What spinal paralysis?
- broad term for conditions caused by injury or disease to the spinal cord and/or spinal nerves
- paralysis can be complete (total) or incomplete (partial)
What are the two criteria assessed that determines the severity of the condition?
- level of lesion
- is it complete or incomplete
What is quadriplegia?
- involvement of all four limbs and the trunk
- 50% of persons with quadriplegia have incomplete lesions
Spinal paralysis involves what systems?
- central and autonomic nervous systems
What parts of the body are controlled by the cervical spine?
- arms, hands, breathing
What parts of the body are controlled by the thoracic?
- balance, trunk control, forceful breathing
What parts of the body are controlled by the lumbar?
- leg and foot movements
What parts of the body are controlled by the sacral?
- bowel, bladder, sexual function
What is high level quadriplegia?
- complete C1 to C4 lesions
- use motorized chairs for mobility
- powerchair sports
What is low level quadriplegia?
- complete C5 to C8 lesions
- use manual chairs and participate in many wheelchair sports
- wheelchair rugby
What is paraplegia?
- effects the legs but often includes trunk balance as well
Why is trunk balance so important in sport?
- trunk balance is the most useful criterion in determining the level of participation
What is spina bifida?
- congenital defect of spinal column caused by
failure of neural arch of a vertebra to properly develop and enclose spinal cord
Which demographics are most effected by spina bifida?
- girls
- caucasians
- most common in GB and Ireland
When does spina bifida occur?
- occurs between the 19th and 32nd day of gestations (normally this is when the neural tube develops and closes)
What is spina bifida Meningomyelocele/ Myelomeningcele?
- spinal cord and meninges protrude into sac
- surgery is required to close wound but it does not lessen disability
What is hydrocephalus?
- 80% of myelomeningocele develop hydrocephalus
- present at birth or develop within first 6 weeks
- results in enlarged head, pressure on brain which
can cause brain damage and/or death
How is hydrocephalus treated?
- problem is treated with a shunt (a tube to drain off the fluid into the abdominal cavity)
- person should not hang upside down for extended periods as shunt may become blocked
- avoid different types of head trauma that may damage shunt/placement
What are the two main functions of a shunt insertion for hydrocephalus?
- it allows fluid to go only in
one direction - the valve allows fluid to flow out only when the pressure in the head has exceeded some value
What is spina bifida meningocele?
- meninges protrude (outpouching of the coverings of the spinal cord but the cord and nerves remain within vertebral column)
- paralysis is rare
What is spina bifida occult?
- Posterior arches of vertebrae fail to form
- no outpouching
- does not cause paralysis or muscle weakness
- associated with back problems
What is the different between congenital and acquired paralysis?
- congenital: less experience and socialization into sport
- acquired: more experience and socialization into sport
What are some things to focus on for congenital SCI?
- focus on developmental activities
- development of upper body and core strength are essential
- push and pull toys, scooter boards, parachute activities, climbing/hanging, weight lifting are high priority
What are some general considerations for physical activity with spina bifida?
- latex sensitivity
- cognitive functioning: perceptual-motor deficits, specific learning disabilities, and attention deficits
- Strabismus (cross eyes)
- posture and orthopaedic concerns
- atrophy of limbs
What are some risks associated with posture and orthopaedic concerns?
- paralysis can cause plantar flexion, hip dislocation, toeing inward, scoliosis, hyperlordosis, gluteus medius lurch, crouched gait
For those in wheel chairs, what are some risk factors of extended sitting?
- tendency for the hip, knee and ankle flexors to become too tight. This can result in contractures
- ulcers or pressure sores
- bruises and friction burns
- obesity because of low energy expenditure
What are some risk factors associated with the possibility of sensation and skin break down?
- inability to feel sensation makes persons vulnerable to injury and skin breakdown
- Ex. wrinkles in socks and poorly fitted shoes or braces
cause blisters that become infected
- persons with spinal paralysis should be taught to inspect their body regularly to see that all sores are cared for
What are some issues with temperature control that people with spinal cord injuries might face?
- spinal paralysis above T8 renders the body incapable of adapting to temperature changes
- body assumes the same temperature as the environment
- special attention needs to be given to appropriate clothing, heating and air conditioning
- fluid intake is related to temp control
How can a person experiencing a spinal cord injury avoid contractors?
- range of motion exercises
What are some concerns regarding spams in people who are experiencing spinal cord injuries?
- paralyzed muscles in people with lesions above L1 often jerk involuntary
- occasional spams can actually help with circulation
- when spasms are too severe several treatment options are available (physical therapy, drug therapy, nerve blocks and surgery)
Why is it important to consider things like using the bathroom in regards to people with a spinal cord injury?
- Catheterization, timing of bathroom breaks
- all persons with spinal paralysis above S2 have some kind of bladder dysfunction, requiring that they urinate in different ways
- retention of urine leads to urinary and kidney infections which is a major cause of illness and death among persons with spinal paralysis
- defecation is managed by scheduling time and amount of eating as well as by
regulating time of bowel movements
- surgical procedures create an opening in the abdomen and a tube is inserted that connects to the intestine and an external bag
Why is sexual function a concern for those who experience spina bifida?
- innervated by the same nerves as urinary
function (S2 to S4) - lesions above the sacral region may make it
necessary to alter roles, methods, and positioning for sex depending on weather the lesions are complete or incomplete - capacity for erection, ejaculation and orgasm must be evaluated individually
- menstruation is not affected
Why is the heart and circulation function an important consideration for someone with spina bifida?
- low resting heart rates
- maximum heart rates and target zones used in aerobic exercise programs for AB persons are not appropriate in high level spinal paralysis
- pooling of blood in the veins of paralyzed
limbs
Why is blood pressure a concern for someone with a spinal cord injury?
- baseline blood pressure with lesions above T6 is
typically low - autonomic dysreflexia: sudden onset of excessively high blood pressure, slowed heartbeat, sweating, & sever headache
