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1、1,Physical Therapy for Adults with Traumatic Spinal Cord Injury,Acknowledgement: International educators for the China Self-Directed Learning Modules,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,2,Traumatic Spinal Cord Injury (SCI),Majority of traumatic SCI occurs in young adult males Trauma
2、tic spinal cord injury is a non-progressive pathology Motor and sensory function on both right and left sides is determined by the level of injury A patient with C6 level injury has intact motor and sensory function bilaterally at and above the C6 level,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord
3、Injury,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,4,Traumatic Spinal Cord Injury,Based on the International Standards for Neurological Classification of Spinal Cord Injury (published by the American Spinal Injury Association, ASIA), patients can be grouped in five categories depending on t
4、he severity of impairment from A to E A is complete spinal cord injury with no motor or sensory function below the levelE is normal even though patient may have initially exhibited symptoms of spinal cord injury, but is now normal,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,ASIA Impairment
5、Scale,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,6,Traumatic Spinal Cord Injury,Definitions Paraplegia is defined as an impairment or loss of motor and/or sensory function of all or part of the trunk and both lower extremitiesTetraplegia is defined as an impairment or loss of motor and/or
6、sensory function in both upper extremities in addition to trunk and both lower extremities; respiration is often affected,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,7,Spinal Cord Anatomy,Spine has 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal spinal nerves (levels) Spinal co
7、rd ends around L1 vertebral level The cervical spinal levels control sensory and motor function of head/neck and upper extremities and the diaphragm (phrenic nerve, C3-5) The thoracic spinal levels control chest and abdominal muscles and sensory function of the trunk The lumbar spinal levels control
8、 motor and sensory function of the lower extremities The sacral spinal levels control the sensory function of the back of lower extremity and buttocks, bowel and bladder control, and sexual function,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,8,Symptoms of Spinal Cord Injury,Motor impairmen
9、t Paralysis or weakness of affected muscles (following the myotomes)Sensory impairment Loss or impaired sensation of affected areas (following the dermatomes),MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,Dermatomes,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,10,Symptoms of Spinal Co
10、rd Injury,Autonomic dysreflexia Often occurs in patients with high level spinal cord injury (lesion level above T5) Caused by distended bladder, distended rectum, blocked catheter, or other stimuli about the sacral innervated area Patient shows flushed face, pounding headache, very high blood pressu
11、re, sweating above the level of injury, piloerection, slow pulse, and nasal obstruction (nasal voice) Autonomic dysreflexia is a medical emergency,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,Piloerection or goosebumps on a human arm http:/en.wikipedia.org/wiki/Goose_bumps,11,Symptoms of Spi
12、nal Cord Injury,Autonomic dysreflexia is managed in the following way Dont let the patient lie down Position the patient in sitting Check the catheter or tube for blockage Check the feet positions for twisted ankles or pinched toes Empty leg bag for urine if it is full Obtain immediate medical help,
13、MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,12,Symptoms of Spinal Cord Injury,Spasticity Most common in patients with cervical and thoracic level injuries Occurs below the level of lesion after the spinal shock period Poor venous return below the level of lesion that may result in orthostat
14、ic hypotension Bradycardia Impaired body temperature control Unable to regulate body temperature in response to environmental changes (stay under sun) Impaired ability to sweat below the level of lesion Impaired respiratory function Decreased tidal volume and vital capacity Impaired cough,MODULE C4/
15、CSDLM/2013/NR Traumatic Spinal Cord Injury,13,Symptoms of Spinal Cord Injury,Bladder and bowel dysfunction for those patients with S2-4 involvement If not managed properly, patient will have urinary tract infections and ultimately kidney failure Must drink sufficient fluid and eat a high fiber diet
16、Most patients can be trained to manage their bladder and bowel problems, including a schedule to void (every 4 hours) and to move bowel (once a day or once every other day) Sexual dysfunction,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,14,Symptoms of Spinal Cord Injury,Secondary complicatio
17、ns Pressure sores Deep vein thrombosis Pain Contracture Heterotopic ossification Osteoporosis,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,15,Prognosis,After stabilizing the spinal (vertebral column) injury, the patient should begin a comprehensive rehabilitation program Life expectancy is r
18、elated to the severity of impairment Individuals with spinal cord injury classified between the *ASIA A to C levels and those with tetraplegia have shorter life expectanciesRef: American Spinal Cord Injury Association (ASIA) Classificationhttp:/www.asia-spinalinjury.org/elearning/ISNCSCI_Exam_Sheet_r4.pdf,
