1. Spinal Cord Injury Elective
Jimmy Flis

2. Weeks 1&2
Introduction to SCI

3. Etiology1 ~11,000 new cases of SCI/year Average age of inury= 37 years
Traumatic injury more frequent
MVA 40.4%
Falls 27.9%
Violence 15%
Sports 8%
Non-Traumatic Less common
Arteriovenous malformation (AVM)
Abcess
Syringomyelia
Neoplasms
Infections

4. ASIA Terminology1
Neurological Level: Most caudal level with normal motor and sensory function
Motor level: Most caudal level of normal motor function bilaterally
Motor considered normal if:
Key muscle scores a 3/5 AND
All key muscles rostral to level score 5/5
Sensory Level: Most caudal level of normal sensory function bilaterally
Tested through light touch and pin-prick
Score of 2 = normal function

5. ASIA Scoring1 ASIA Impairment Scale
ASIA A- Complete Injury
No sensation in S4-S5
ASIA B- Incomplete Injury
Sensory function preserved below neurological level (includes S4-S5)
No motor function preserved below motor level
ASIA C- Incomplete Injury
Both sensory and motor preserved below neurological level
More than half of muscles score <3
ASIA D- Incomplete
Sensory and motor preserved below neurological level
At least half of muscles below level score >3
**To be scored C or D pt. must have:
Motor function preserved 3 or more levels below neurological level OR
Voluntary anal sphincter contraction

6. Bowel, bladder, and sexual function
Week 6
Bowel, bladder, and sexual function

7. Innervation of Bladder2
Sympathetic innervation carried by hypogastric nerve
Controls urinary storage
Parasympathetic innervation carried by pelvic nerve (S2-S4)
Controls Mictruition
Afferent information about bladder distension carried through pelvic nerve
Manages switch between storage and mictruition
Pudendal Nerve provides somatic innervation to muscles of external sphincter

8. Bladder Dysfunction1 Injuries above T12 result in reflexive bladder
Injuries below T12 result in flaccid bladder
Detrusor sphincter dyssynergia
Bladder contracts against closed sphincter
Complications: UTI’s, hydronephresis, vesicouretal reflux

9. Week 63 FES and bladder control Brindley approach
Pros: effective
Cons: Invasive, Requires Dorsal Rhizotomy
Genital Nerve Stimulation
Newer approach
Has been found to be effective in acute situations
Non-invasive

10. Driver Rehabilitation
Week 7
Driver Rehabilitation

11. Week 7- Driver Rehabilitation

12. Driver Rehabilitation contd.

13. FES and Lower Extremity/Trunk
Week 8
FES and Lower Extremity/Trunk

14. Implanted FES system4 Implanted neuroprosthesis
Assist patients suffering from SCI in transfers, standing, and swing to ambulation.
Also can assist in trunk control and other functional movements
Can be used of exercise (recumbent bikes)
Positive response found among users
Cons: Still not functional for community ambulation (distance, speed)

15. Pt. perceptions

16. Week 8- FES use in Trunk and Lower Extremity
FES cycling5
Mixed results on improving BMD
FES gait6
Limited research
Found to improve walking speed and endurance
Easy to don, more cosmetic
No effect found on BMD
Varying results reported on cardiovascular improvements

17. FES and Trunk Control7 Implanted neuroprosthesis in 8 subjects
Improved pelvic tilt, trunk angle, and total reach in reaching tasks
Improved return to erect sitting from forward flexed position in all 6 subjects tested in task
4/6 unable to perform task without stimulation

18. FES and Pressure Relief8
8 patients with implanted neuroprosthesis (level of injury C5-T8)
LE exercise program for 8 weeks through stimulation
No significant increase in total pressure
Significant decrease in pressure in the area of the ischial tuberosities
Varied results on tissue oxygenation levels (5/8 improved, values not significant)

19. References
O’Sullivan SB, Schmitz TE. Physical Rehabilitation: Assessment & Treatment, 5th ed. Philadelphia, PA: FA Davis; 2013.
Krassioukov A, Biering-Sorensen F, Donovan W, et al. International Standards to Document Remaining Autonomic Function after Spinal Cord Injury, 1st ed.
Chester et al. Functional Electrical Stimulation and Spinal Cord Injury. Phys Med Rehabil Clin N Am Aug; 25(3): 631–ix.
Agarwal S, Triolo R, Davis JA J, et al. Long-term user perceptions of an implanted neuroprosthesis for exercise, standing, and transfers after spinal cord injury. Journal Of Rehabilitation Research & Development [serial online]. May 2003;40(3):
Dolbow D, Gorgey A, Daniels J, Adler R, Moore J, Gater D. The effects of spinal cord injury and exercise on bone mass: a literature review. Neurorehabilitation [serial online]. 2011;29(3):
Nightingale E, Raymond J, Middleton J, Crosbie J, Davis G. Benefits of FES gait in a spinal cord injured population. Spinal Cord [serial online]. October 2007;45(10):
Triolo RJ, Bailey SN, Miller ME, Lombardo LM, Audu ML. Effects of Stimulating Hip and Trunk Muscles on Seated Stability, Posture, and Reach After Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation. 2013;94:1766–1775
Bogie K, Triolo R. Effects of regular use of neuromuscular electrical stimulation on tissue health. Journal Of Rehabilitation Research & Development [serial online]. November 2003;40(6):