This document discusses spinal cord injury (SCI) management in Nepal. It defines SCI and notes resource limitations in developing countries. The aim of treatment is to prevent further injury and complications. The spinal column consists of vertebrae in the cervical, thoracic, lumbar, and sacral regions. The spinal cord relays sensory, motor, and reflex signals. SCI is an insult to the spinal cord that changes motor, sensory or autonomic function. Management requires a multidisciplinary approach including aggressive initial care, transport care, clinical evaluation, definitive acute care, comprehensive rehabilitation, and lifelong follow-up to minimize complications.

1. Chanda Rana, MPT
Rehabilitation In charge
Spinal Injury Rehabilitation Centre
Sanga, Nepal

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3. Overview
 Definition - SI vs. SCI
 Developing country- ~fatal.
 Resource limitations.
 Mass casualty vs. normal situation
 SCI management
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4. Aim of Treatment
 To prevent further injury
 To prevent complications
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5. The spinal column
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 Small bones called vertebrae
 Begins in the neck and ends at tailbone.
 Backbone surrounds and protect the
spinal cord.

6. The cervical area
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 Seven cervical
Vertebrae
 Called as C1- C7

7. The thoracic area
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 Twelve thoracic
Vertebrae
 Called as T1-T12

8. The lumbar
vertebrae
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 Five lumbar
Vertebrae
 Called as L1-L5

9. The sacral area
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 One sacral bone
Located at lowest
Part of the back

10. Functions of spinal cord
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 To relay message
Or signals from body
To brain and vice versa
Sensory ( feeling)
Motor (movement)
Reflexes

11. SCI
 An insult to spinal cord resulting in a
change, either temporary or permanent in
its normal motor, sensory or autonomic
function.
International Standard for Neurological Classification
of Spinal Cord Injury (ISNCSCI)
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12. How is it different from other
injuries??
 Lack of inherent ability of neurons to
regenerate effectively for functional
improvement.
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13. Determinants of degree of
disability
 Site of injury
 Completeness of injury
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14. Epidemiology
 Month
Most - July and least -February
 Day
 Saturday
 During daylight hours.
 Marital status
Single
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15. Epidem…
 Gender
Males >4 times females
 Age 16-30 years
 Older Higher mortality
 Divorce
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16. Causes
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20. Principles of
Care
Aggressive and rapid
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21. Principle
 Establish SI
 Immediate care
 Identify other injuries
 Care with transport
 Prevention of complications
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Care with Transport

23. Clinical Evaluation-
Symptoms
Weakness of limbs
Retention/ incontinence
↓Sensation
Radicular pain/ tingling
Neck/Back pain
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24. Clinical Evaluations-
Signs
 ‘Step- off’ deformity
 Sphincters
 Reflexes
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25. Level
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26. Grading –ASIA Impairment
Scale
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27. Definitive Care
 Acute care
 Specific
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28. SCI Management
 Most expensive as compared to any other
alignment.
 Requires prolong hospitalization and life
long follow up
 Requires a multidisciplinary team
approach.
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29. SCI Management…..
 Comprehensive rehabilitation
 Pre discharge planning
 Community inclusion
 Life long follow up
 Prevention of complications
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31. Conclusions
 Protocol with defined role of different
providers.
 Minimize neuro deterioration.
 Decrease complications.
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