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1、RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling,Spinal Cord Injury,Anatomy of the Spine,Vertebrae Body Front section, shaped like drum Supports weight Lamina Towards the back Boney arch surrounds spinal canal Spinous process Boney process from arch Points of attachment for mus
2、cles and ligaments Discs Cushions between vertebrae,Anatomy of the Spine,Vertebrae: 7 Cervical Flexion, extension, bending and turning of head 12 Thoracic Chest region, allows mostly for rotation 5 Lumbar Larger boney structures to support added wgt 5 Sacral Fused together Coccyx,Anatomy of the Cord
3、,Cervical Cord C1-C2: C3-4: Phrenic nucleus C4: Deltoids C4-5: Biceps C6: Wrist extensors C7: Triceps C8: Wrist extensors C8-T1: Hand muscles,Anatomy of the Cord,Thoracic Cord Intercostal muscles and associated dermatones Lumbarsacral Starts at T9 and continues to L2 Innervates hips, legs, buttocks
4、and anal region Cauda Equina (horses tail) Spinal cord ends at L2 Tip called conus, below conus a spray of spinal roots,Dermatomes/Sensory Level,Dermatome: patch of skin innervated by a given spinal cord level,C2 to C4. The C2 dermatome,Myotomes/Motor Level,Myotome: Spinal nerve roots which innervat
5、es muscles groups Most muscles are innervated by more than one root,ASIA Impairment Scale,ASIA A: Complete: no motor or sensory function is preserved in the sacral segments S4-S5 ASIA B: Incomplete: sensory but NOT motor function is preserved below the neurological level and includes the sacral segm
6、ents ASIA C: Incomplete: motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade 3 ASIA E: Normal,Definition of Disability,Tetraplegia (preferred to quadriplegia) Refers to impairment or loss of motor/sensory functio
7、n in cervical segments of the spinal cord Impairment of function in arms, trunk, legs and pelvic organs ASIA Scale vs quadriparesis,Definition of Disability,Paraplegia Refers to impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord Arm function spared
8、 Possible impairment of function in trunk, legs and pelvic organs ASIA Scale vs paraparesis,Clinical Syndromes,Central Cord Syndrome: lesion occurring almost exclusively in the cervical region Sacral sensory sparing Weakness UE vs LE Brown-Sequard Syndrome: Lesion that produces ipsilateral, proprioc
9、eptive and motor loss and contralateral loss of sensitivity to pain and temp,Clinical Syndromes,Anterior Cord Syndrome: Lesion that produces variable loss of motor function and of sensitivity while preserving proprioception Cauda Equina Syndrome: Injury to the lumbosacral nerve roots w/ in the neuro
10、canal resulting in areflexive bladder, bowel and lower limbs,Achievement of Functional Goals,Age Body type Comorbidities Prior athletic sense Fatigue level,Type of stabilization HX HO/POA Spasticity Psychosocial factors Nutrition,Functional Outcomes,Motor/sensory recovery Ability to perform or direc
11、t ADLs Social reintegration Quality of life,Functional Outcomes,LEVEL C1-C3 Limited head/neck movement Rotate/flex neck (sternocleidomastoid) Extend neck (cervical paraspinals) Speech and swallowing (neck accessories) Total paralysis of trunk,UE and LE,LEVEL: C1-3,24 hr care needs Able to direct car
12、e needs ADLs Ventilator dependent Impaired communication Dependent for all care needs Mobility Power wheelchair Hoyer lift,LEVEL: C1-C3,Equipment Needs Adapted computer Bedside/portable ventilator Suction machine Specialty bed Hoyer Reclining shower chair,Functional Outcomes,LEVEL: C4 Head and neck
13、control (cerv paraspinals) Shoulder shrug (upper traps) Inspiration(diaphragm) Lack of shoulder control (deltoids) Paralysis of trunk, UE and LE Inability to cough, low respiratory reserve,LEVEL: C4,24 hr care needs Able to direct care needs ADLs May or may not be vent dependent Improved communicati
14、on Assisted cough Dependent for all care needs Mobility Power wheelchair Hoyer lift,LEVEL: C4,Equipment Needs Adapted computer Bedside/portable ventilator as needed Suction machine Specialty bed Hoyer Reclining shower chair,Functional Outcomes,LEVEL: C5 Shoulder control (deltoids) Elbow flexion (bic
15、eps/elbow flexors) Supinate hands (brachialis and brachioradialis) Lack elbow extension and hand pronation Paralysis of trunk and LE,LEVEL: C5,10hrs personal care need 6 hrs homemaking assistance ADLs Set-up/equipment: eating, drinking, face wash and teeth Assisted cough Dependent for bowel, bladder
16、 and lower body hygiene Dependent for bed mobility and transfers,LEVEL: C5,Mobility Hoyer or stand pivot Power wheelchair w/ hand controls Manual wheelchair Drive motor vehicle w/ hand controls Equipment Needs Power and manual wheelchairs Adaptive splints/braces Page turners/computer adaptations,Functional Outcomes,LEVEL: C6 Wrist extension (extensor carpi ulnaris and extensor carpi radialis longus/brevis) Arm across chest (clavicular pectrocialis) Lack elbow extension (triceps) Lack wrist
