TRAUMATIC SPINAL CORD INJURIES

1. 1
QURATULAIN MUGHAL
IIRS
DOCTOR OF PHYSICAL
THERAPY
BATCH IV

2.  SCI is a relatively low-incidence, high-cost
injury that results in tremendous change in an
individual’s life.
 Paralysis of the muscles below the level of the
injury.
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3.  It is estimated that approximately 11,000 new
cases of SCI occur in the United States
annually.
 Primarily affect young adults.
 However, the age at injury has steadily
increased.
 The majority of persons with SCI are male
(78.3% male vs. 21.7% female).
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4. 1. TRAUMATIC INJURIES:
Traumatic events such as:
 Motor vehicle accidents (40.4%)
 Falls (27.9%)
 Violence (15.0%)
 Sports (8.0%)
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5.  In adult populations generally results from disease or
pathological influence, such as:
 Arteriovenous malformation [AVM]
 Thrombosis
 Embolus
 Hemorrhage
 Vertebral subluxations secondary to rheumatoid
arthritis or degenerative joint disease; spinal
neoplasms; syringomyelia; abscess of the spinal cord;
infections, such as syphilis or transverse myelitis.
 Neurological diseases, such as multiple sclerosis and
amyotrophic lateral sclerosis.
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6.  The most common type of injury is
incomplete tetraplegia (39.5%)
 Followed by complete paraplegia (22.1%)
 Incomplete paraplegia (21.7%)
 Complete tetraplegia (16.3%).
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7.  Individuals with an incomplete neurological
SCI have a longer life expectancy than those
with a complete injury.
 Individuals with more caudal injuries also
have a greater life expectancy.
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8. FUNCTIONALCATEGORIES:
1. Tetraplegia refers to complete paralysis of
all four extremities and trunk, including the
respiratory muscles, and results from lesions
of the cervical cord.
2. Paraplegia refers to complete paralysis of all
or part of the trunk and both lower
extremities (LEs), resulting from lesions of
the thoracic or lumbar spinal cord or cauda
equina.
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9. ASCENDINGTRACTS:
 Dorsal column (conveys proprioception,
vibratory sensation, deep touch, and
discriminative touch).
Anterolateral system consisting of:
 Spinothalamic
 Spinoreticular
 Spinotectal tracts (conveys pain, temperature,
and crude touch)
 Dorsal and ventral spinocerebellar tracts
(conveys unconscious proprioception)
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10.  Lateral corticospinal (voluntary movement)
 Anterior corticospinal (voluntary movement of axial
muscles, minimal clinical significance due to small
size)
 Medial vestibulospinal (positioning of head and
neck)
 Lateral and medial vestibulospinal (posture and
balance)
 Lateral and medial reticulospinal (posture, balance,
automatic gait-related movements)
 Rubrospinal (movement of limbs)
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12.  International Standards for Neurological
Classification of Spinal Cord Injury (ISNCSCI).
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13. SCORING OF SENSATION:
3-point ordinal scale
0 = absent
1 = impaired
2 = normal.
KEY MUSCLE STRENGTH IS SCORED:
6-point ordinal scale commonly
 Manual muscle testing (MMT).
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14.  COMPLETE INJURY : No sensory or motor
function in the lowest sacral segments (S4
and S5).
 Incomplete injury: If an individual has motor
and/or sensory function below the
neurological level but does not have function
at S4 and S5.
 The areas of intact motor and/or sensory
function below the neurological level are
termed zones of partial preservation.
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16.  Brown-Sequard Syndrome
 Anterior Cord Syndrome
 Central Cord Syndrome
 Cauda Equina Injuries
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17.  Occurs from hemisection (Partial lesions) of the spinal
cord (damage to one side) and is typically caused by
penetration wounds, that is, gunshot or stab.
 Clinical features of this syndrome are asymmetrical.
IPSILATERAL (SAME) SIDE ASTHE LESION:
 There is paralysis and sensory loss.
 Loss of proprioception
 Light touch
 Vibratory sense is due to damage to the dorsal
column
 Paralysis results from damage to the lateral
corticospinal tract.
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18.  Damage to the spinothalamic tracts results in
loss of sense of pain and temperature.
 Loss begins several dermatome segments
below the level of injury.
 Discrepancy in levels occurs because the
lateral spinothalamic tracts ascend two to
four segments on the same side before
crossing.
 Achieve good functional gains during
inpatient rehabilitation.
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19.  Related to flexion injuries of the cervical region with
resultant damage to the anterior portion of the cord
and/or its vascular supply from the anterior spinal artery.
 Typically compression of the anterior cord from fracture,
dislocation, or cervical disk protrusioncharacterizedby loss
of motor function (corticospinal tract damage) and loss of
the sense of pain and temperature (spinothalamic tract
damage) below the level of the lesion.
 Proprioception, light touch, and vibratory sense are
generally preserved, because they are mediated by the
dorsal columns with a separate vascular supply from the
posterior spinal arteries.
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20.  Most common SCI syndrome.
 Generally occurs from hyperextension
injuries to the cervical region.
 Associated with congenital or degenerative
narrowing of the spinal canal.
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21.  Cauda equina lesions are peripheral nerve
LMN injuries.
 Individuals exhibit areflexic of bowel and
bladder and saddle anesthesia.
 Lower extremity paralysis and paresis is
variable depending on the extent of the injury
to the cauda equina.
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22.  Spinal Shock
 Motor and Sensory Impairments
 Autonomic dysreflexia (AD, also referred to
autonomic hyperreflexia)
 Spastic Hypertonia
 Cardiovascular Impairment
 ImpairedTemperature Control
 Pulmonary Impairment
 Bladder and Bowel Dysfunction
 Sexual Dysfunction
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24. LEVEL OF INJURY
1. C1–C2
2. C3–C4
3. C5–C8
4. T1–T5
5. T6–T10
6. T11 and below
RESPIRATORY MUSCLES
1. Sternocleidomastoid, upper
trapezius, cervical extensors.
2. Partial diaphragm, scalenes,
levator scapulae.
3. Diaphragm, pectoralis major
and minor, serratus anterior,
rhomboids, latissimus dorsi.
4. Some intercostals, erector
spinae.
5. Intercostals and abdominals.
6. All of the muscles above.
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25.  Pressure ulcer
 Deep vein thrombosis
 Pain
 Contractures
 Heterotopic ossification
 Fracture/osteoporosis
 Syringomyelia
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26. 1. Emergency Care
2. Fracture Stabilization
3. Immobilization
Cervical Orthoses
Minerva
Thoracolumbosacral Orthoses
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27.  PhysicalTherapy Examination
1. Motor and Sensory Function
2. Respiratory
3. Integument
4. Passive Range of Motion
5. Early Mobility Skills
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28. SUPINE
 Occiput
 Scapulae
 Vertebrae
 Elbows
 Sacrum
 Coccyx
 Heels
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29.  Ears (head rotated)
 Shoulders (anterior aspect)
 Illiac crest
 Male genital region
 Patella
 Dorsum of feet
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30.  Ears
 Shoulders (lateral aspect)
 Greater trochanter
 Head of fibula
 Knees (medial aspect from contact between
knees)
 Lateral malleolus
 Medial malleolus (contact between malleoli)
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31.  Respiratory Management
 Deep-Breathing Exercises
 Glossopharyngeal Breathing
 Air Shift Maneuver
 Respiratory Muscle Strengthening
 Coughing
 Abdominal Binder
 Manual Stretching
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34.  Early Mobility Interventions
 Education
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35.  Independent mobility can be achieved in a
way that:
(1) either uses new movement strategies to
compensate for neuromuscular impairments.
(2) uses the neuromuscular system to
accomplish the task with a movement
pattern similar to that before the injury.
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36.  Compensation refers to use of an alternative
or new movement strategy, or technology to
compensate for neuromuscular deficits to
accomplish a daily task.
 Recovery of function refers to the
restoration of the neuromuscular system so
that the motor task is performed in the same
manner as it was before the SCI.
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37. COMMONLY USED OUTCOME MEASURES
ANDTESTS AND MEASURES CATEGORIES
Aerobic Capacity/Endurance
 A 6-minute arm test
Arousal, Attention, Cognition
 Mini Mental State Exam and the Montreal Cognitive Assessment
Environmental or Work Barriers Gait, Locomotion, and Balance
 Wheelchair SkillsTest,Wheelchair Circuit, Modified Functional
ReachTest, Berg Balance Scale,Walking Index for Spinal Cord
Injury, Spinal Cord Injury Functional Ambulation Inventory, 10-
Meter WalkTest, 6-Minute WalkTest, Neuromuscular Recovery
Scale
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38. Integument
 Braden Scale
 Spinal Cord Injury Pressure Ulcer Scale
 Spinal Cord Injury Pressure Ulcer Scale–Acute
Motor Function
 Modified Ashworth Scale, Spinal Cord Injury
Spasticity EvaluationTool
Muscle Performance
 ASIA ISNCSCI, manual muscle test, handheld
dynamometer
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39. Pain
 Visual analog scale, International SpinalCord Injury Basic Pain Data Set,
Wheelchair User’s Shoulder Pain Index
Range of Motion
 Goniometer
Self-Care and Home Management
 Functional Independence Measure, SpinalCord Injury Independence
Measure, Quadriplegia Index of Function, Capabilities of Upper Extremity
Instrument
Ventilation
 Chest circumference with measuring tape
 Vital capacity with handheld dynamometer
 Respiratory rate
Work, Community, and Leisure Integration or Reintegration
 Craig HandicapAssessment and ReportingTechnique, Assessment of Life
Habits, and Reintegration to Normal Living Index
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40.  Ramp slope: 12:1 (12 ft [3.7 m] of horizontal distance for
every 1 ft [0.31 m] of rise)
 Ramp width: 36 in (0.91 m)
 Ramp landings every 30 ft (9.1 m)
 No thresholds through doorways
 Lever-type door handles
 Door width at least 32 in (0.81 m)
 Open floor plan
 Tile or hardwood floors
 Wheelchair access to bathroom
 Toilet seat height same as wheelchair seat height
 Adequate clearance under sinks
 Insulated pipes
 Roll-in shower
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41.  Motor level
 Age
 Concomitant injury
 Preexisting health conditions
 Secondary complications
 Body type
 Psychosocial support
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42.  Orthopedic/stress at the fracture site
 Skin integrity
 Blood pressure
 Fall risk
 Overstretching
 Overuse/stress
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43.  Position wheelchair
 Set wheel locks
 Remove and replace arm rests on wheelchair
 Remove and replace leg rests on wheelchair
 Manage transfer board
 Manage lower extremities
 Manage body position in wheelchair
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