Lecture Set 16 - SCI - URC PDF

SHERRILL, C. (2004). ADAPTED PHYSICAL ACTIVITY, RECREATION, AND SPORT: CROSSDISCIPLINARY AND LIFESPAN. BOSTON: MCGRAW-HILL. SPINAL CORD INJURIES (SCI) Spinal Paralysis ¡ Broad term for conditions caused by injury or disease to the spinal cord and/or spinal nerves ¡ Paralysis can be complete (tot...

SHERRILL, C. (2004). ADAPTED PHYSICAL ACTIVITY, RECREATION, AND SPORT: CROSSDISCIPLINARY AND LIFESPAN. BOSTON: MCGRAW-HILL. SPINAL CORD INJURIES (SCI) Spinal Paralysis ¡ Broad term for conditions caused by injury or disease to the spinal cord and/or spinal nerves ¡ Paralysis can be complete (total) or incomplete (partial) ¡ Paresis is muscle weaknesses in partial paralysis Spinal Paralysis & The Nervous System ¡ Spinal paralysis involves the central (spinal cord and nerves) and autonomic (vital functions) nervous system Severity of Condition ¡ Depends on two criteria… − Level of lesion − Is it complete or incomplete? ¡ Higher the lesion = Less functioning ¡ Complete lesions = Less functioning Functioning & The Spinal Cord ¡ Cervical − Arms, hands, breathing ¡ Thoracic − Balance, trunk control, forceful breathing ¡ Lumbar − Leg and foot movements ¡ Sacral − Bowel, bladder, sexual function Physical activity personelle should be familiar with the body parts innervated by various nerve groups Quadriplegia (Tetraplegia) ¡ Involvement of all four limbs and the trunk ¡ 50% of persons with quadriplegia have incomplete lesions − ‘Walking Quads’ Quadriplegia (Tetraplegia) ¡ High-Level Quads − C1 – C4 lesions − Use motorized chairs for mobility − Powerchair sports (soccer & bowling) Quadriplegia (Tetraplegia) ¡ Low-Level Quads − C5 – C8 lesions − Use manual chairs and participate in many wheelchair sports − Wheelchair rugby Paraplegia ¡ Involvement of the legs but often includes trunk balance as well ¡ For sport programming, trunk balance is the most useful criterion in determining level of participation − Why is trunk balance an advantage in sport? Spina Bifida ¡ Congenital defect of spinal column caused by failure of neural arch of a vertebra to properly develop and enclose spinal cord ¡ Incidence related to gender (more girls are affected), race (more Caucasians are affected), geographical location (more common in Great Britain and Ireland), and socioeconomic status ¡ Occurs between the 19th and 32nd day of gestations (normally this is when the neural tube develops and closes) FETAL DEVELOPMENT § Neural tube which houses the brain and spinal column SPINA BIFIDA – MENINGOMYELOCELE/ MYELOMENINGOCELE − Spinal cord and meninges protrude into sac − Hydrocephalus (4 – 5 times more common than other types) − Surgery is required to close wound (does not lessen disability) ¡ 80% of myelomeningocele develop hydrocephalus ¡ Present at birth or develop within first 6 weeks ¡ Results in enlarged head, pressure on brain which can cause brain damage and/or death Hydrocephalus ¡ Problem is treated with a shunt − A tube to drain off the fluid into the abdominal cavity ¡ Shunt does not require any special care − Person should not hang upside down for extended periods as shunt may become blocked − Avoid different types of head trauma that may damage shunt/placement (i.e. heading a ball in soccer) Hydrocephalus ¡ The insertion of a shunt has two main functions… − It allows fluid to go only in one direction − The valve allows fluid to flow out only when the pressure in the head has exceeded some value SHUNT SYSTEM TO TREAT HYDROCEPHALUS SPINA BIFIDA – MENINGOCELE − Meninges protrude (outpouching of the coverings of the spinal cord but the cord and nerves remain within vertebral column.) − Paralysis is rare (surgery is required to close wound) SPINA BIFIDA – OCCULTA − Posterior arches of vertebrae fail to form − No outpouching. Does not cause paralysis or muscle weakness (associated with back problems) CONGENITAL & ACQUIRED PARALYSIS: CONSIDERATIONS FOR PHYSICAL ACTIVITY ¡ Time of onset can have two (2) different impacts on development in sport… CONGENITAL & ACQUIRED PARALYSIS: CONSIDERATIONS FOR PHYSICAL ACTIVITY Congenital = Less experience/socialization into sport Acquired = More experience/socialization into sport CONGENITAL & ACQUIRED PARALYSIS: CONSIDERATIONS FOR PHYSICAL ACTIVITY ¡ Congenital SCI - Be sure to focus on developmental activities ¡ Development of trunk, shoulder, arm and hand control and strength is important − Pushing, pulling and lifting with arms are major goals − Push and pull toys, scooter boards, parachute activities, apparatus climbing/hanging, weight lifting are high priority ¡ Posture & Orthopaedic Concerns: ¡ Paralysis causes an imbalance SPINA BIFIDA: CONSIDERATIONS FOR PHYSICAL ACTIVITY between muscle groups that further complicates the orthopaedic problems of growing children − Plantar flexion, hip dislocation, toeing inward, scoliosis, hyperlordosis, gluteus medius lurch, crouched gait ¡ Extended Sitting: − Tendency for the hip, knee and ankle flexors to become to tight. This can result in contractures − Ulcers or pressure sores − Bruises and friction burns − Obesity b/c of low energy expenditure CONSIDERATIONS FOR PHYSICAL ACTIVITY