Neuromuscular condition 2: Spinal Cord Injury Flashcards by Deleted Deleted

What is spinal cord injury

A complete or incomplete loss of somatic, sensory and autonomic functions below the lesion level

How well did you know this?

Not at all

Perfectly

Lesions in the cervical region typically result in

Tetraplegia

How well did you know this?

Not at all

Perfectly

Lesions in the thoracic, lumbar and sacral regions lead to

Paraplegia

How well did you know this?

Not at all

Perfectly

C4 in the spine is

Artificial support for breathing

How well did you know this?

Not at all

Perfectly

C5 - C8 in the spine is

Control of shoulder, elbow and wrist

Decreased hand function

How well did you know this?

Not at all

Perfectly

T1 - T6 in the spine is

Autonomic dysreflexia

Poor thermoregulation

Orthostatic hypotension

Diminished breathing capacity

How well did you know this?

Not at all

Perfectly

What is Autonomic dysreflexia

An uncoordinated spinally mediated reflex response called the mass reflex

How well did you know this?

Not at all

Perfectly

T6 - L2 in the spine is

Respiratory and motor control depends on abdominal muscles

How well did you know this?

Not at all

Perfectly

L2 - S2 in the spine is

Lack of voluntary control

Normal upper extremities

How well did you know this?

Not at all

Perfectly

Approx how many spinal cord injury possess tetraplegia

How many in men

50%

80% are men

How well did you know this?

Not at all

Perfectly

Spinal cord injury of traumatic origin usually occurs at

Early age

How well did you know this?

Not at all

Perfectly

Individuals with spinal cord injury have ______ for developing secondary complications

High risk

How well did you know this?

Not at all

Perfectly

What causes spinal cord injury

Accidents

Infection

Tumor

How well did you know this?

Not at all

Perfectly

What injuries are result of spinal cord injury

Paraplegia

Tetraplegia

Segmental neuromuscular

Autonomic

physiologic impairment

Spinal bifida

How well did you know this?

Not at all

Perfectly

Primary injury refers to

Acute spinal cord injury

Such as:
Contusion
Shear
Compression
Laceration
Stretch

How well did you know this?

Not at all

Perfectly

Secondary injury refers to

Systemic injury to neurons and cells nearby

Cellular injury 1

Cellular injury 2

How well did you know this?

Not at all

Perfectly

Systemic injury to neurons and cells nearby involves

Hypotension

Hypoxia

How well did you know this?

Not at all

Perfectly

Cellular injury 1 involves

Reperfusion of ischemic area

Leads to free radicals

Excitotoxicity

Neuronal malfunction

Death

Cellular injury 2 involves

Neutrophils

Macrophages

Pro inflammatory cytokines

Glial scars

What are the barrier to regeneration and recovery

Cell necrosis

Cell apoptosis

Myelin loss

Oligodendrocyte

Glial scar

Cyst formation

Myelin matrix inhibition

Primary injury acutely leads to

Which then leads to

Also causes

Neuronal damage/disruption

Spinal cord, axon, demyelination and cell death

Also:
Cytokine release
Hemorrhage

Primary injury processed leads to

Inhibitory proteoglycan scar

Limited schwann cell remyelination

Restricted axonal regrowth

What is the cycle of deconditioning

Spinal cord injury

Muscle paralysis

Less physical activity

Lower fitness

Change in body - more fat and less muscle

High risk factors/chronic disease

Causes more of cycle to occurs

Management and medication for spinal cord injury is

Complex due to associated complications

List is on slide 12

What is the exercise response to spinal cord injury

Limited mobility Restricted peak values (around half) Orthostatic and exercise hypotensive Peak heart rate typically do not exceed 120 bpm

What is the exercise testing for spinal cord injury INITIALLY

Function assessment Such as trunk ROM, wheelchar mobility Allows to facilitate choice of exercise equipment etc

What should we consider when doing exercise testing for spinal cord injury

The purpose of the exercise test The level of spinal cord injury The physical fitness level To optimise equipment and protocol selection

What cardioresipiratory exercise test can be done for spinal cord injury

Arm ergometer Cycle ergometer Wheelchair ergometer Rowing

Arm ergometry is

The easiest way to perform The reference method May not be accurate

Stationary wheelchair roller system allows for

Realistic simulation of external condition

What is vital to do after exercise testing in patients with tetraplegia

``` To treat for post exercise hypotension and exhaustion with: Rest, Recumbency, Leg elevation Fluid ingestion ```

What should spinal cord injury patients exercise prescription consist of

Wheelchair mobility: Develop joint contracture Muscle spasticity and position in wheelchair Excessive wheelchair pushing and manual transfers Upper extremity stretching and strengthening program needed to promote muscular balance around joints Prevent upper extremity overuse

Why do spinal cord patients who are prescribed exercise need to have upper extremity stretching and strengthening

To promote muscular balance around joints

What are the special considerations (conditions) for patients with spinal cord injury

Depression Cognitive impairment and learning diability Osteopenia Osteoporosis Bradycardia Monitor blood pressure - due to hypotension

Spinal cord injury patients should do what before exercising Why

Empty bowels and bladder Due to autonomic dysreflexia can be triggered by a full bladder or bowel distension

Decreased cardiovascular performance be found in in individuals with Why is this

Complete spinal cord injury above T6 Have tetraplegia They have no cardiac sympathetic innervation with HRpeak limited to 115 - 130 bpm

Individuals with high spinal lesions may reach their ______, ________, and _______ at ________ than those with paraplegia with lesion levels below T5 to T6

Peak HR CO VO2 At lower exercise levels

During exercise what does autonomic dysreflexia result in

Increased release of catecholamines Increases HR, VO2, BP and exercise capacity Excessive BP elevation 250-300 mmHG SBP

If there has been an increase release of caecholamines from autonmoic dysreflexia, what is immediate emergency response

Stop exercise Sit upright to decrease BP Identify and remove the irritating stimulus

If serious symptoms persist what is required

Medical attention

In competition, athletes with a resting SBP of greater or equal to 180 mm HG should

Not be allowed to compete

Individuals who have higher spinal cord levels such as tetraplegia may benefit from

use of lower body positive pressure Such as: Compressive stockings Electrical stimulation to leg muscles

What is the bottom line for spinal cord injury patients

Proper exercise and physical activity reduce the prevalence of secondary complications Level of spinal cord lesion must be considered Individuals with spinal cord injury have compromised thermoregulatory responses to exercise - problem with endurance exercise