This action might not be possible to undo. Are you sure you want to continue?
and motor control. This causes myelopathy or damage to nerve roots or myelinated fiber tracts that carry signals to and from the brain. Depending on its classification and severity, this type of traumatic injury could also damage the gray matter in the central part of the cord, causing segmental losses of interneurons and motorneurons. Spinal cord injury can occur from many causes, including Trauma, Tumor, Ischemia , Developmental disorders, Neurodegenerative diseases, Demyelinative diseases, Transverse myelitis, or Vascular malformations. Incidence Rate in the Philippines About 250,000 people are affected with Spinal Cord Injury each year. Spinal cord injuries can happen to anyone at any time of life. The typical patient, however, is a man between the ages of 19 and 26, injured in a motor vehicle accident (about 50% of all SCIs), a fall (20%), an act of violence (15%), or a sporting accident (14%). Alcohol or other drug abuse plays an important role in a large percentage of all spinal cord injuries. Six percent of people who receive injuries to the lower spine die within a year, and 40% of people who receive the more frequent higher injuries die within a year. Classifications of Spinal Cord Injury Traumatic spinal cord injury is classified into five categories by the American Spinal Injury Association and the International Spinal Cord Injury Classification System:
A- indicates a "complete" spinal cord injury where no motor or sensory function is preserved in the sacral segments S4-S5. B- indicates an "incomplete" spinal cord injury where sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete, i.e. ASIA C or D. C- indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3, which indicates active movement with full range of motion against gravity. D- indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more. E- indicates "normal" where motor and sensory scores are normal. Note that it is possible to have spinal cord injury and neurological deficits with completely normal motor and sensory scores.
In addition, there are several clinical syndromes associated with incomplete spinal cord injuries.
The Central cord syndrome is associated with greater loss of upper limb function compared to lower limbs. The Brown-Séquard syndrome results from injury to one side with the spinal cord, causing weakness and loss of proprioception on the side of the injury and loss of pain and thermal sensation of the other side.
inflammation and fluid accumulation in and around your spinal cord. It may also result from a gunshot or knife wound that penetrates and cuts your spinal cord. not really spinal cord injury but injury to the spinal roots below the L1 vertebra. or disk degeneration of the spine. Auto and motorcycle accidents are the leading cause of spinal cord injuries. traumatic blow to your spine that fractures. Causes of Spinal Cord Injury • Injury may be traumatic or non-traumatic: A traumatic spinal cord injury may stem from a sudden. often involving gunshot and knife wounds. Motor vehicle accidents. • • • • • • The Risk Factors of Spinal Cord Injury Although a spinal cord injury is usually the result of an unexpected accident that can happen to anyone. osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries. Cauda equina syndrome is. A non-traumatic spinal cord injury may be caused by arthritis.• • • • The Anterior cord syndrome results from injury to the anterior part of the spinal cord. Conus medullaris syndrome results from injury to the tip of the spinal cord. falls cause about one-quarter of spinal cord injuries. Tabes Dorsalis results from injury to the posterior part of the spinal cord. Athletic activities. cause about 8 percent of spinal cord injuries. Diseases. according to the National Institute of Neurological Disorders and Stroke. Spinal cord injury after age 65 is most often caused by a fall. inflammation or infections. including: . causing loss of touch and proprioceptive sensation. Overall. crushes or compresses one or more of your vertebrae. Sports and recreation injuries. causing weakness and loss of pain and thermal sensations below the injury site but preservation of proprioception that is usually carried in the posterior part of the spinal cord. Alcohol use is a factor in about 1 out of every 4 spinal cord injuries. certain factors may predispose you to a higher risk of sustaining a spinal cord injuring. Cancer. such as impact sports and diving in shallow water. Additional damage usually occurs over days or weeks because of bleeding. located at L1 vertebra. As many as 15 percent of spinal cord injuries result from violent encounters. Alcohol. usually from infection diseases such as syphilis. Acts of violence. accounting for more than 40 percent of new spinal cord injuries each year. arthritis. swelling. cancer. strictly speaking. Falls. dislocates.
with localized edema. While being active is one of the best things you can do for your overall health. it is first necessary to review the pathophysiology of spinal cord injury. the immediate acute injury processes do not offer a clinically useful target for therapeutic intervention unless the Emergency Medical . Being active in certain sports. Within these four injury types. There are three phases of SCI response that occur after injury: the acute. You're most likely to suffer a spinal cord injury if you're between the ages 16 and 30. such as arthritis or osteoporosis. The most commonly used animal model in SCI research is patterned after the contusion injury. In the first two injuries. Upon initial impact or injury. while falls cause most injuries in older adults. rollerskating. is instantaneous.• • • • Being a man. and loss of vasculature autoregulation. women account for only about 20 percent of spinal cord injuries. In the acute phase. and 4) solid cord injury. In fact. It is important to note that the clinical presentation of SCI is most often characterized as an anatomically incomplete lesion. loss of microcirculation by thrombosis. ice hockey. PATHOPHYSIOLOGY OF SPINAL CORD INJURY To understand the rationale of the recent advances. degree of completeness must be considered. Hemorrhage occurs. Because in the best circumstances the time to admission after spinal cord injury is about three hours. it may place you at greater risk of a spinal cord injury. 1). which lasts for about 24 hours and represents a generalized failureof circuitry in the spinal neural network. the surface of the cord is lacerated and a prominent connective tissue response is invoked. Thus necrosis. surfing. irrespective of initial neurological presentation. compression of the spinal cord occurs as a result of vertebral displacement followed by edema and later by fibrotic responses. principally involving the monovalent and divalent cations Na+ (intracellular concentrations increase). contributing further to the neural injury. secondary. 3) contusion injury. Motor vehicle crashes are the leading cause of spinal cord injuries for people under 65. in which there is no central focus of necrosis as in contusion injury. which leads to a central hematomyelia that may evolve to syringomyelia. there is immediate mechanical damage to neural and other soft tissue. 2) cord lacerations (gun shot or knife wounds). After the insult. diving. Athletic activities that may increase your risk of a spinal cord injury include football. in-line skating. Being between the ages of 16 to 30. that contribute to a failure in normal neural function and spinal shock. resulting in a ring of preserved white matter at the contusion site (Fig. Accompanying this are significant electrolytic shifts. wrestling. or cell death. as incomplete lesions will benefit more dramatically from experimental interventions than complete lesions in terms of degree of recovery that can be obtained. results from these mechanical and ischemic insults. which encompasses the moment of injury and extends for the first few days. downhill skiing and snowboarding. the injured nerve cells respond with an injury-induced barrage of action potentials. including endothelial cells of the vasculature. gymnastics. There are four general types of spinal cord injury: 1) cord maceration. Furthermore. vasospasm and mechanical damage. in which the morphology of the cord is severely distorted. the contusion injury represents from 25 to 40% of the cases and is a progressive injury that enlarges over time. horseback riding. a variety of parallel pathophysiological processes begins. K+ (extracellular concentrations increase). all of which further exacerbate the neural injury. over the next few minutes. and chronic injury processes. and 2+ Ca (intracellular concentrations increase to toxic levels). in a contusion injury. appears to be more predominant in the grey matter of the spinal cord than in the white matter. and. A relatively minor injury can cause a spinal cord injury if you have another disorder that affects your bones or joints. Of these four injury types. Having an underlying bone or joint disorder. whereas in the latter two the spinal cord surface is not breached and the connective tissue component is minimal. Spinal cord injuries affect a disproportionate amount of men. rugby.
extracellular concentrations of glutamate and other excitatory amino acids reach cytotoxic concentrations that are six. In addition. your injury is called complete. Finally. inhibitory factors and/or barriers to regeneration are expressed in the perilesion site. are strategically better for therapeutic targets. This paralysis affects all or part of the trunk. and edema continue from the acute phase. followed by lymphocytes (which secrete a variety of cytokines and growth factors) that invade and reach peak numbers within 48 hours. Paraplegia. a variety of receptors and ion channels are altered in expression levels and activation states. and in many cell types. neural circuits are altered due to changes in inhibitory and excitatory input. lipid peroxidation and free-radical production also occur as a result of glutamate receptor-activated and subsequently mediated pathways. Additionally. legs and pelvic organs.to eightfold higher than normal as a result of cell lysis from mechanical injury and both synaptic and nonsynaptic transport. The invading inflammatory cells increase the local concentrations of cytokines (cyto = ‘cell’. such as taking aspirin once a day to prevent cardiac death after an episode of cardiac ischemia as recommended by the American Heart Association. in the chronic phase. a cyst forms in a subset of all SCI patients (20%). programmable cell death different from necrosis—occurs and involves reactive gliosis that includes increased expression of glial fibrillary acidic protein (GFAP) and astrocytic proliferation. This means your arms. legs and pelvic organs are all affected by your spinal cord injury. The lesion grows in size from the initial core of cell death with cells at risk of dying in the perilesioned region. your injury is called incomplete. Within the first 15 minutes after injury. apoptosis continues in both orthograde and retrograde directions including brain regions. paralysis from a spinal cord injury may be referred to as: • • Tetraplegia or quadriplegia. to a larger region of cell death. which results in chronic pain syndromes in a majority of SCI patients. Clinical Manifestations: Your ability to control your limbs after spinal cord injury depends on two factors: the neurological level of the injury and the completeness of injury. permanent hyperexcitability develops. Apoptosis—asecondary. In addition. The completeness of the injury is classified as either: • • Complete. and/or the population adopts a preventative stance. which occurs over a time course of days to years.Neutrophils (which secrete myeloperoxidase) invade the spinal parenchyma from the circulatory system within 24 hours. The lowest normally functioning segment of your spinal cord is referred to as the neurological level of your injury.Service can adapt an easy-to-administer intervention. and continues to enlarge in a condition called syringomyelia. If you have some motor or sensory function below the affected area. Spinal cord injuries of any kind may result in one or more of the following signs and symptoms: • Loss of movement . demyelination results in conduction deficits. because these occur within minutes to weeks after injury. If all sensory (feeling) and motor function (ability to control movement) is lost below the neurological level. cut and nearby uncut axons exhibit regenerative and sprouting responses but go no farther than 1 mm. electrolytic shifts. scarring and tethering of the cord occurs in the penetrating injuries (about 25% of all SCI). the ischemic cellular death. trunk. Incomplete. In the secondary phase (which occurs over the time course of minutes to weeks). the secondary and chronic injury processes. In contrast. kine = ‘small protein’) and chemokines (chemotactic cytokine).
this is not a cure for a spinal cord injury. spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life. prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury. sexual sensitivity and fertility Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord Difficulty breathing. coughing or clearing secretions from your lungs Emergency Signs and Symptoms Emergency signs and symptoms of spinal cord injury after an accident may include: • • • • • • • Extreme back pain or pressure in your neck. tingling or loss of sensation in your hands. If methylprednisolone is given within eight hours of injury. However. incoordination or paralysis in any part of your body Numbness. including innovative treatments. therapists and social workers with expertise in spinal cord injury. Early (acute) stages of treatment: In the emergency room.In the meantime. such as stool or urine retention. some people experience mild improvement from their spinal cord injury. nurses. Emergency Actions Urgent medical attention is critical to minimizing the effects of any head or neck trauma. fingers.• • • • • • Loss of sensation. there's no way to reverse damage to the spinal cord. including the ability to feel heat. which they'll use to transport you to the hospital. You may even be transferred to a regional spine injury center that has a team of neurosurgeons. So treatment for a spinal cord injury often begins at the scene of the accident. head or back Weakness. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. researchers are continually working on new treatments. spinal cord medicine specialists. feet or toes Loss of bladder or bowel control Difficulty with balance and walking Impaired breathing after injury An oddly positioned or twisted neck or back Medical Management Unfortunately. and formation of deep vein blood clots in the extremities You may be sedated so that you don't move and sustain more damage while undergoing diagnostic tests for spinal cord injury. doctors focus on: • • • • Maintaining your ability to breathe Preventing shock Immobilizing your neck to prevent further spinal cord damage Avoiding possible complications. • Medications. orthopedic surgeons. cold and touch Loss of bowel or bladder control Exaggerated reflex activities or spasms Changes in sexual function. psychologists. . If you do have a spinal cord injury. Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board. A. respiratory or cardiovascular difficulty. Methylprednisolone (Medrol) is a treatment option for an acute spinal cord injury. you'll usually be admitted to the intensive care unit for treatment. B. But.
attached to weights or a body harness. For someone that has limited hand function. . C. herniated disks or fractured vertebrae that appear to be compressing the spine. Some devices may also restore function. pressure ulcers. You'll be educated on the effects of a spinal cord injury and how to prevent complications. dietitian. and will use equipment and technology that can help you live on your own as much as possible. computers can be very powerful tools. Sometimes. to your skull to keep your head from moving. a rigid neck collar also may work. After the initial injury or disease stabilizes. respiratory infections and blood clots. recreation therapist and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries. bowel control and sexual functioning. You'll be taught many new skills. Computer adaptations. lighter weight wheelchairs are making people with a spinal cord injury more mobile and more comfortable. control inflammation and promote nerve regeneration. bowel and bladder issues. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. you may transfer to a rehabilitation facility. D. muscle contractures. These include medications to control pain and muscle spasticity. travel over rough terrain and elevate a seated passenger to eye level to reach high places without help. Your team may include a physical therapist. therapists usually emphasize maintenance and strengthening of existing muscle function. traction is accomplished by securing metal braces. an electric wheelchair may be needed.• • • Immobilization. but they're difficult to operate. Some examples of computer adaptations range from simple to complex. Ongoing care The length of your hospitalization depends on your individual condition and what medical issues you're facing. occupational therapist. redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks. Rehabilitation team members may begin to work with you while you're in the early stages of recovery. Ask your doctor about the availability of such treatments. and return to school or the workplace. Surgery may also be needed to stabilize the spine to prevent future pain or deformity. A special bed also may help immobilize your body. Scientists are trying to figure out ways to stop cell death. Medications. rehabilitation nurse. Experimental treatments. In some cases. You may need traction to stabilize your spine. Surgery. as well as be given advice on rebuilding your life and increasing your quality of life. Medications may be used to manage some of the effects of spinal cord injury. You'll be encouraged to resume your favorite hobbies. Rehabilitation. doctors turn their attention to preventing secondary problems that may arise. New technologies. surgery is necessary to remove fragments of bones. Often. social worker. During the initial stages of rehabilitation. foreign objects. Once you're well enough to participate in therapies and treatment. as well as medications that can improve bladder control. Some wheelchairs can even climb stairs. participate in social and fitness activities. For some. such as key guards or voice recognition. Improved. to bring the spine into proper alignment or both. rehabilitation psychologist. such as deconditioning. These include: • • Modern wheelchairs.
duskiness Reposition /turn periodically. Perform/assist with full ROM exercises on all extremities and joints using slow. Instruct in and encourage deep breathing focusing attention on steps of breathing Auscultate breath sounds. smooth movements Assist with/ encourage pulmonary hygiene(deep breathing. typically starts between a week and six months after an injury. Electrical stimulation devices. Observe for pressure areas and provide meticulous skin care Reposition periodically even when sitting in chair. and use airway adjuncts as indicated. Essentially any device that uses electricity can be controlled with an electronic aid to daily living (EADL). warm/cold packs) Encourage use of relaxation techniques(guided imagery. Nursing Care Plans 1. 2. However. and they use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand. Acute pain r/t nerve root compression secondary to spinal injury Interventions • • • • • Provide comfort measures(position changes. radio) Administer medication as indicated Maintain patient airway: keep head in neutral position. reach and grip. These sophisticated devices use electrical stimulation to produce actions. if it occurs. The Prognosis and Recovery It's often impossible for your doctor to make a precise prognosis right away. halo. Devices can be turned on or off by switch or voice-controlled and computer-based remotes. coughing. Impaired physical mobility r/t muscle weakness and paralysis Interventions • • • • • Inspect skin daily. hard/soft cervical collars. deep breathing exercises) Provide diversional activities(television. walk.g. elevate head of bed slighty if tolerated. e.• • Electronic aids to daily living. Avoid / limit prone position when indicated . brace 3. traction. Risk for ineffective breathing pattern r/t the inadequate respiratory function due to paralysis of the intercostal muscles or diaphragm Interventions • • • • • Maintain patent airway: keep head in neutral position.. sandbags. ROM exercises. They're often called functional electrical stimulation (FES) systems. suctioning) Maintain bed rest and immobilization device(s). some people experience small improvements for up to one year or longer. use airway adjuncts as indicated Assist patient in taking control of respirations as indicated. elevate head of bed slightly if tolerated. Recovery. Note areas of absent or decreased breath sounds or development of adventitious sound Observe skin color for developing cyanosis.
Provide catheter care as necessary Palpate for bladder distention and observe for overflow Observe for cloudy or bloody urine. contraction of abdominal muscles) . Impaired urinary elimination r/t decreased or absent tone of urinary sphincter Interventions • • • • • Assess voiding pattern (frequency and amount). hot/cold). Compare urine output with fluid intake Cleanse perineal area and keep it dry. integration Interventions • • • • Protect from bodily harm(falls.progressing from area of deficit to neurologically intact area Provide uninterrupted sleep and rest periods 5.4. pinprick. Disturbed sensory perception r/t destruction of the sensory tract with altered sensory reception. (fluids between certain hours. burns. transmission. foul odor Begin bladder retraining per protocol when appropriate. digital stimulation of trigger area. positioning) Assist patient to recognize and compensate for alterations in sensations Assess/document sensory dysfunction or deficit (by means of touch.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.