Spinal Cord Injury Rehabilitation

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Questions and Answers

What is the primary cause of contractures in individuals with spinal cord injury (SCI)?

Prolonged stretching of muscles

Excessive physical activity

Increased joint mobility

Prolonged shortening of structures around a joint (correct)

Which joint is least likely to be affected by heterotopic ossification (HO)?

Hip joint

Knee joint

Wrist joint (correct)

Elbow joint

What are early symptoms of heterotopic ossification?

Swelling and joint pain (correct)

Improved circulation

Enhanced range of motion

Increased strength in joints

What is the most significant factor leading to bone mineral loss in individuals with SCI?

Limited muscle activity and weight-bearing Signup and view all the answers

Which type of pain following spinal cord injury is characterized as being musculoskeletal or visceral in origin?

Nociceptive pain Signup and view all the answers

What is the primary cause of contractures in individuals with spinal cord injury?

Prolonged shortening of structures across joints Signup and view all the answers

Which management technique is important for preventing contractures?

Consistent and concurrent ROM exercises Signup and view all the answers

What factor does NOT contribute to the risk of developing contractures in people with spinal cord injury?

Increased flexibility Signup and view all the answers

How does heterotopic ossification potentially impact a patient's quality of life?

By causing contractures and impaired mobility Signup and view all the answers

What is a primary concern with performing passive range of motion (PROM) exercises in patients at risk for heterotopic ossification?

Overly vigorous PROM may cause trauma. Signup and view all the answers

What is a significant risk for individuals with spinal cord injury related to their bone health?

Osteoporosis and skeletal fractures Signup and view all the answers

Which condition refers to the abnormal growth of bone in the non-skeletal tissues following a spinal cord injury?

Neurogenic heterotopic ossification Signup and view all the answers

What skeletal region is most commonly affected by osteoporosis following a spinal cord injury?

Lower extremities only Signup and view all the answers

Which statement about pain following spinal cord injury is accurate?

Both acute and chronic pain can affect quality of life. Signup and view all the answers

Which strategy is NOT commonly used in the management of bladder dysfunction post spinal cord injury?

Daily weight training Signup and view all the answers

Which of the following is a goal in managing bladder dysfunction in spinal cord injury patients?

To achieve catheter-free status Signup and view all the answers

What is a common activity that can lead to fractures in individuals with spinal cord injury (SCI)?

Stretching during rehabilitation Signup and view all the answers

What type of medical treatment is used to prevent and reduce bone mineral density (BMD) loss in individuals with SCI?

Bisphosphonate therapy Signup and view all the answers

Which factor is NOT directly related to the potential for recovery from spinal cord injury?

Age of the patient Signup and view all the answers

How do individuals with SCI generally report their quality of life compared to nondisabled individuals?

Lower quality of life Signup and view all the answers

Which type of spinal cord injury is unlikely to regain the ability to walk?

Complete lesion (AIS A) Signup and view all the answers

What contributes to the management strategies for individuals with SCI regarding bone health?

Weight-bearing activities and assistive devices Signup and view all the answers

In which cases is lower-extremity muscle strength particularly useful as a predictor of walking ability?

Motor incomplete injuries Signup and view all the answers

Which of the following factors can negatively influence recovery outcomes for individuals with SCI?

Lack of psychosocial support Signup and view all the answers

Study Notes

Spinal Cord Injury (SCI) Rehabilitation

Rehabilitation of people with spinal cord injury is a complex process.
SCI classification is crucial for understanding the injury and its effect.

SCI Classification

Tetraplegia: Affects all four limbs (Upper and lower body)
Paraplegia: Affects only the lower body (lower limbs)

Neuroanatomical Organization and Structure

Understanding neuroanatomical organization and structure is essential for SCI rehabilitation.
Ascending and descending tracts of the spinal cord are vital pathways for sensory and motor information.

Designation of Lesion Level

The location of the injury in the spinal cord helps define the extent of the damage to the segments.
Tetraplegia and Paraplegia have different injury levels, according to the slides.

International Standards for Neurological Classification of SCI (ISNCSCI)

The American Spinal Injury Association (ASIA) created the ISNCSCI to standardize injury severity assessment.
This method provides a means for communication between professionals.
It assists with prognosis establishment and clinical research.

Complete vs. Incomplete Injuries

Complete SCI: No sensory or motor function in the lowest sacral segments.
Incomplete SCI: Some motor / or sensory function below the neurological level of the injury with sacral sparing.
Zone of Partial Preservation: In incomplete injuries, areas below the neurological level may have function.

ASIA Impairment Scale (AIS)

The ASIA scale grades the completeness of the injury based on sensory and motor function.
AIS grades are A, B, C, D, and E.

Clinical Syndromes

Anterior Cord Syndrome: A clinical presentation affecting the anterior part of the spinal cord.
Central Cord Syndrome: Affects the central part of the spinal cord and impacts the arms more, than the legs.
Brown-Sequard Syndrome: This syndrome has a hemisection of the spinal cord, which results in symptoms on the side opposite the injury.
Cauda Equina Injuries: Affect the nerve roots at the end of the spinal cord.

Impact of SCI Across the ICF

The International Classification of Functioning, Disability, and Health (ICF) framework describes the effect of spinal cord injury.
Environmental factors (accessibility) and personal factors (support systems) also affect function.

Spinal Shock

A temporary period of areflexia (lack of reflexes) and autonomic dysfunction immediately following SCI.
Initially, characterized by absence of reflex activity.
May include hypotension, and loss of sweating control.

Motor and Sensory Impairments

Complete or partial loss of muscle function (paresis/paralysis) below the level of the lesion.
Impaired or absent sensation below the level of the injury is also common.
The specific impairment depends on the injury site (lesion level) and injury type (complete/incomplete).

Autonomic Dysreflexia (AD)

A potentially life-threatening autonomic reflex.
It typically arises from lesions above T6.
Triggers of AD include noxious stimuli below the injury level; bladder distension or bowel issues being common triggers.
AD is characterized by hypertension and other symptoms.

Spastic Hypertonia

Often occurs below the level of the lesion, after spinal shock has subsided.
A gradual increase in spasticity typically reaches a plateau after injury.
Various triggers, such as positional changes, and other factors.

Cardiovascular Impairment

SCI can affect the autonomic regulation of heart rate, blood pressure and blood vessels (vascular tone).
This imbalance can affect the entire body, with different blood pressure and heart rate issues arising with upper vs lower body function compromise.

Impaired Temperature Control

SCI affects the hypothalamus's thermoregulatory function below the level of the lesion
The ability to regulate temperature and shiver is compromised.
Impairment varies with severity of injury,

Pulmonary Impairment

Damage to spinal cord can cause pulmonary issues during respiration.
Important respiratory muscles are affected.

Bladder and Bowel Dysfunction

Various bladder and bowel issues can result, including hyperreflexia or areflexic bladders/bowels.
Depending on the injury level and type, intermittent catheterization, or other management may be needed.

Pain

Pain is common in people with SCI, both during the acute and chronic stages.
Pain can be categorized into nociceptive (musculoskeletal/visceral) or neurogenic (allodynia/hyperalgesia).

Contractures

Caused by prolonged shortening of joint structures which results in limited range of motion.
Factors including spasticity, positioning, and muscle tone play a role in contracture development.

Heterotopic Ossification (HO)

Abnormal bone growth in soft tissues.
Commonly develops in the hips and knees, near the injury level.
Often associated with high spasticity, severe injury with inflammation, and other factors.

Osteoporosis and Skeletal Fracture

People with SCI experience bone loss in the early stages of recovery, especially from lack of body weight-bearing or the absence of functional activity.
This increases risk of fracture and osteoporosis (bone loss).

Prognosis for Recovery of Walking and Motor Function

Recovery rates depend heavily on the neurological level and injury type
Preservation of sensation is a positive recovery predictor.
Strength in some limb muscles can be helpful in predicting functional walking ability.
Other psychosocial recovery factors such as social support are also important for recovery.

Early Medical Management

Early management after SCI involves emergency care, fracture stabilization, and immobilization.
Halo orthoses are typically used for cervical spine stabilization.

Activity Limitations

Various barriers relating to employment (transportation), health (physical limitations), and lack of social/family support impact daily life activities in people with SCI.
People with SCI generally experience a lower quality of life (QOL) compared to nondisabled individuals.

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Description

This quiz covers key concepts in the rehabilitation of spinal cord injuries, including classifications such as tetraplegia and paraplegia. It emphasizes the importance of understanding neuroanatomical organization, lesion level designation, and standardized classifications like ISNCSCI for effective rehabilitation strategies.