Spinal Cord Injuries By: Kaila Kerrane

What is a Spinal Cord Injury  Spinal Cord Injuries (SCI) affects conduction of neural signals across the site of the injury.  Each SCI is classified by the lowest segment of the spinal cord with normal sensory and motor function on both sides of the body.  Examples of syndromes resulting in Spinal Cord Injury are:  Central cord syndrome  Brown-Sequard syndrome  Anterior cord syndrome  Conus medullaris syndrome  Cauda equia syndrome

Spinal Injury Impairment Scale  Each degree of impairment is give a letter on the scale of A-E

Progression of Spinal Cord Injuries  Spinal cord is a portion of the central nervous system that links our conscious and and subconscious functions with the peripheral and autonomic nervous systems.  The spinal cord consists of the spinal column, a pair of nerves, and a vascular supply.  Primary injury will occur  Secondary injury will then occur  Followed by infarction of the gray matter  Necrosis will then follow  Formation of fibrous is the final phase of the injury process  Injury to the spinal cord will result in the loss of somatic and autonomic control

Signs and Symptoms  Signs  Motor paralysis  Sensory loss  Hyperreflexia  Flaccidity  Hypotension  Pulmonary Dysfunction  Neurogenic bladder  Neurogenic bowel  Symptoms  Impaired or absent voluntary motor functions  Impaired or absent sensation  Spasticity or spasms  Flaccid paralysis without DTR’s  Dizziness or loss of consciousness  Require accessory muscles of respiration  Urinary incontinence, urinary tract infection  Fecal incontinence, constipation

Diagnosis of SCI  Diagnosis is largely based on a physical examination  Pinprick and light touch  Electrodiagnostic studies  Somatic evoked potentials

The Effect of SCI on the Exercise Response  Cardiovascular- bradycardia is common  Pulmonary- ventilation is impaired in most patients because of paralysis of the rib cage and abdominal musculature  Hyperrefexia- this spasticity can interfere with musular function  Thermoregulation- unable to regulate body temperature by sweating  Osteopenia- results from the withdraw of stress and strain on the bone  Will need appropriate seating and positioning to reduce the risk of pressure sores, autonomic dysreflexia, spasticity, and musculoskletal trauma.

Management and Medicine  There is no cure for the affects a spinal cord injury does to the body  Management is focused on maintenance and function  Some common medication used in SCI are as listed  Elavil- Neuropathic pain  Tegretol- Neuropathic pain  Valium- Spasticity  Mininpress- Autonomic dysreflexia  Detrol- Bladder spasms  Typically peoples with a SCI will be on multiple medications at a time

Case Study  Patient/Client Details- Ms. Mailey is a 28 year old with thoracic paraplegia since age 19 caused by a car accident.  Before the accident she was very active participating in various sports but has been wheelchair bound since.  She weighs 150 lbs (68kg) with a BMI of 31.  Her blood pressure s 100/60 and her resting heart rate is 85.  She is a non smoker and has no history of heart disease that runs through her family.

Case Study  Risk Stratification- Ms. Mailey would be considered to be at a moderate risk for exercise  Special Considerations- Ms. Mailey is a paraplegic with neurogenic bowel and bladder, spasticity and occasional autonomic dysreflexia. According to the Spinal Injury Association

Exercise Testing  Graded exercise testing is most used in asymptomatic or athletic populations but can not be used in most persons with SCI  Arm crank ergometry is the most often used test  Special systems have been developed  Wheelchair ergomerty  When the two are compared the results in the wheelchair ergometry results in similar or greater VO 2 peak response with lower peak power output.

Exercise Prescription- Aerobic  Mode: Wheelchair ergometry, arm crank cyclng, community wheeling, seated aerobics, aquatics, wheelchair recreation  Goals: Improved functional capacit and reduction in activity affected cardio vascular disease risk factors  Frequency: 3-7 days per week  Intensity: RPE 11-14, 50-85% VO 2 peak or 30-85% HRR  Duration: minutes, continuous or interval

Exercise Prescription- Resistance Training  Mode: Elastic bands, wrist weights, body weight, dumbbels, free weights, wheelchair accessible machines  Goals: Improved strength and improved ability to ambulate using arms  Frequency: one to three sets on 2-3 days per week  Intensity: 8-12 reps at 60-75% 1RM  Duration: mins per sesion

Exercise Prescription- Range of Motion  Mode:  Active assisted- anterior shoulder, pectoral, rotator cuff  Passive assisted- hip flexors, knee flexors, plantar flexors  Goals: reduction in contractures and spasticity and improved joint ROM for affected and nonaffected joints  Frequency: 7 days per week  Intensity: As tolerated  Duration: 5-15 minutes

References  Dolbow, D. R., Gorgey, A. S., Recio, A. C., Stiens, S. A., Curry, A. C., Sadowsky, C. L., &... McDonald, J. W. (2015). Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions. Aging & Disease, 6(4), doi: /AD  Gater, David R., Jr. “Spinal Cord Injury.” Clinical Exercise Physiology. By Jonathan K. Ehrman. Second ed. Champaign, IL; Human Kinetics, Print.  Mulrooy S, Hatchett P, Eberly V, Lighthall Haubert L, Conners S, Requejo P. Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study. Physical Therapy, 95(7): doi: /ptj