spinal cord injuries

1. Spinal Cord Injury
OT 537

2. SCI Statistics
• Approximately 12,000 new cases of SCI each year
• Causes?
• Males are more likely than females to
sustain an injury.

3. SCI Statistics
• Twenty years post injury, 35.2% are employed with a
similar level of employment through post-injury year
35.
• Lifetime cost varies by level of injury and age at injury.
• Surviving the first 24 hours indicates 85% chance of
survival for 10 years or more.

4. What is a Spinal Cord Injury?

5. Spinal Cord Injury
Two broad categories:
• Traumatic Injury
• Non-Traumatic Injury
Spinal Cord Injuries are classified as:
Tetraplegia/Quadriplegia Complete
Paraplegia Incomplete

6. Specific Cord Lesions
• Central cord syndrome- most common,
incomplete, greater weakness in UE than LE,
associated with cervical stenosis
• Brown-Sequard Syndrome- incomplete,
damage to half the cord causing ipsilateral
proprioceptive and motor loss and
contralateral loss of pain and temperature
sensation
• Anterior cord syndrome- absent blood supply
to the cord, loss of motor control, pain, and
temperature sensation below injury,
proprioception and light touch preserved

7. Specific Cord Lesions (con’t)
• Cauda equina Syndrome
• LMN injury to lumbrosacral
roots within spinal canal
• Results in areflexic bladder and
bowel, paralysis or weakness of
lower limbs
• Conus medullaris Syndrome
• In addition to lesions to the
lumbar nerve roots, the spinal
cord is also damaged, resulting
in a mixed physical picture with
some preservation of reflex
activity
• Bladder, bowel, and lower limbs
are also affected.
Both conditions are neurosurgery emergencies!

8. Severity
Depends on:
1. The level of the spinal cord that was affected
2. Whether the lesion is complete or incomplete
Complete Lesion- no sensory or motor function
below the level of the lesion
Incomplete Lesion- characterized by the
preservation of some sensation or motor
function below the level of the lesion.

9. Predictors of Motor Return
• In first 24 hours, predictions are not accurate because
conditions improve or deteriorate
• 72 hours to 1 week after injury- more reliable predictions
• Degree of impairment (incomplete or complete)
• Preserved motor function- best predictor
• Preserved pin prick sensation in sacral region
• Pattern of neurological injury- central cord or Brown-Sequard
better than anterior cord syndrome
• Early neurological return
• Age- younger is better

10. Complete vs. Incomplete
Injuries

11. Reviewofthe SpinalCordAnatomy&Physiology

12. Autonomic Nervous System
• Responsible for control of the bodily functions not consciously
directed, such as breathing, the heartbeat, and digestive
processes.
• Supplies the internal organs, including the blood vessels,
stomach, intestine, liver, kidneys, bladder, genitals, lungs,
pupils, heart, and sweat, salivary, and digestive glands.

14. Sympathetic
• Fight or flight
• Increases heart rate
• Force of heart contractions and dilates the airways to make
breathing easier
• Muscular strength is increased.
• Palms sweat, pupils to dilate, and hair to stand on end.

15. Parasympathetic
• Controls body process during ordinary situations.
• Conserves and restores.
• Slows the heart rate and decreases blood pressure.
• Stimulates the digestive tract to process food and eliminate
wastes.
• Energy from the processed food is used to restore and build
tissues.

16. Dermatome

17. The ASIA Impairment Scale
To help classify differing degrees of spinal cord injury, the ASIA
Impairment Scale is used to help compare and understand
residual function after a SCI.

18. The ASIA Impairment Scale
Level A Complete No motor or sensory function in the
lowest sacral segment (S4-S5)
Level B Incomplete Sensory function below neurological
level and in S4-S5, no motor function
below level of injury
Level C Incomplete Motor function preserved below injury
level and more than half of the key
muscle groups below neurological
level have a muscle grade <3
Level D Incomplete Motor function preserved below injury
level and at least half of the key
muscle groups below neurological
level have a muscle grade of 3
Level E Normal Sensory and motor function is normal

19. Upper Motor Neurons and Lower Motor Neurons

21. Spinal (Neurogenic) Shock
• Loss of reflexes below lesion immediately after SCI
• Motor pathways lost, causing flaccid paralysis, loss of tendon
reflexes, loss of autonomic function
• Lasts for hours, days, or weeks
• Spinal activity returns

22. Temperature Control
• Many individuals with SCI cannot regulate body temperature.
• SCI causes disruption between hypothalamic temperature
regulators and sympathetic function below lesion
• Lose ability to sweat and shiver
• Poikilothermy- body takes on the temperature of the external
environment; T6 and above
• With lesions above the T6 level, it is important to look out for
signs and symptoms of autonomic dysreflexia.
Resource to check out: http://archive.is/www.apparelyzed.com

23. Autonomic Dysreflexia
• Clinical emergency- can result in death
• Exaggerated sympathetic reflex responses
• Occurs only after spinal shock resolved and autonomic
reflexes return
• Severe hypertension, bradycardia, headache, vasodilation,
flushed skin, profuse sweating above lesion level
• Usually T6 and above
Resource to check out: http://pushliving.com/reviewing-a-d-one-more-time/

24. Autonomic Dysreflexia
https://www.christopherreeve.org/

25. Autonomic Dysreflexia
1) Stop activity
2) Elevate head to avoid excessive BP to brain
3) Loosen clothing and other constrictions

26. Orthostatic Hypotension in SCI
• Also called postural hypotension
• Blood pressure drops dangerously low when individual with an
SCI at the T6 level or higher is in upright position
• Causes dizziness, pallor in the face, blurred vision, excessive
sweating above lesion, possible fainting
1) Check BP
2) In bed - lower the head of bed
3) In wheelchair - lift legs and if symptoms persist, recline the w/c
to place head at or below heart level.
4) Continue to monitor BP

27. Respiratory Function
With high SCI levels such as C1-C3, the phrenic nerve is
injured and therefore respiratory function is
significantly compromised

28. Edema
• Fluid accumulation in interstitial tissue
• Result of immobility causing increased venous pressure and
pooling of blood in abdomen, upper and lower extremities

29. Skin Breakdown
• Loss of sensation and circulatory changes can compromise
skin integrity.
• Common but preventable complication
• Repositioning is key for pressure relief

30. Deep Vein Thrombosis (DVT)
• Clot in venous system
• Results from impaired vasomotor tone, loss of muscle tone,
trauma to the vein wall, immobility, hypercoagulation
• Can cause pulmonary embolism if clot dislodges and travels to
lungs

32. ReferencesCatz, A., Itzkovich, M., et al. (1997). "SCIM-spinal cord independence measure: a new disability scale for patients with spinal cord
lesions.” Spinal Cord, 35(12): 850-856.
Crepeau, E. B., Cohn, E. S., Boyt-Schell, B. A. (2009) Willard and Spackman’s Occupational Therapy (11th ed.), Wolters Kluwer –
Lippincott Williams & Wilkins.
Guidetti, S., Asaba, E., & Tham, K. (2009). Meaning of context in recapturing self-care after stroke or spinal cord injury. AJOT, 63,
323-332.
Lancaster, S. L. (2014). SCI Powerpoint presentation.
Randomski, M. V., Trombley-Latham, C. A. (2008). Occupational Therapy for Physical Dysfunction (6th ed.), Wolters Kluwer –
Lippincott Williams & Wilkins.
Robertson, E. (2012). SCI Powerpoint presentation.
Ward, K., Mitchell, J., & Price, P. (2007). Occupation-based practice and its relationship to social and occupational participation in
adults with spinal cord injury. Occupational Therapy Journal of Research: Occupation, Participation, and Health, 27,
149-156.
http://www.spinalinjury101.org/details/levels-of-injury
http://www.christopherreeve.org
http://www.disabled-world.com
http://www.spinalcord.uab.edu
http://nm.gov/disorders/sci/sci.htm
http://www.spinalcord.org/life-in-action/