Spinal Cord Injury (SCI) and Spinal Shock

Spinal Shock

• Spinal shock is areflexia immediately following a spinal cord injury (SCI).
• Autonomic regulation is impaired, leading to hypotension and loss of control of sweating and piloerection.
• Loss of all reflexes occurs, including DTR, bulbocavernosus reflex, cremasteric reflex, and a Babinski response.

Recovery from Spinal Shock

• The initial period of areflexia lasts about 24 hours.
• The gradual return of reflexes happens within 1 to 3 days.
• A period of increasing hyperreflexia occurs within 1 to 4 weeks.
• Final hyperreflexia manifests within 1 to 6 months after the injury.

Complications of SCI

• Primary complications of SCI include: spinal shock, autonomic dysreflexia, spastic hypertonia, CV complications, pulmonary complications, and bladder and bowel dysfunctions.
• Secondary complications of SCI include: pressure sores, pneumonia, DVT, pain, heterotrophic ossification, and fractures.

Sympathetic vs. Parasympathetic Nervous Systems

• The sympathetic nervous system's control area is the Sympathetic Ganglion Chain along the spine T1-L2 and it mediates stress.
• The parasympathetic nervous system's control area is the Sacral Segment S2, S3, S4 and CN Nerves CN III, VII, IX, X, in the Brain Stem which mediates relaxation.
• The sympathetic system is not normally active during rest, whereas the parasympathetic system prevail during rest.
• The sympathetic system initiates the "fight or flight" response during stress by: increasing heart rate, dilating lungs, inhibiting digestion, dilating pupils, and causing vasoconstriction.
• The parasympathetic system initiates the "rest and digest" response by: reducing heart rate, increasing salivation, increasing urine secretion from the kidneys, constricting pupils, and promoting digestion.
• The sympathetic and parasympathetic pathways work in parallel to maintain homeostatic balance in the body.

Autonomic Dysreflexia

• Symptoms include: increased sweating, flushing, headache, and blurred vision.
• Hypertension triggered by AD can lead to seizures, cardiac arrest, subarachnoid hemorrhage, stroke, or death.
• AD commonly occurs in the chronic stage of recovery (more than 3 to 6 months after injury), but can occur in early stages of SCI
• A rise in systolic blood pressure of 20 to 30 mm Hg is diagnostic of AD.

Intervention for Autonomic Dysreflexia

• Change the position to upright to reduce blood pressure.
• Loosen tight clothing.
• Check for trigger points like bladder distension, bowel impaction, and pressure sores.
• Monitoring pulse and blood pressure is important.

Decreased Forced Expiratory Volume

• Decreased forced expiratory volume involves that the lack of abdominal muscle (T5-T12) innervation causes abdominal contents to fall forward, pulling down on the diaphragm's central tendon.
• This changes the diaphragm's motion during inspiration, leading to an inefficient breathing pattern.
• The lack of full abdominal muscle function impairs the ability to cough and clear the airway.
• FEV is the volume of air expired after normal expiration and requires abdominal and intercostal muscles.

Overview of spinal shock, areflexia following spinal cord injury. Covers autonomic regulation impairment, hypotension, and reflex loss. Also includes recovery stages, primary and secondary complications of SCI.