spinal cord injury2

7/30/2019 Spinal Cord Injury2

1/34

Looks familiar?


2/34


3/34

GERALDINE ROMULO


4/34

A spinal cord injury (SCI) is an insult to the spinal cord

resulting in a change, either temporary or permanent, in its

normal motor, sensory, or autonomic function. Patients with

spinal cord injury usually have permanent and often

devastating neurologic deficits and disability.

A devastating and common neurologic disorder that has profound influences on modern society

from physical, psychosocial, and socio- economic perspectives.

WHAT IS A SPINAL CORD INJURY (SCI) ?

According to the National Institutes of Health (NIH), among neurological disorders, the cost to

society of automotive SCI is exceeded only by the cost of mental retardation.

SCI are described at various levels of incomplete, which

can vary from having no effect on the patient to a completeinjury which means total loss of function.
http://en.wikipedia.org/wiki/Nerve_roots


5/34

Spinal cord injury may be divided into both primary and secondary mechanisms of injury:

1) The primary injury, in large part, determines a given patients neurologic grade on

admission and thereby is the strongest prognostic indicator.

2) Secondary mechanisms of injury can exacerbate damage and limit restorative processes,and hence, contribute to overall morbidity and mortality.

Spinal cord injuries occur most frequently in July

and least commonly in February. The most

common day on which these injuries occur is

Saturday. Spinal cord injuries also occur more

frequently during daylight hours, which may bedue to the increased frequency of motor vehicle

accidents and of diving and other recreational

sporting accidents during the day.

After a suspected SCI, the goals are to establish the diagnosis and initiate treatment to prevent

further neurologic injury from either mechanical instability secondary to injury from the deleterious

effects of cardiovascular instability or respiratory insufficiency.


6/34

MECHANISMS:

Direct trauma

Compression by bone fragments / hematoma / disc materialIschemia from damage / impingement on the spinal arteries


7/34

RISK FACTORS:

Young healthy individuals, ages 16-35 y / o

Risky physical activities

People with medical

problems


8/34

Motor vehicle accidents - 56%

CAUSES:

Accidental falls - 14%


9/34

Firearm injuries - 9%


10/34


11/34

Diving in shallow water


12/34

High Risk activities


13/34

Activities without proper protection


14/34

Children sitting in front of the

car/ not wearing seatbelt-67.7%

Alcohol and drug on SCI pediatric

Cases- 30%


15/34

ANATOMY OF NERVOUS SYSTEM


16/34

ANATOMY & PHYSIOLOGYOF THE SPINAL CORD

The spinal cord is about 18 inches longand extends from the base of the brain,

down the middle of the back, to about the

waist.

31 pairs of spinal nerves

8 Cervical

12 Thoracic

5 Lumbar

5 Sacral1 Coccygeal


17/34

Upper motor neurons (UMNs) lie withinthe spinal cord which carries messages

back and forth from the brain to the spinalnerves along the spinal tract.

Lower motor neurons (LMNs) branchout from the spinal cord to the other

parts of the body. Sensory portions of theLMN carry messages about sensation

from the skin and other body parts and

organs to the brain.

The motor portions of the LMNsend messages from the brain to

the various body parts to initiate

actions such as muscle movement.


18/34

GREY MATTERcontains cell bodies (dendrites

and terminals, Spinal reflex

integrating centers)Sensory and Motor Nerve cells

WHITE MATTERconsists of :A.) Myelinated axons that

occur in bundles called tracts

Ascending tracts-sensoryDescending tracts-motor

B.) Dorsal rootsC.) Ventral rootsD.) Ventral roots

CENTRAL CANAL

contains CSF


19/34

Stimuli

I

Nerve impulse from sensory receptor

I

Inter neurons in the spinal cord

I

Nerve impulse from motor neurons

I

Skeletal muscle contraction

I

Response to stimuli


20/34

PATHOPHYSIOLOGY:


21/34

DERMATOMES

Area of skin innervated by sensoryaxon within a particular segmental

nerve root.

Essential in determining level of injury

and assessing the improvement

or deterioration

MYOTOMES Segmental nerve root innervating a

muscle

Important in determining level of injury


22/34

Normal

Post SCI


23/34

Areas affected post in SCI:

QUADRILEGIA/ TETRAPLEGIA-injury in cervical region

-4 extremities involvement

PARAPLEGIA-Injury in the thoracic, lumbar,

and sacral segments

-2 extremities involvement


24/34

TYPES OF SPINAL CORD INJURY:

COMPLETE:--Loss of voluntary movement of parts innervated by segments/ innervation

--Loss of sensation / Spinal shock

Ex. Central Cord Syndrome, Anterior Cord Syndrome, Posterior Cord Syndrome,

Cauda Equina Syndrome

INCOMPLETE:--Some function is present below the site of injury

--Favorable prognosis

--Pattern of injury varies

S/Sx: Loss of power, decrease pain below lesion


25/34

CLASSIFICATION OF SCI:(according to American Spinal Injury Association)

A COMPLETE-no sensory/ motor fxn preserved in sacral

segment S4-S5

B INCOMPLETE-sensory but no mo-tor fxn in sacral segment

C INCOMPLETE-motor fxn preserved below and powergraded


26/34


27/34

Loss of normal bowel and bladder control (may include constipation, incontinence,

bladder spasms)


28/34

Numbness


29/34

Sensory changes


30/34

Weakness, paralysis


31/34

Pain


32/34

Abnormal sweating,altered temperature and BP(chest injury)


33/34

Difficulty in breathing( neck injury)


34/34

spinal cord injury2

Documents