Spinal Cord Injuries Class 3 Notes PDF

Class 3 – Notes 2025-01-19 12:05 PM Spinal Cord Injuries: Definition Occurs from a direct injury to the spinal cord or indirectly from damage to the surrounding bones, tissues, or blood vessels...

Class 3 – Notes 2025-01-19 12:05 PM Spinal Cord Injuries: Definition Occurs from a direct injury to the spinal cord or indirectly from damage to the surrounding bones, tissues, or blood vessels These events cause paralysis or a complete or total loss of the ability to move or feel sensation in part or most of the body Classifications Direct Vs. Indirect Direct Direct trauma on the spinal cord Indirect Damage to tissues and bones surrounding the spinal cord Primary Vs. Secondary Damage Primary Immediate damaged caused directly from trauma Secondary Delayed damaged caused by complications after the injury Complete Vs. Incomplete Lesion Complete Full lesion of spinal cord → total motor and sensory loss below lesion Incomplete Partial lesion of spinal cord → partial loss of sensory and motor function Etiology Trauma More common than non-traumatic (can be direct & indirect) Motor vehicle accidents: Most common – 97% of times, patients did not wear a seatbelt Diving: often leads to quadriplegia and paraplegia Contact sports: American football & rugby, hurling Violent trauma: gunshot/stab wounds (incidence increasing) Non-Traumatic Injuries Spinal hematoma, infection, radiation, neoplasm Vascular complication: cardiac arrest, aortic aneurysm, surgery Specific Spinal Cord Injuries – Incomplete: ***** 1. Central Cord Syndrome 2. Brown-Sequard Syndrome 3. Anterior Cord Syndrome 1. Central Cord Syndrome Damage to centre with periphery unaffected Most common incomplete injury Cause – hyperextension or arthritic changes to C-spine Signs & Symptoms: Upper limbs: motor and sensory abilities affected, mm weakness, flaccidity Lower limbs: less affected Bowel and bladder control normal or partially affected (not ususally) 2. Brown-Sequard Syndrome Damage to one side of the spinal cord Cause – stabbing/gunshot wound Signs & Symptoms: Ipsilateral impairment: motor function, proprioception, sensation (vibration, 2-point discrimination) - NORMAL: pain and temperature perception Contralateral impairment: loss of pain and temperature perception - NORMAL: motor function Because of the tracts crossing in the brain 3. Anterior Cord Syndrome Damage to anterior spinal artery/anterior spinal cord – corticospinal & spinothalamic tract injury Cause – Hyperflexion injury Signs & Symptoms: Bilateral loss of motor function, perception (pain, temperature, crude touch "deep touch") Signs & Symptoms: Level of Injury Most vulnerable part of the spine is C4 – C6, where the spinal canal loses stability in favour of mobility most rotational portion of c-spine T12 – L1 also commonly injured Muscle function obtained depending on level and severity of spinal cord lesion C1 – C3 No function maintained from neck down Need ventilator to breathe C4 – C5 Diaphragm, which allows breathing C6 – C7 Some arm and chest muscles (feeding, dressing, propelling wheelchair) T1 – T3 Intact arm function T4 – T9 Control of trunk above the umbilicus T10 – L1 Most thigh muscles, allows walking with long leg braces L1 – L2 Most leg muscles, allows walking with short leg braces Types of Plegia: **** Monoplegia Paralysis of one limb Diplegia Paralysis of both upper OR lower limbs Paraplegia Paralysis of both lower limbs Paraparesis Muscle weakness in legs Hemiplegia Paralysis upper limb, trunk and lower limb unilaterally Quadriplegia Paralysis of all four limbs Quadriparesis Muscle weakness in all limbs Autonomic Dysreflexia: An acute exaggerated sympathetic response People at risk generally are those with a lesion at or above T6 How? By a painful or uncomfortable stimulus in the abdomen or pelvic area eg. Distention of a full bladder Mm spasms, an extensive stretch placed on the muscle A kink in the catheter bag (causes a backup in the kidneys) The presence of infection such as decubitus ulcers Stimulus sends nerve impulses to the spinal cord – they travel upward until they are blocked by the lesion at the level of injury the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of ANS This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure Signs & Symptoms: Severe hypertension (300/160), bradycardia Sudden pounding headache Vasospasms, piloerector response and skin pallor occur Flushed skin and sweating It is considered a medical emergency and is potentially life threatening – CI to massage, call 911 Massage & Spinal Cord Injuries Most clients are wheelchair-bound, adapt massage to clients need and abilities Clients are generally inactive so have a larger risk to bone density and blood clots in the legs Avoid deep pressure over bones and forceful PROM because of risk of fractures Avoid vigorous massage techniques because of risk for clots Assess contractures Asses for potential decubitus ulcers Transfer Techniques: General Guidelines Safety is always the #1 concern When assisting or supervising a patient transfer or to help them with there assisted devices preparation and making sure everyone fully understands what is about to happen is essential Approach Respect Respect the person inside the patient Be careful not to offend their pride, they may be sensitive to terms like disabled/handicapped/impaired Communicate Ensure the patient understands and agrees with your intentions Explain and demonstrate – invite questions Do not use excessive professional terminology and do not talk down to them Lead Balance authority and courtesy – control the situation do not be confrontational Avoid being aggressive Listen to the clients opinions Act as a leader not a pusher Preparation 1. Choose the type or level of transfer needed 2. Make sure patient fully understands what is about to happen – confirm they understand 3. Remove all potential hazards – small rugs, furnishing, and personal clutter 4. Equipment – make sure brakes are on (applied) the wheelchair foot/armrests are removed where necessary Preposition chair for transfer 5. Ensure clothing allows for free movement but is unlikely to catch on anything 6. Posture: have a walking stance (feet shoulder width apart), knees bent in lift, and pelvic tilt throughout manoeuvre Use both hands; holding client close to your body 7. Use body weight and momentum to perform the moves – work as a unit, counting 1-2-3-LIFT 8. Tuns: place feet to provide a stable base but avoid blocking the patient – pivot or step around to avoid twisting 9. Lifts: avoid lifting above the waist level of the patient 10. Ensure that the procedure can be safely aborted at any stage of the transfer Move slowly and be prepared for the unexpected If the patient begins to slip, stumble or fall, propel them gently but firmly back to the chair, bed or control their descent to the floor Bed Mobility Maximum patient participant is encouraged Count aloud and rocking the patient in the direction of the move on each count is used to achieve coordination Whole body momentum – not just your arms to shift weight Support the patients shoulder and pelvic girdle – DO NOT pull on their shoulders The bottom sheet is your turning sheet – this allows better biomechanics and eliminates friction, facilitates the turn and prevents damage to the patient's skin Lateral Shift Therapist faces table, slightly wider than shoulder width, or 1 knee on the table Bend your body over the patient & grab the turning sheet as close to the patient as possible, at the hip & shoulder level One the count of 3 shift your body weight from front leg to back leg & gentle pull Pull turn to Side Lying Patients far leg is flexed & crossed over the near leg (unless CI'd) Therapist grasps the patient at the hip & shoulder On the count of 3 pull the patient towards them Push turn to Side Lying Same position as above, with leg flexed over the far leg Grasp the hip & shoulder, have a pillow for the patient's knee to land on On the count of 3, push the patient on their shoulder – make sure their arm doesn’t get caught up Transfers and Lifts: Over Side of Bed Position your patient in side lying facing the edge of the table, knees bent, feet clear of the table, upper hand in a fist in front of their abdomen Therapist faces patient in a lunge, bent knee nearest the patient's head, one hand on the scapula the other on the SI region Count 1-2-3-UP, the patient pushed down on their fisted hand as the rise, the therapist helps by guiding them up, then draws them to the edge to the table Positioning in Chair To centre your patient in their chair: Therapist crouches, facing the patient and stabilises the patients knees b/w their own One hand supports the thorax on the side that is opposite to the direction of movement, the other is beneath the patients buttocks Rock the patient sideways to a count of three, the therapist lifts the clients buttock and applies a sideways pressure at the thorax level To move the patient back in their chair: Therapist crouches facing the client and grips the patients knees b/w their own Lock your hands behind the patients low back and then tilt the patient forward, and places their arms across the therapists shoulders Therapist rocks the patient forward, taking the weight off their buttocks and the pushes back on their knee Hemi Transfer Lock wheelchair on patients strong side at a 45 degree angle to table Patient sits forward on the edge of the table, feet on the floor (weak leg slightly further back) Therapist stands on the patients weaker side, facing them and blocking the weaker foot and knee Support the patient around the waist Patient leans forward and grasps the far arm of the chair with their sound hand Rocking in time to a count of 1-2-3-UP. The patient stands on UP for a few seconds gains their balance and then turns and sits into the chair Standing Pivot If moving from the chair to the bed ensure the patients strong side is closest to their destination The above technique is repeated, except that the patient pivots before reaching back with their sound side Standing Step Around Lock wheelchair in a parallel position Patient sits forward, feet on the floor, their hands on the side of the bed Therapist faces the patient, in a walking stance, one foot on either side of the patients feet, ready to prevent slipping Therapists knees are bent securing the patient's knees between their own, grasp patients waistband or around the low back Patient leans forward, with their hands around the therapists shoulders, gently rock for momentum, counting 1-2-3-stand Stand briefly to gain balance, before the patient steps around and sits Moving from chair to table is from the same positioning get the patient leaning on table with their backside then cradle them on to the table with one hand on the patients shoulder and the other under the patients knees