Cours 10 : Spinal Cord Injury

Question 1

What are SCI?

Answer 1

Quadraplegia and paraplegia acquired through some kind of trauma

Question 2

What are the causes of SCI?

Answer 2

48% motor vehicles (more car accidents)

21% falls ( increase of construction workers + seniors)

14% violence

14% sport injuries : recreational & competitive sports

3% others

• Diving (pool, lake) is the #1 for spinal cord injuries *

Question 3

Can you walk after spinal cord injury?

Answer 3

It depends

Question 4

What is the incidence of SCI?

Answer 4

1100 new cases per year and 44 000 Canadians now living with the impacts of a SCI

Annual health care costs of 3.6 billion

Lifetime health care costs between 1.6 to 3 million dollars

Question 5

Why the wide range?

Answer 5

Because of age and severity

About 89% are males and most range in age between 16 and 30 years old because they tend to take more risks when they are young

Lesions can be complete or incomplete (50%-50%)

Question 6

What is the organization of the nervous system for sensory information?

Answer 6

Sensory information –> ascending pathways (dorsal tracts ) from the cutaneous info proprioceptive info (cutaneous info + proprioception = somatosensory system)

Question 7

Are sensations intact above the lesion?

Answer 7

Yes

Question 8

What is the organization of the nervous system for motor commands?

Answer 8

Descending pathways (ventral tracts)

Question 9

Can an individual with a spinal cord lesion t the lumbar level contract his arm muscles?

Answer 9

Yes, the signal from the motor cortex goes to the motor neurones from cervical. cord and since the lesion is lower, you will be able to contract the arm muscles

Question 10

How can we determine the severity of the condition?

Answer 10

It depends on the level of the lesion + whether it is complete or incomplete (injury can affect more than one vertebra)

Question 11

What is quadriplegia?

Answer 11

involvement of all 4 limbs and trunk
Cause : damage tot he cervical segments

C5-C6 : most common, why? because of car accidents, this is why airbags are important to limit the forward and back movement of the head during the crash

C7 : elbow extension : important for wheelchair users because if triceps innervation –> movement of the elbow flexion –> extension use of your triceps to use a manual chair

Question 12

What is paraplegia?

Answer 12

Involvement of the lower limbs and/or trunk (trunk is not always involved.. why? because it depends on the lesion

Cause : damage to the thoracic or lumbar spine

Complete lesions
T1 to T6 = no sitting balance
T7 to L1 = some useful sitting
L2 to lower = normal trunk of control

Question 13

What are the health concerns in Spinal cord injury people?

Answer 13

Sensation loss
- complete lesion = total loss (below lesion)
- incomplete lesion = partial loss (below lesion). ** you lose some sensations but not others (hot vs cold.. type of fibres ) + vulnerable to injury (visual inspection after playing sports to get treated if injured before going into septic shock.)

Contractures and injury prevention (spasticity)
- Shortening and tightening of muscles (flexors in upper limbs + extensors in lower limbs)
- Stretching 2x/day (Full ROM)

Question 14

What are the other health concerns in SCI

Answer 14

Lower limb atrophy

Osteoporosis

Weight management - more prone to hypo kinetic diseases

Autonomic Nervous System (ANS) Dysfunction during exercise
- decrease in heart beat, decrease in blood pressure, sweating impairment + impairment of the vasoconstrictor function = decrease in blood which gives less oxygen tot he muscles = early fatigue

Question 15

What is the autonomic nervous system?

Answer 15

Part of the nervous system that regulates involuntary function
- Sympathetic system during exercise : increase heart rate, and blood pressure in active muscles and organs (cardiac sympathetic fibres originate from T1 to T5

Ans dysfunction can be present in quadriplegics and high paraplegics *lesions at T5 and above)

Question 16

Where does the ANS signal originate from?

Answer 16

Brain stem

Question 17

What are the recommendation for exercise programming?

Answer 17

High intensity exercises may not be tolerated in persons with quadriplegia and high paraplegia because of hypotension (impaired blood distribution

Cause : sympathetic nervous system (ANS dysfunction)

Symptoms : dizziness or nausea (feeling faint

Question 18

What are the special recommendations?

Answer 18

With SCI, the cardiovascular capacity and endurance decreases and less than 50% in people are paraplegic and less than 75% of people are with quadriplegia that means :

There’s less active muscle mass during exercise for paraplegia = lower limb muscles = 2/3 of our muscle mass and quadriplegics = greater loss than paraplegics = greater loss of cardiovascular capacity

Question 19

What happens when the ANS is dysfunctionning?

Answer 19

Decrease in drive from the sympathetic nervous system : heart rate cannot be raised over 110 to 120 beats/min

Question 20

What does the cardiovascular training may include?

Answer 20

Arm Ergonometer
- Suitable for use either in the home or in center
- Workload can be adjusted (as for leg ergometers)
- Grip cuffs used for quadriplegics

Locomotor training with crutches or body weight support )overhead harness)
- Can increase muscle strength and bone mineral density
- Can prevent pressure sores (by increasing blood circulation)

Wheel chair propulsion using rollers : rollers are to wheelchair users what treadmill are to ambulatory runners

Question 21

How can we prevent upper-extremity overuse syndromes?

Answer 21

Vary exercises from week to week

Strengthen muscles of the upper back and posterior shoulder (external shoulder rotators)

Stretch muscles of anterior shoulder and chest

Question 22

How can we prevent contractures and injury?

Answer 22

Stretching exercises for lower+ upper extremities

Question 23

Clasp hands behind your back. Take a deep breath in. Exhales and roll your shoulders back as you stick out your chest and hold (20-30 sec). Unclasp hands and relax

Question 24

Take a deep breath in. Exhale and bring your shoulders back as far as you can, squeezing your shoulder blades inward

Question 25

Take a deep breath in, an extend both arms above the head. Reach down the center of the back with one arm, and exhale pressing down slightly with the opposite hand on the elbow. Repeat on the opposite side

Question 26

Place an arm bent at 90 degrees in doorway. Take a deep breath in, exhale while turning the head to the opposite side, looking over that shoulder. Repeat with other arm, looking over the opposite shoulder

Question 27

Why do many spinal cord injured people prefer a wheelchair to walking with braces and crutches?

Answer 27

Because it’s about what you want to accomplish during the day

Question 28

What are sports wheelchairs?

Answer 28

They are designed for specific sports like tennis, basketball, rugby, racing and more!

Common characteristics among sports chairs : no push handles, do not fl=old, wheel camber, and anti-tipping support (all but racing chair)

Question 29

What are the same characteristics of the basketball wheel chair and the rugby wheel chair?

Answer 29

Fixed camber bars
Rollerblade casters
Anti-tipping support
Spoked wheels + quick release
Adjustable back and footplate height

** Unique to rugby wheelchair = front bumper + wings

Question 30

What are the characteristics of a racing wheelchair?

Answer 30

Camber = rear tires usually 11-15 degrees. Higher ranger is more stable

Cage = Seating area of a racing chair, built according to body dimensions

Frame = the base of the racing chair, usually made of aluminunm

Streering = allows the athlete to maneuver the front wheel during sharp turns

Fenders = provide protection for the torso and arms from road debris and rear wheel

Hand ring = a ring mounted onto the rear wheel used for propulsion

Tires = most racing professionals prefer tubular tires that feature an integral tube and tire combined

Question 31

What are the wheel chair propulsion?

Answer 31

Shor propulsion thrusts in activities of daily living, basketball, tennis, and most sports except racing

• The athlete pushed forward and downward (from A to b) while moving the trunk forward (move it from noon to 3 o’clock)

Long-duration circular-propulsion thrust in track and marathon racing
- Athlete maintains hands in contact with the handrails through 3/4 of a circle applying force the entire time

• Flexed position of the trunk
• Shoulder extension provides the final propulsive thrust

Question 32

What is wheel chair basketball?

Answer 32

5 players/teams
Net 10 feet
3 sec in the key
Dribble, shoot or pass after 2 pushes
There is no double dribble rule
Raise buttocks off the chair = technical foul
Open to able-bodied (no major competitions)

Question 33

Wheelchair basket is mainly played by players with Spinal Cord Injury. Which condition comes second?

Answer 33

Amputation

Question 34

How can you play wheelchair basketball?

Answer 34

To be eligible to play wheelchair basketball an athlete must have permanent physical disability in the lower limbs that prevents him or her from running, jumping, and pivoting as an able-bodied player

Player classification is not based on medical diagnosis, but on observed trunk movements and stability during actual basketball competition

Question 35

What is adapted tennis?

Answer 35

Individuals (singles) or pairs (doubles)

Rules :
Ball may bounce once or twice, with the first bounce in the opponent’s court

Scoring is the same

Played by people with paraplegia and quadriplegia

Created in 1976 in the USA

More than 6000 players worldwide

Question 36

What is adapted Rugby?

Answer 36

Objective : to score points by carrying the ball the opponent’s goal line (in wheelchair)

Very fast, contact team sport

Played with volleyball (because they hit the ball with their forearm)

Rules
- Played with hands or forearms
- Must dribble or pass at least once every 10 sec
- Goal scored when player touches the goal line with 2 wheels
- There are number of violations including charging, interference, etc, that may occur