Spinal Cord Injuries Kristy Sandman

1. Spinal Cord Injuries Kristy Sandman

2. Statistics • 10,000 every year • 183,000 – 230,000 current cases • Avg. Age 31.7 years • Highest incidence between 15 & 25 years • Lifetime cost of treatment = $500,000 – 2 million • Total cost of treatment in US = 7 billion • Sport of Diving has highest incidence

3. 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

5. Non-Traumatic Causes • Congenital / developmental -- cerebral palsy -- spina bifida • Degenerative disorders -- spinal muscular atrophy -- spondylolysis -- disc disease • Infectious -- bacterial, fungal, leukemia

6. Ischemic -- cardiac arrest -- atherosclerosis -- thrombosis • Rheumatoligical -- arthritis • Tumors

7. Physiology • The majority of SCI are the result of compression & traction forces • Fracture of bones • Injury to discs • Ligament sprains • Broken blood vessels • Damaged cell membranes • Injured nerve axons

8. Primary Injuries • Hemorrhaging 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.

9. Secondary Injuries • Injured 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

10. Diagnoses • Assessment should always include entire CNS, 50% of SCI include brain injuries. • Gait • Coordination • Cranial nerves • Motor function • Sensory perception • Autonomic systems

12. American Spinal Injury Association (ASIA) Impairment Scale: 5 grades, A – E Pharmacology • Methylprednisolone • Given within 8 hours of injury • Reduces swelling • Controls glutamate release • Inhibits accumulation of free radicals

13. Complications • Osteoporosis and Muscular Atrophy • In persons who are immobile, calcium reabsorbed faster than it’s deposited. • Muscle spasms • Can cause injury to muscles, tendons, and ligaments. • Urinary infection / kidney failure • Loss of sensation, leads to incomplete emptying or overflow of bladder • Infection & kidney stones result

14. Constipation • Caused by muscle atrophy & lack of gravity • Respiratory dysfunction • Injury to C2, C3, C4 affects inervation of the diaphragm. • Impaired circulation • Heart atrophies & leads to poor circulation • Phlebothrombosis • Movement of blood through veins is dependent on movement of muscle

15. Immobility leads to blood clots & pooling of blood in legs & abdomen • Pulmonary embolism • Blood clots dislodge & land in the lungs • Often fatal • Hypotension • In persons who recline, blood pools in legs & abdomen • Person sits or stand, BP drops

16. 10. Thermoregularity • Sitting/lying for long periods affects constant body temp. • Leads to rashes, fungi, dry skin, skin disorders 11. Decubitus ulcers • Person in one position for extended periods of time. • Pressure of bones collapse blood vessels, cuts off circulation • Tissue dies

18. Therapeutic Treatments • Tendon transfer • Restores limited function • Muscles must be voluntary, strong, have a secondary role • Electrical Stimulation • Strengthens muscles & heart, relieves pain, paces the diaphragm • Phrenic nerve stimulation • Implanted electrode can keep diaphragm working

19. Abdominal trussing • Pushing the abdomen inward • Abdominal pressure increases, rib cage rises, expiratory muscles lengthen • Use of corsets, elastic wraps, belts, custom built devices • Increases vital capacity, tidal volume, inspiratory pressure, expiratory pressure

20. Mobility in Wheelchairs • Tipping chair backwards to a 35 or 65-degree angle • Flexing the trunk towards the knees • Leaning to either side • Push-ups in the chair

21. Exercise Lack of exercise leads to: • Reduced heart rate • Reduced stroke volume • Reduced cardiac output • Ventricular atrophy • Reduced vital capacity • Impaired thermoregulatory system • Decreased muscle mass

22. Ability to exercise is dependent on location and extent of injury. • Endurance exercises useful for cardiovascular benefits • Calisthenics • Weight lifting • Swimming • Wheelchair mobility exercises • Sitting, standing, walking

23. Aquatic Exercising • 90% reduction of body weight • Reduced forces on musculoskeletal system • Buoyancy can be used for assistance, support, resistance Physiological benefits • Cardiorespiratory system • Muscular system • Coordination, balance • Respiratory system • mobility

24. Spatial awareness • Prevents osteoporosis Psychological benefits • Self esteem • Decreases anxiety • Decreases depression

25. Spinal cord Repair • Neurons in CNS can grow when placed by axon bundles in PNS • Transplanted neurons maintain nerve activity in muscles • Injecting spinal cord cells from pig fetuses • Fetal cell transplants • Combination cell transplant & muscle activity • Cord transplantation