Spinal Cord InjuriesKristy Sandman

Statistics

10,000 every year10,000 every year183,000 – 230,000 current cases183,000 – 230,000 current casesAvg. Age 31.7 yearsAvg. Age 31.7 yearsHighest incidence between 15 & 25 Highest incidence between 15 & 25 yearsyearsLifetime cost of treatment = Lifetime cost of treatment = $500,000 – 2 million$500,000 – 2 millionTotal cost of treatment in US = 7 Total cost of treatment in US = 7 billionbillionSport of Diving has highest Sport of Diving has highest incidenceincidence

Traumatic Causes

Car accidents (38%)Contact sports (7%)Violence (27%)Falls (21%)Other (7%)

-- recreational activities-- Diving into shallow water /

diving from high places

-- Blow to the head, neck, face

Non-Traumatic Causes

Congenital / developmental-- cerebral palsy-- spina bifida

Degenerative disorders-- spinal muscular atrophy-- spondylolysis-- disc disease

Infectious-- bacterial, fungal, leukemia

Ischemic-- cardiac arrest-- atherosclerosis-- thrombosis

Rheumatoligical -- arthritis

Tumors

Physiology

The majority of SCI are the result of compression & traction forcesFracture of bonesInjury to discsLigament sprainsBroken blood vesselsDamaged cell membranesInjured nerve axons

Primary InjuriesHemorrhaging occurs in gray matter of spinal column and spreads outward.Spinal cord swells, filling the spinal canal at the level of the injury.Pressure of swelling exceeds venous return.Ischemia affects circulation and leads to release of toxic chemicals from injured neural membranes, neurogenic shock, & hypotension.

Secondary InjuriesInjured cells, axons, & blood vessels release toxic chemical that attack surrounding healthy cells.Glutamate is released in large amounts, overexciting neurons.Overexcited cells, let in large amounts of calcium, causing the release of free radicals that attack healthy cells

Diagnoses

Assessment should always include entire CNS, 50% of SCI include brain injuries.

GaitCoordinationCranial nervesMotor functionSensory perceptionAutonomic systems

American Spinal Injury Association (ASIA) Impairment Scale:

5 grades, A – E

PharmacologyMethylprednisolone

Given within 8 hours of injuryReduces swellingControls glutamate releaseInhibits accumulation of free radicals

Complications

1. Osteoporosis and Muscular AtrophyIn persons who are immobile, calcium reabsorbed faster than it’s deposited.

2. Muscle spasmsCan cause injury to muscles, tendons, and ligaments.

3. Urinary infection / kidney failureLoss of sensation, leads to incomplete emptying or overflow of bladderInfection & kidney stones result

4. ConstipationCaused by muscle atrophy & lack of gravity

5. Respiratory dysfunctionInjury to C2, C3, C4 affects inervation of the diaphragm.

6. Impaired circulationHeart atrophies & leads to poor circulation

7. PhlebothrombosisMovement of blood through veins is dependent on movement of muscle

Immobility leads to blood clots & pooling of blood in legs & abdomen

8. Pulmonary embolismBlood clots dislodge & land in the lungsOften fatal

9. HypotensionIn persons who recline, blood pools in legs & abdomenPerson sits or stand, BP drops

10. ThermoregularitySitting/lying for long periods affects constant body temp.Leads to rashes, fungi, dry skin, skin disorders

11. Decubitus ulcersPerson in one position for extended periods of time.Pressure of bones collapse blood vessels, cuts off circulationTissue dies

Therapeutic Treatments

1. Tendon transferRestores limited functionMuscles must be voluntary, strong, have a secondary role

2. Electrical StimulationStrengthens muscles & heart, relieves pain, paces the diaphragm

3. Phrenic nerve stimulationImplanted electrode can keep diaphragm working

4. Abdominal trussingPushing the abdomen inwardAbdominal pressure increases, rib cage rises, expiratory muscles lengthenUse of corsets, elastic wraps, belts, custom built devicesIncreases vital capacity, tidal volume, inspiratory pressure, expiratory pressure

Mobility in Wheelchairs

Tipping chair backwards to a 35 or 65-degree angleFlexing the trunk towards the kneesLeaning to either sidePush-ups in the chair

Exercise

Lack of exercise leads to:Reduced heart rateReduced stroke volumeReduced cardiac outputVentricular atrophyReduced vital capacityImpaired thermoregulatory systemDecreased muscle mass

Ability to exercise is dependent on location and extent of injury.Endurance exercises useful for cardiovascular benefitsCalisthenicsWeight liftingSwimmingWheelchair mobility exercisesSitting, standing, walking

Aquatic Exercising90% reduction of body weightReduced forces on musculoskeletal systemBuoyancy can be used for assistance, support, resistance

Physiological benefitsCardiorespiratory systemMuscular systemCoordination, balanceRespiratory systemmobility

Spatial awarenessPrevents osteoporosis

Psychological benefitsSelf esteemDecreases anxietyDecreases depression

Spinal cord RepairNeurons in CNS can grow when placed by axon bundles in PNSTransplanted neurons maintain nerve activity in musclesInjecting spinal cord cells from pig fetusesFetal cell transplantsCombination cell transplant & muscle activityCord transplantation