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Spinal Cord Injury

Physiotherapy Management
Edwin Firmansyah
Anatomy and Physiology Vertebral Column (Spine)

Composed of vertebral
bodies separated by
intervertebral disks
 33 vertebrae
 7 cervical, 12
thoracic, 5 lumbar, 5
fused sacral, 4 fused
Anatomy and Physiology Vertebral Column (Spine)

Intervertebral disks act as cushion/Shock absorbers between vertebrae

Motions of flexion, extension, lateral flexion, rotation occur with greatest
range in cervical region
Discreet, cylindrical mass of nerve tissue contained within the spinal column
A continuation of the medulla
Surrounded by dura mater, arachnoid, and pia mater meninges
Divided into cervical, thoracic, lumbar, sacral and coccygeal regions
Anatomy and Physiology Spinal Cord
Anatomy and Physiology Spinal Cord

Two major levels of enlargement that correspond to the attachment of

nerve groups
 Cervical enlargement
 C5 to T1
 Origin of nerves for upper extremities (Brachial plexus)
 Lumbar enlargement
 L1 to S4
 Origin of nerves for lower extremities (Lumbar plexus)
Anatomy and Physiology Spinal Cord

31 pairs of spinal nerves

Each has two roots or
 Ventral (Anterior)
 Efferent (motor) fibers
 Cell bodies located in
anterior horn of gray matter
 Conducts impulses from
the cord
 Dorsal (Posterior)
 Afferent (sensory) fibers
 Carry impulses from body
receptor to cord
Anatomy and Physiology Spinal Cord

Cord is made up of
butterfly-shaped gray
matter surrounded by
white matter
 Gray matter
 Consists of cell bodies of
neurons and their dendrites
 Divided into horns
 Anterior/ventral
 Posterior/dorsal
Anatomy and Physiology Spinal Cord

White matter
 Composed of myelinated nerve fibers
 Divided into 3 large fiber columns/bundles
 Anterior
 Lateral
 Posterior
Anatomy and Physiology Neuron

Functional unit of the nervous system

Upper motor neuron (UMN)
 Cells originate and terminate within the CNS
Lesions result in spastic paralysis
 Hyperreflexia (> response to stimuli)
 Spasticity (hypertonia)
 A little atrophy - from disuse than degeneration
Lower motor neuron (LMN)
 Cell bodies within spinal cord, axons exit spinal cord to innervate muscles
Lesions result in flaccid paralysis
 Areflexia (loss of reflex activity)
 Fasciculation's (small, localized, involuntary)
 Atrophy of involved muscles
Spinal Cord Injuries
More prevalent in males under age 40
Trauma is most common cause
 Auto accidents, sporting injuries

Risk factors
 Young males, alcohol, drugs, no helmets

Education is best prevention

Most common at C5-C7 and T12-L1
Much injury, rehab, VERY expensive
Spinal Cord Injuries
Can be mixed (UMN & LMN) lesions
Can be concussion, contusion, laceration; compression or
complete transection of cord
Then hemorrhage resulting in ischemia, swelling, hypoxia
leading to destruction of myelin and axons
Secondary injuries are thought to be somewhat reversible 4
to 6 hrs. following injury
Mechanism Of Injury
Flexion-Rotation, dislocation or fracture dislocation
 Most often cervical spine - C5 to C6
 Ruptures supporting ligaments, vessels, fractures the vertebrae
and leads to ischemia of cord
 Commonly seen in elderly with degenerative changes - young
men - auto accidents - hit windshield or steering wheel or diving
 This stretches the spinal cord and can lead to dorsal column
contusion and posterior dislocation of the vertebrae
 Complete transection can follow a hyperextension injury
Mechanism Of Injury
 Compression injuries are often caused by jumps or
falls in which the individual lands on feet or buttocks.
 Force of impact fractures the vertebrae and
compresses the cord.
 Lumbar and lower thoracic most often injured.
 50% incomplete (some spinal tracks are intact).
Level Of Injury
Location Deficits
 At or above C8 = Quadraplegic
 At or below T1 = Paraplegic
 C1 - C3 = Death from respiratory, cardiovascular
 C3 - C5 = Death from phrenic nerve involvement
resulting in respiratory paralysis
 There is loss of sensory, motor function below
neurologic level, loss of bladder/bowel, loss of
sweating and vasomotor tone
Level Of Injury
ASIA Classifications
 Complete lesion
 All motor and sensory functions lost at & below level of
 irreversible
 Incomplete lesion
 Remaining function may be mixed loss of voluntary motor or
sensory activity,
 depending on tracts spared
ASIA Impairment Scale
A  Complete no motor and sensory function is
preserved in sacral segments S4-S5
B  Incompletesensory but not motor function is
preserved below the neurological level and includes in
sacral segments S4-S5
C  Incompletemotor function is preserved below the
neurological level, and more than half of key muscle below
the neurological level have a muscle grade less than 3
D  Incomplete motor function is preserved below the
neurological level, and at least half of key muscle below the
neurological level hava muscle grade of 3 or more
E  Normal motor and sensory motor normal