Central cord syndrome is an acute spinal cord injury caused by trauma, most commonly from hyperextension injuries in individuals with cervical spondylosis. It is characterized by disproportionate weakness in the upper extremities compared to the lower extremities, along with bladder dysfunction and sensory loss below the injury level. Rehabilitation focuses on physical, occupational, speech, and recreational therapies to preserve mobility and range of motion, restore activities of daily living, and help patients return to pre-injury activities through adapted devices and techniques.

1. CENTRAL CORD SYNDROME
Hari Prakash Bharathi
Group 4
Year 6
Department of Rehabilitation and Physical Medicine
Tbilisi State Medical University
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2. INTRODUCTION
 an acute cervical spinal cord injury
 is marked by a disproportionately greater impairment of motor
function in the upper extremities than in the lower ones,
 as well as by bladder dysfunction and a variable amount of
sensory loss below the level of injury.
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5. CAUSES
 The most common cause of central cord syndrome (CCS) is
trauma.
 In older adults, premorbid cervical spondylosis is a significant
risk factor.
 Accordingly, even minor falls may result in tetraplegia in
populations with a narrowed spinal canal.
 In younger age groups, CCS results from major trauma, such as
that associated with cervical fracture/subluxations.
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6. PATHOPHYSIOLOGY
 Central cord syndrome (CCS) most often occurs after a
hyperextension injury in an individual with long-standing
cervical spondylosis.
 Injury may result from posterior pinching of the cord by a
buckled ligamentum flavum or from anterior compression of the
cord by osteophytes.
 Spinal cord damage originate from concussion or contusion of
the cord with stasis of axoplasmic flow, causing edematous
injury rather than destructive hematomyelia.
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7. PATHOPHYSIOLOGY
 CCS may be caused by bleeding into the central part of the cord,
portending a less favorable prognosis.
 CCS is associated with axonal disruption in the lateral columns at the
level of the injury to the spinal cord, with relative preservation of the
grey matter.
 The syndrome may be associated with fracture
dislocation and compression fracture, especially in a congenitally
narrowed spinal canal.
 These anteroposterior compressive forces also distribute the
greatest damaging effect on the central mass of the cord substance.
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8. SYMPTOMS
 Symptoms of central cord syndrome occur following trauma (most commonly
falls) and consist of upper and lower extremity weakness, with varying degrees of
sensory loss.
 Pain and temperature sensations, as well as the sensation of light touch and of
position sense, may be impaired below the level of injury.
 Neck pain and urinary retention are common.
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9. REHABILITATION
Physical therapy
Occupational therapy
Speech therapy
Recreational therapy
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10. PHYSICALTHERAPY
 Aim:To preserve range of motion (ROM) and the enhancement of mobility
skills
 The strengthening of any preserved lower extremity musculature is
essential, as are trunk balance and stabilization.
 Patients with CCS offer a unique challenge for the physical therapist with
regard to ambulation and gait training.
 Despite the usual preservation of some lower extremity strength, upper
extremity deficits can limit the use of possible assistive devices and,
ultimately, the functional quality of ambulation.
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11. OCCUPATIONALTHERAPY
 Aim: To restoration of the basic activities of daily living (ADLs), upper extremity
strength, and ROM.
 Splinting is used to maintain the functional position of the hand and to prevent
the formation of contractures in the fingers.
 Surface electromyelogram (EMG) biofeedback can often be beneficial to patients
in the isolation of specific weak muscles in the upper extremities.
 Facilitating self-care skills by selecting appropriate assistive devices and training
patients in their usage is another priority.
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13. SPEECHTHERAPY
 A speech therapist should be involved in the treatment of
patients with central cord syndrome who have dysphagia from
the head position maintained by cervical orthoses or as a result
of anterior cervical spine fusion.
 Various compensatory strategies need to be taught to these
patients to make swallowing safer and to prevent aspiration.
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14. RECREATIONALTHERAPY
 Aim: To help patients to return to preinjury areas of interest.
 Potential sources of recreational activities are explored with the
patient, and the adaptive devices (for instance, an adapted
fishing rod) that will allow the individual to enjoy previous
activities are explored and provided.
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15. THANKYOU
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