Spinal Cord Injury


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Spinal Cord Injury

  1. 1. SPINAL CORD INJURY At Thoracic, Lumbar, Sacral and Cauda-equina levels
  2. 2. Paraplegia • is when the level of injury occurs below the first thoracic spinal nerve. The degree at which the person is paralyzed can vary from the impairment of leg movement, to complete paralysis of the legs and abdomen up to the nipple line. Paraplegics have full use of their arms and hands.
  3. 3. Segmental spinal Cord level and Function Tl -T6 intercostals and trunk above the waist T7-Ll Abdominal muscles Ll, L2, L3, L4 Thigh flexion L2, L3, L4 Thigh adduction L4, L5, S1 Thigh abduction L5, S1 S2 Extension of leg at the hip (gluteus maximus) L2, L3, L4 Extension of leg at the knee (quadriceps femoris) L4, L5, S1, S2 Flexion of leg at the knee (hamstrings) L4, L5, S1 Dorsiflexion of foot (tibialis anterior) L4, L5, S1 Extension of toes L5, S1, S2 Plantar flexion of foot L5, S1, S2 Flexion of toes
  4. 4. Thoracic Paraplegia: T1-T4 Abilities Disabilities • Full head, neck and upper extremity movements possible. • Good strength of chest muscles. • Breathing normal. • Functional independence in self care like house keeping, feeding themselves, meal preparation and in bladder and bowel skills. • Can drive a car adapted with hand controls. • Normal communication • Complete paralysis of lower body and legs. • Autonomic Dysreflexia. • Respiration capacity and endurance may be compromised.
  5. 5. Autonomic Dysreflexia • Autonomic dysreflexia (hypereflexia) is a pathological autonomic reflex that typically occurs in lesions above T6 (above sympathetic splachnic outflow). Acute onset of autonomic activity from noxious stimuli Afferent input from here reaches lower thoracic and sacral areas Mass reflex response : elevation of blood pressure This is a critical, emergency situation owing to the lack of inhibition from higher centers. Hypertension persists if not treated promptly. Death may occur.
  6. 6. Initiating stimuli: Autonomic dysreflexia is reported mainly after bladder distension (urinary retention), rectal distention, pressure sores, urinary stones, bladder infections, noxious cutaneous stimuli , kidney malfunction, urethral or bladder irritation, and environmental temperature changes. Symptoms: Hypertension, bradycardia, severe and pounding headache, profuse sweating, increased spasticity, restlessness vasoconstriction below the level of lesion, vasodialation above the level of lesion, constricted pupils, nasal congestion, piloerection(goose bumps) and blurred vision.
  7. 7. T5-T9 spinal cord injury: Abilities Disabilities • Full head, neck and upper extremity movements possible. • Ability to transfer from bed to chair and chair to car. • Can drive a car with hand controls. • Normal communication skills. • Breathing normal. • Complete lower body paralysis. • Severe spasticity can be present.
  8. 8. • May use an electric wheelchair for long distance independent travel or uneven outdoor surfaces. A manual wheelchair is used for everyday living, with the ability to go over uneven ground for short distances. • Individuals should receive advanced wheel chair training to do “wheelies” and make transfers from the floor to wheelchair. • Car transfers may need assistance depending upon upper body strength. • Partial domestic assistance is required, such as heavy household cleaning and home maintenance. • These individuals have variable control of the paraspinal and abdominal muscles, and they may be able to stand by using bilateral Knee-Ankle-Foot Orthoses along with walker or crutches.
  9. 9. T10-L1: spinal cord injury Abilities Disabilities • Full head, neck and upper extremity movements possible with normal strength. • Ability to drive car. • Normal respiratory system. • Normal communication • Partial paralysis of lower body and legs. • Spasticity can be present.
  10. 10. • Ability to transfer independently from bed to chair and chair to car. It may be possible to transfer from floor to chair depending on upper body strength. There is possibility to transfer from sitting position to standing frame independently. • These people have better trunk control than do patients with a higher injury and they may be able to walk household distances independently with Knee- Ankle-Foot Orthoses and assistive devices; they may even attempt to walk upstairs. • Unfortunately these maneuvers can require extreme energy expenditure, and many individuals prefer wheelchair mobility.
  11. 11. L2-S5 : spinal cord injury Abilities • Full upper body control and balance. • Can prepare complex meals and general house hold duties independently. • Can drive car independently with hand controls. • Normal respiratory system. • Normal communication skills. • Some hip, knee and feet movements possible. • Walking slow and difficult, possible with assistance.
  12. 12. • Individuals with an injury at the lumbar level can become functionally independent in terms of household and community ambulation, which is often defined as unassisted ambulation for distances greater than 150feet, with or without the use of braces and assistive devices. • Orthotic devices (Knee-Ankle-Foot orthoses and Ankle- Foot orthoses) are often prescribed to assist patients with lower extremity standing and walking. • Full or part time use of manual wheelchair is necessary.
  13. 13. Conus Medullaris Syndrome • Characterized by injury to the sacral cord and to the lumbosacral nerve roots. • The result is symmetric and (often) completes saddle anesthesia, bladder and bowel dysfunction and lower extremity motor weakness. • The functional prognosis for mobility and activities of daily living is good, bladder bowel dysfunction is less likely than in other conditions, neurological recovery is limited.
  14. 14. Cauda equina syndrome • Cauda equina syndrome is characterized by injury to the lumbosacral nerve root, it is not truly a spinal cord injury. • It causes saddle anesthesia, bladder and bowel dysfunction and variable motor weakness of the lower extremity. • This syndrome is often less complete and symmetric than is Conus medullaris injury. • Neurologic recovery can continue for many months or years as the peripheral nerve roots can regenerate(unlike spinal cord axons) and because these injuries are incomplete. • The functional prognosis for mobility and self-care is good, although bladder and bowel continence