2301 Path - Spinal Cord Injuries (SCI)

S2-S4

Structures innervated- Pelvic Diaphragm; Genitals Functional effect- Sphincter Control (bladder and bowel); Sexual function Effect of injury- Neurogenic Bladder/bowel; Loss of sexual function

T1-L5

Structures innervated- Trunk muscles, Intercostals, Abdominal wall muscles Function effect- Trunk stability and movement accessory respiratory muscles Effect of Injury- Loss of Trunk Stability Decreased Respiratory Function

injury of the cervical region at C1-C4

Structures innervated- neck muscles Function effected- would cause the lose of neck stability and mobility Effect of injury- loss of neck stability

Injury of C5- T1

Structures of innervated- upper Extremity Functional effect- Upper extremity movement Effect of injury- Tetraplegia- Quadriplegic

Tetraplegia or Quadriplegia

-Paralysis of all four extremities- no moblity on their own. Will always need assistance to transfer Not able to do basic ADL's Feeding, (Possible not able to eat or swallow), Dressing, bathing or grooming, toilet hygiene -Possibility of no respiratory function and body temperature control -Total loss of anal sensation or contraction- no sphincter control - bladder and bowel control No sexual function

Describe the range of psychological reactions to a SCI

1. Grieving 2.loss of control 3.Talking about your disability 4.Dealing with intimacy, sexuality and sexual activity 5.Looking ahead

body functions which may be affected by a SCI

1. Sensory function- vestibular; proprioceptive function; touch ;pain; sensitivity to temperature and pressure 2. Neuromusculoskeletal and movement - a. Joint mobility b. Joint Stability c. Muscle function -Muscle power -Muscle tone -Spastic - Muscle endurance d. Movement function - motor reflexes - involuntary movement reactions -control of voluntary movement -Gait patterns 3. Cardiovascular -respiratory system function

Blood supply to the spinal cord

3 primary arteries - anterior spinal artery and 2 posterior spinal arteries

Ascending track of the spinal cord

Afferent Sensory Pathway- Carry sensory information from the body upwards to the brain such as touch, skin temperature, pain and joint position Convey sensation from the body to the brain 1. posterior column- 2 point discrimination, vibration, stereognosis 2. Lateral Spinothalamic: Pain, Temperature 3. Ventral Spinothalamic: Touch, Pressure 4. Spinocerebellar: Non conscious expropriation Can't feel your body in space 5. spinocervicothalamic- touch, preconception, stereognosis( 3 denominational) , vibration (

Incomplete SCI

Any Motor or Sensory Function Below the Level or injury --- SOME FEELING Anal Sensation or Contraction PRESENT Sacral Sparing- a phenomenon where some or all Functions are intact below or at the site of injury Mixed loss of voluntary motor activity and sensation, some tracts in tact.

DECUBITUS (PRESSURE SORE

Body structure: Skin - largest organ of the body Cause: circulation is impaired Mechanism - continuous pressure>capillary damage 4 stages PREVENTION is the KEY Positioning, pressure relief Skin inspections, boney prominences Proper nutrition Environment

Efferent Motor Pathway

Descending tract from the brain to the body function. Efferent Motor Pathway: 1. Lateral Corticospinal- Movement of extremities 2. Ventral Corticospinal: Movement of neck and trunk 3. Reticulospinal: autonomic functions: Motor Respiratory functions 4. Vestibulospinal : equilibrium

Medical management of SCI

Immobilization- at site of injury diagnostic evaluation surgical or nonsurgical intervention Decompress realign stabilize w/o need of surgery removal of bone fragments or bullet spinal fusions external alignment devices following surgery- Halo Pharmacological Management

Deep Vein Thrombosis (DVT) BLOOD CLOT

Life Threatening- complication - untreated can result in Embolism RISK -First 2 wks after surgery Reasons- 1. reduces circulation due to decreased tone 2. Direct trauma to legs, causes vasuuular damage 3. Prolonged bed rest Signs of DVT- 1. Swelling in LE 2. Localized redness 3. Low-Grade Fever ( some DVT are asymptomatic) Treatment- Bed Rest and Medication to not Tx or move Report ASAP

risk factors to spinal cord

Male age from 16-30 risky behavior bone and joint disorder

Injury of C3-C5

Structures innervated- Diaphragm Functional effect- Breathing Effect of injury -ventilator dependent

Classification of the Spinal Cord injury

Myotomes- functional muscle groups innervated Dermatomes- Represent areas of the skin innervated by each segment

Complete SCI

No motor or sensory function below the level of injury; No Anal sensation or contraction(S5)--No FEELING total loss of sensory and motor function below level of injury

Decubitus pressure sore

Pressure point to protect: make sure to neleviate the point of pressure on any one area of the body in any position

Reflect Arc

Receptor, Sensory neuron, Interneuron , Motor neuron, Effector an impulse that enter the dorsal root and exits the ventral nerve root. muscle function that does not get information and direction from the brain

Postural Hypo tension (Orthostatic Sypotension)

Results from prolonged bed rest- Blood Pools in distally in the LE Symptoms: -Light headedness -Dizziness -Pallor-Coloring in face -Sudden weakness -unresponsiveness TREATMENT- Preventives measures Antiembolism Hosiery and Abdominal Hinders( assist with circulation) -Changes Position SLOWLY - Recline

L2- S4

Structures innervated- Lower extremity Functional effect- Lower extremity movement Effect of Injury- Paraplegia ( diplegia)

SCI classified by

Segment level of injury sentimental level of intact function Number of limbs affected- Quad -4 para-2 number of limbs Hemiplegia- one side of the body monophegia- one extremity affected

Autonomic Dysreflexia

Serious and LIFE THREATENING-ed response of the Autonomic nervous system caused by an irritation of nerves below the level of injury( Overfull Bladder or Bowel; UTI, Decubitus, Inqrown Toenails. When a person has a spinal cord injury and is not able to have a fight-or-flight response ( the body responds to a threat) but the when injury blocks that response then the autonomic nervous system can send a signal to the body that can become life threatening- . Signs: -Pounding Headache -Profuse sweating, flushing, goose bumps -Tachycardia TREATMENT- NEED to FIND Issue and alleviate it before becomes life threatening

Etiology of Spinal Cord injury

Trauma Motor vehicle accidents Falls - senior population Non Trauma- Spina bifide scoliosis spinal cord agenesis bacterial / viral infection

Dermatomes

an area of the skin supplied by nerves from a single spinal root Sensory

Identify performance skills which may be affected by a SCI

body functions- Motor skills: movement of objects or any ADL's 1. aligns 2. Stability 3. walks - ambulates 4. Positioning 5. reaching 6. bend 7. grip 8. manipulate 9. coordinate 10. move and object 11. lift 12. calibrates 13. flow 14. endures 15. paces

Spinal Cord function

communication from the PNS to the CNS

Myotomes

muscle or group of muscles innervated by a specific motor nerve Motor Deep tendon reflexes

Paraplegia

paralysis from the waist down-Does have hand and some possible trunk control. Can breath on their own ADL's Effected- Walking; bladder and bowel control - need assist with Bathing, showing, possibly with dressing, No sexual Function ADL's - No loss of function of Feeding, eating and swallowing, personal hygiene and grooming, Mobility- Can transfer on their own and can be independently mobile with the assist of a wheel chair or other apparatus but re able to propel this device with their own power

Anatomy of the Spinal cord

part of the CNS ( Brain and Spinal cord) Transmit information to from the PNS through the Spinal nerves up to the Brain through the spinal column. sensory information from the body upwards to the brain The Ascending track - Afferent: Sensory pathway Spinal column is protected by the vertebral column that broken into regions The Descending Track- Information from the Brain to the body efferent - Motor Cervical - 8, Thoracic - 12, Lumbar - 5, Sacral - 5 correlated with viscera/motor/muscle systems cylinder of nerve tissue within the vertebral column; 31 pairs of spinal nerves

Cervical region

the first 7 vertebrae, comprising the neck C1-C7 The region of the vertebral column made up of the first 7 vertebrae region referred to as the neck. neck referred to as the cervix -