SCI

• automobile accident (40%)
• contact sports
• diving into shallow water

• compression (tumor), hemorrhage, degenerative disease
• disruption of blood flow
• infection

temporary loss of function due to violent blow

spinal cord surface intact, internal damage

glia are disrupted and cord tissue is torn

• ischemia: microhemorrhage in SC grey matter and edema causes release of nts and inflammatory mediators which causes vasoconstriction, necrosis and glial scarring result
• inflammation: results in apoptosis
• disturbances in ion/electrolyte levels: Na/K balance (inability to generate APs), influx of Ca (triggers neuron death)
• demyelination: damage to oligodendrocytes
• scar formation
• dural scarring: causes adhesions of cord to dura
• syringomyelia: can block CSF flow and cause pressure build up

steriodal anti-inflammatory that dec secondary damage to neurological tissue, recommended within 8 hrs of injury; however may inc risk of infection, wound complications

all reflexes, motor, and sensory function below level of injury absent in initial period after injury; reflexes return 1-3 days post

resumption of some voluntary motor and sensory function; most occurs in first year after injury

resolution of hemorrhage, re-myelination of surviving neurons, injury induced plasticity

affects thoracic, lumbar, and sacral regions

affects cervical region

lowest level myotome that scores at least 3/5 when level above scores 5/5

complete

incomplete- sensory but not motor preserved below

incomplete- motor function preserved below level and more than 1/2 key muscles below level less than 3/5

incomplete- motor level preserved below and at least 1/2 key muscles below level at least 3/5

recover to normal

used only with complete; lowest segment that has some sensory and/or motor function

areflexic during spinal shock; spasticity after resolves; may have flaccidity where AHCs damaged or nerve root/peripheral nerve damage

bone formation within soft tissue (below neurological level); may be caused by microtrauma to soft tissue; swelling, pain, redness, inc temp

in extremities but not spine below level of injury; may be due to dec muscle action, dec weight bearing, changes in circulatory/ANS/endocrine functions

risk of contractures due to dec movement (adaptive shortening); due to muscle imbalances, spasticity, postural effects

disruption of sympathetic responses in injuries above T6, reduced venous return, inc risk of DVT (**risk of pulmonary embolism- leading cause of death in 1st yr post SCI)

ventilator dependent

require ventilation in acute stage, but may be able to breathe independently later on; can't cough

preserve diaphragm, lose accessory muscles (altered breathing); can't cough

risk of aspiration, pneumonia

due to disconnect between brain and autonomic reflexes in sc; sudden inc BP, pounding headache, profuse sweating above level of lesion

remove noxious stimuli, place pt upright to inc postural hypotensive response **medical emergency, if this doesn't dec BP, contact physician

• hypothermia soon after injury (loss of vasomotor tone causes excess vasodilation and heat loss)
• hyperthermia later on

• stress ulcers in acute stage
• constipation long term

• micturition center S2-4
• during spinal shock, bladder is flaccid (won't empty), need indwelling catheter
• lesion to S2-4 causes flaccid detrusor muscle (reflex loop interrupted)
• lesion above sacral levels- may have refexive bladder emptying
• inc risk of UTI

• psychogenic- input from higher brain centers via T/S
• reflexive- reflex response to sensory stimulation

achieve reflexive erection but not ejaculation

can ejaculate but erection more difficult

Erection and ejaculation both not possible

achieve reflexive arousal but not psychogenic

may have both types of arousal

may have psychogenic but not reflexive

menstrual cycle resumes several months after, can become pregnant although risk of autonomic dysreflexia; lesion above T10- may not notice when labor begins

younger; compression fx instead of crush fx

respiratory infection

UTI

acute care; may begin out of bed activity, prevent secondary complications

Early rehab; inc tolerance for out of bed activity

intensive rehab; functional skills aimed at inc independence, mobility skills, transfers, ADLs, begin community re-integration

pre-discharge; activities focused on transition to home

continue community re-integration, continue functional skills

stretching and positioning, rhythmic passive movements, prolonged standing, low frequency vibration, NMES, orthoses or casting

• deteriorating neuro status
• continuing cord compression
• gross mal-alignment
• fracture that won't reduce with traction

• S2-4 yes
• above sacral levels maybe