Spinal Cord Injury Trombly Ch 43 OT 451-E & I II

Overview of SCI Epidemiology Assessment Intervention

Epidemiology SCI affects 10K people a year in the US ~ 200K people w/SCI are alive in the US Ratio of male to female= 4:1 Average age of injury= 31.8 (though 50% of clients range from y/o) Causes: 43% MVA; 22% falls/object;19% violence; and 11% sports injury. 5% are non- traumatic (tumors, ischemia, infection)

Epidemiology (cont’d) 59% white, 27% A.American (greater representation of minorities sustain SCI) Slightly lower educ level and higher unemployment rate than the general pop. Most SCI clients are single at time of injury

Course after SCI Disruption in sensory motor pathways at site of lesion Spinal shock- areflexia at and below the level of the injury lasting for hours/days. Reflexes return and become hyper reactive below the level of the injury. At the level of the injury, areflexia may remain

Neuro classifications of SCI Motor level is determined by testing 10 key muscles on each side of the body Sensory level is determined by testing 28 key points on the body Neurological level- is the lowest level at which MMT 3/5 or above on MMT and sensation is intact for this level’s dermatome. The level above must also have normal strength and sensation Skeletal level- refers to the level of greatest vertebral damage Functional level- last segment at which key muscles have a grade of 3/5 or above

Neuro Classifications (cont’d) Tetraplegia (quadraplegia) or Paraplegia Incomplete: used when there is partial preservation of sensory and/or motor function below the neurological level and including the sacral segment Complete: absence of sensory or motor function in the lowest sacral segments Zone of partial preservation- pts with complete injuries who have partial innervation in dermatomes below the neuro level

Prognosis Depends on injury type and level When spinal shock resolves patients have an excellent change to regain motor and sensory functions initially, but as time progresses the recovery rate declines Most return occurs for complete and incomplete injuries in first 6 mos. Life expectancy of SCI beyond 1 st year is only slightly less than that of able-bodied persons

Impairments and therapeutic implications Respiration- diaphragm, assisted cough, abdominal binder, suction techniques, ventilator Autonomic dysreflexia- a life threatening condition due to sudden rise in BP associated with lesions T6 and above. Brought on by unopposed sympathetic response to noxious stimuli. Causes can be full bladder, infection, fecal impaction, ingrown toe nails. SX: pounding headache, flush face, hypertension

Impairments and therapeutic implications Orthostatic or postural hypotension Pressure ulcers and pressure relief Bowel function and management- S2-S5 Bladder management

Impairments and therapeutic implications Sexual function Males w/complete injuries are unable to have psychogenic erections and ejaculations, but can have reflex erections Pt’s w/complete injuries at S2-S5 have a complete loss of erection Male fertility is significantly decreased but w/technology, both fertility and erection can be attained Women are less affected but also impaired. Usually considered a high risk pregnancy Psychological factors are the greatest concern w/sexuality

Impairments and therapeutic implications Temperature regulation Pain Acute vs. chronic Mechanical vs. radicular (segmental root pain) or central pain (deafferent or neurogenic pain) Fatigue Spasticity and spasms DVT Heterotopic ossification- in 15-20% of SCI- connective tissue calcifies around the joint (usually appears 1-4 months after injury) Psychosocial adaptation

Assessment Occupational history Physical evaluation Functional evaluation Hand and wrist ADL’s Leisure School and vocation Home and community

Intervention Acute Support and prevention Envio controls, ROM, Prevent deformities Acute Rehab Support, education, meaningful activities Educating pts and families Encouraging problem solving D/c context Self maintenance skills, meaningful activities Choosing equipment

C1-C4 Tetraplegia Respiration Mouth sticks ECU W/C and Computer use through sip and puff / scanning program W/C recline control w/head Dependent in all self care

C5-C8 Positioning Splinting Strengthening FES/ Muscle re-ed C5- deltoid and biceps MAS, rachet brace, Can do table top activities, but dependent in dressing, bathing, toileting

C5-C8 (continued) C6-have radial wrist extensors, C-7 have triceps. C6- weak use a tenodesis brace C6 and C7- can roll in bed, can dress, bathe, groom, and drive w/equipment C7- indep in transfers w/slide board C8- hand function available (essentially they are paraplegic functionally)

Other dysfunctions Paraplegia Incomplete injury Concomitant brain injury

Other interventions Outpatient/ day program Hydro therapy Advocacy/ peer support Sports and leisure programs