rehabilitation’, 5th edn. Philadelphia; F.A. DAVIS
COMPANY.
By: Gan Quan Fu, PT

39. By: Gan Quan Fu, PT