PART 2 Spinal Cord Injury * introduction * evaluation * examination * asia scale etc.

1. SPINAL CORD INJURY
ASSESSMENT

2. INTRODUCTION
 The term ‘spinal cord injury’ is used to refer to
neurological damage of the spinal cord following trauma.
 The most common causes of spinal cord injury are motor
vehicle and motor-bike accidents, followed by falls. Work-
related injuries are also common, as are injuries from
sport and water-based activities. Spinal cord lesions can
also be due to disease, infection and congenital defect.

5. EVALUATION

6. HISTORY
 Ask/Interrogate the sequence of events led to the
admission “or”
Identify the list of problems/symptoms the patient
presented with
 To be presented in the Chronological order- Event by
event with further details

7.  A history should include the date, level, extent
and etiology of the damage to the spinal cord, any
complications or additional injuries sustained at or
since the time of cord injury
 a brief summary of the medical and surgical
management received.
 It should also include any change in the
neurological status since the time of injury

8.  a brief summary of the rehabilitation he underwent
 a description of functioning since injury
 History should also include impaired sensation e.g.
type of sensation, severity, impaired or lost, pain
history
 Incontinence history based on the extent and type of
damage which includes onset, circumstances, amount
loss, urinary symptom ,fluid intake.

9. ASSESSMENT
OBSERVATION
❑ Generalized observation
E.g: Built of the patient, external injury over the face or
extremities, oedema, pressure ulcers, others( surgical
bandage, crepe bandage, DVT pump, IV line, type of
urinary catheter, brace etc.)
❑ Localized observation
E.g: Attitude of the limb, posturing of the extremities etc.
❑ Auscultation

10. PALPATORY FINDINGS
 Superficial
note skin temperature
Skin texture
Skin hypersensitivity
 Deeper
Pitting/non-pitting edema
Pain/tenderness
 Deepest
Bony irregularities
Tissue adhesion
Scar adhesion

11. EXAMINATION
▪ Vitals
Blood pressure, heart rate, temperature, respiratory rate,
saturation
▪ Sensory assessment based on dermatome distribution
o Superficial
o Deep
o Combined cortical
Further evaluation to be performed based on ASIA scale.
▪ Reflexes (including abdominal, anal, and bulbo
cavernosus)

12. MOTOR EVALUATION
 Voluntary motor function
 Tone ( MAS scale)
 Range of motion
 Muscle strength

14.  Functional abilities
✓ Mat and bed skills
such as ability to turn from supine to prone, prone to supine, to achieve
side sitting, quadruped position, sitting, kneeling etc.
BADL ( bedside activities of daily living)
✓ Transfers
✓ Wheelchair skills
✓ Ambulation
Hand functions
 Observational gait analysis
Other examination includes
skin integrity

15. B
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16. Respiratory system
i. Assess the strength of the diaphragm and intercostal muscles through
observation while the patient is breathing.
Normally, the epigastric region should rise and the chest wall expands
during inhalation while in supine. Contractions of the sternocleidomastoids
and scalenes or paradoxical breathing patterns indicate weakness or lack
of innervation of the diaphragm or intercostal muscles.
i. Respiratory rate should be assessed. (Normal rate 12-20 Brpm)
the respiratory rate will typically increase to compensate the weak
diaphragm
i. Maximal chest excursion can be assessed using a tape measure with the
patient supine.
At both the level of the axilla and xiphoid process
Chest expansion measurements are the difference between chest
measurements at maximal exhalation and at maximal inhalation.
(Normal range: 2.5 to 3 in (6.35 to 7.62 cm)
and negative values are an indication of paradoxical chest motions.

17. i. Vital capacity (VC)
Vital capacity can be measured with a handheld spirometer.
Typically, VC is approximately less than 25% of normal in
individuals with high cervical lesions (above C3), 25% to 50% in
mid cervical lesions, 50% to 75% in lower cervical and upper
thoracic lesions, and 70% to 80% in mid to lower thoracic lesions.
i. The ability to cough effectively
It is vital for the removal of secretions. The abdominal muscles
are the major contributors to generating enough force to expel
secretions.
Cough function can be categorized into three types: functional
cough, weak functional cough, and nonfunctional cough.

18. • A functional cough is loud and forceful and the patient is able to
generate two or more coughs with one exhalation.
In this case the patient is able to clear all respiratory secretions.
• A weak functional cough is soft and the patient is only able to
generate one per exhalation. The patient can clear small amounts of
secretions and clear the throat.
• A nonfunctional cough is a clearing of the throat and has no expulsive
force. In this case, assistance is needed to clear secretions from the
airway.

19. Integument
• Assessment for pressure ulcers should combine both direct skin
inspection, which combines both visual observation and palpation.
Palpation is useful for identifying skin temperature changes that may
be indicative of a hyperemic reaction. This is particularly important in
examining individuals with dark skin, because early skin responses to pressure
may not be readily apparent

20. To assess the risk of
developing skin ulcers.
Braden Scale

21. COMMON SCALES USED IN
SPINAL CORD INJURY

22. Motor and sensory function should be assessed using
the ISNCSCI
Motor and sensory function should be assessed using the ISNCSCI to
determine the level of neurological injury.
i. The ISNCSCI provides a standardized examination method to
determine the extent of motor and sensory function loss after a SCI.
It promotes better communication between and among
professionals, provides guidance for establishing the prognosis, and
is an important tool for clinical research trials
The neurological level is defined as the most caudal level of the
spinal cord with normal motor and sensory function on both the left
and right sides of the body.

24. Motor level is referred to as the most caudal segment of the spinal
cord with normal motor function bilaterally.
Sensory level is defined as the most caudal segment of the spinal cord
with normal sensory function bilaterally.
i. Sensory level is determined by testing the patient’s sensitivity to
light touch and pinprick on the left and right side of the body at
key dermatomes. Scoring of sensation is based on a 3-point ordinal
scale:
0 = absent, 1 = impaired, and 2 = normal.
i. Motor level is determined by testing the strength of a key muscle on
the right and left side of the body at myotomes adjacent to the
suspected level of impairment using a 6-point ordinal scale
commonly used for manual muscle testing.

25. ASIA CLASSIFICATION
ASIA Impairment Scale:
 Individuals with incomplete injuries may have variable
clinical presentations in terms of motor and/or sensory
function below the neurological level.
For example, one patient may have close to normal sensory and motor
function below the level of the lesion whereas another with the same lesion
level may have impaired sensation and no motor function below the
neurological level.
 The ASIA impairment scale was created so that clinicians
and researchers could better communicate the degree of
motor and sensory impairment of individuals with SCIs.

27. SPINAL CORD INDEPENDENCE MEASURE
The SCIM has been developed to address three specific areas of
function in patients with spinal cord injuries (SCI).
 Assess traumatic and non-traumatic spinal cord injury.
 It has 19 items and 3 domains: self care (feeding, grooming,
bathing, and dressing), respiratory and sphincter
management, mobility (bed and transfers and
indoors/outdoors).
 The total score ranges from 0-100.
score of 0 defines total dependence and a score of 100 is indicative of
complete independence.
Each subscale score is evaluated within the 100-point scale (self-care:
0-20; respiration and sphincter management: 0-40; mobility: 0-40)

28. REFERRENCES
 Spinal cord injury functional rehabilitation –
Martha freeman.
 Management of spinal cord injuries- Lisa Harvey
 Darcy Umphered
 Susan O sullivan

29. THANKYOU
Presented by Dinu Dixon
MPT(Neurology)