2. • Complete injury:
People with no
sensory or motor
function below the
level of spinal cord
injury around the anal
area (S4 and S5)
• Incomplete injury:
Preservation of some
function below the
level of spinal cord
injury
Types of injury
3. • Paraplegia: Injury to
thoracic, lumbar or sacral
segments of the spinal cord
• Quadriplegia: Injury to the
cervical segments of the
spinal cord i.e. between C1
and T1
Types of injury
6. C1-C4
Breathing
Head and Neck movement
C4-T1
Heart rate control
Upper Limb movement
T1-T12
Trunk control
Temperature regulation
Abdominal muscles
L1-S1
Lower limb movement
S2-S4/S5
Bowel, Bladder
and Sexual
function
8. Triggers - any
noxious stimulus
(most commonly
distended / blocked
bowel or bladder)
• Heavy sweating
• Severe headache
• Reddened skin
• Blurred vision
• Body hair standing
• Cardiac arrhythmias
Sudden increase in blood pressure
Seen in individuals with SCI at or above
T6level
Autonomic dysreflexia
9. Most common in acute and
sub acute phase
But can occur any time
Most common cause –
long term immobility
• Pain
• Swelling
• Tenderness
• Skin discoloration
• Warmth
Risk factors –
• Age
• Obesity
• Lower limb fractures
• Pregnancy
• Previous history of DVT
Preventive measures:
• Anti coagulants
• Wearing compression stockings
!!Can lead to pulmonary embolism
Deep venous thrombosis
10. • Fatigue
• Light headedness
• Dizziness
• Blurred vision
• Muscle weakness
• Temporary loss of consciousness
!!! Sudden drop
in blood pressure
When a person moves
from lying to
sitting/standing position
Orthostatic hypotension
11. Urinary tract infections
Signs and symptoms
• Episodes of incontinence
• Painful urination
• Increase in spasticity
• Neuropathic pain
• Autonomic dysreflexia
• Fever
• Malaise
• LethargyMethods of bladder emptying-
• Intermittent cathetarization
• Indwelling cathetarization
• Other methods
Bladder overdistention, reflux,
high-pressure voiding, large
postvoiding residual volume,
stones, and outlet obstruction
Faulty, unsterile technique
13. PROBLEMS
• Poor colonic motility
• Chronic constipation
• Abdominal distension
• Prolonged bowel transit time
• Faecal incontinence
Gastrointestinal system
SOLUTIONS
Proper nutritional and fluid intake
Dietary supplements and oral
medications when needed
Appropriate methods to assist
defecation (physical techniques
and stimulants such as laxatives,
suppositories and enema)
Surgery to form a stoma
14. There is increased stiffness of the
limbs and it is difficult to move
through the range of motion
Spasticity
Can lead to
• Disabling contractures
• Involuntary movements
• Weakness
• Fatigue
• Difficulty in sleeping because of
painful spasms
• Difficulty with maintaining
hygiene
Physical therapy - exercise, stretching,
and joint movements
Casting or bracing
Medications orally or by injection to
affected muscle groups (Botox) or
“intrathecally”
Surgical options
15. Loss of bone mass immediately
following SCI
Sublesional osteoporosis Can lead to fractures during
trivial falls, transfers
Further morbidity
Risk factors
-Old age, use of steroids, calcium
and vitamin D deficiency
Management
• PREVENT!!! – Drugs, care
during transfers, diet
• If fracture occurs, splints,
immobilization, surgery
16. Heterotrophic ossification
Formation of bone in soft tissue leading to loss
of range of motion of that particular joint
Most commonly affected joints: Hip, Knee,
shoulder, Elbows
Management
• Avoid ROM
• Drugs – bisphosphonates, Anti
inflammatory drugs
• Surgery
17. Respiratory system
• Pneumonia
• Atelectasis
• Aspiration
• Respiratory failure
Lung capacity, ease of breathing and
ability to cough and clear secretions
are often compromised following a
SCI
Management
• Annual influenza vaccine
• Five yearly pneumcoccal
vaccine
• Prompt treatment of
respiratory tract infections
with anti biotics
• Yearly implementation of
assisted coughing for
people with high level SCI
18. • Weight transfers
• Proper bed positioning, wheelchair sitting
Pressure ulcers
Management
• Regular skin checks
• Pressure relieving methods
• Adequate bladder and bowel care
• Appropriate assistive devices
• Good nutrition
• Surgery
PREVENT!!!!
19. • Reduces the quality of life
Pain –
neuropathic/musculoskeletal
Management
• Drugs
Others-
• Physical therapy
• Working with a counselor
20. Problems
• Decrease or loss of
sensation, difficulties in
achieving orgasm
• Difficulties in moving and
positioning
• Lowered self esteem and
confidence
• In men, partial or complete
impairment of penile
erection and ejaculation
• Female menstruation may
be impaired
Sexual dysfunction Respectful discussion at the
appropriate time with both
individual and partner
Medical care and rehabilitation
relevant to the individual
Provision of education and
information on positioning and
preparation for sexual activity,
birth control, prevention of
STDs
Assistive devices for arousal
or to enhance positioning
Treatment of erectile
dysfunction in men( vibratory
stimulation, oral medications,
penile injections, vacuum
devices, penile implants
Assisted fertility
