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Looks familiar?
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GERALDINE ROMULO
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A spinal cord injury (SCI) is an insult to the spinal cord
resulting in a change, either temporary or permanent, in its
normal motor, sensory, or autonomic function. Patients with
spinal cord injury usually have permanent and often
devastating neurologic deficits and disability.
A devastating and common neurologic disorder that has profound influences on modern society
from physical, psychosocial, and socio- economic perspectives.
WHAT IS A SPINAL CORD INJURY (SCI) ?
According to the National Institutes of Health (NIH), among neurological disorders, the cost to
society of automotive SCI is exceeded only by the cost of mental retardation.
SCI are described at various levels of incomplete, which
can vary from having no effect on the patient to a completeinjury which means total loss of function.
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Spinal cord injury may be divided into both primary and secondary mechanisms of injury:
1) The primary injury, in large part, determines a given patients neurologic grade on
admission and thereby is the strongest prognostic indicator.
2) Secondary mechanisms of injury can exacerbate damage and limit restorative processes,and hence, contribute to overall morbidity and mortality.
Spinal cord injuries occur most frequently in July
and least commonly in February. The most
common day on which these injuries occur is
Saturday. Spinal cord injuries also occur more
frequently during daylight hours, which may bedue to the increased frequency of motor vehicle
accidents and of diving and other recreational
sporting accidents during the day.
After a suspected SCI, the goals are to establish the diagnosis and initiate treatment to prevent
further neurologic injury from either mechanical instability secondary to injury from the deleterious
effects of cardiovascular instability or respiratory insufficiency.
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MECHANISMS:
Direct trauma
Compression by bone fragments / hematoma / disc materialIschemia from damage / impingement on the spinal arteries
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RISK FACTORS:
Young healthy individuals, ages 16-35 y / o
Risky physical activities
People with medical
problems
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Motor vehicle accidents - 56%
CAUSES:
Accidental falls - 14%
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Firearm injuries - 9%
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Diving in shallow water
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High Risk activities
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Activities without proper protection
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Children sitting in front of the
car/ not wearing seatbelt-67.7%
Alcohol and drug on SCI pediatric
Cases- 30%
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ANATOMY OF NERVOUS SYSTEM
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ANATOMY & PHYSIOLOGYOF THE SPINAL CORD
The spinal cord is about 18 inches longand extends from the base of the brain,
down the middle of the back, to about the
waist.
31 pairs of spinal nerves
8 Cervical
12 Thoracic
5 Lumbar
5 Sacral1 Coccygeal
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Upper motor neurons (UMNs) lie withinthe spinal cord which carries messages
back and forth from the brain to the spinalnerves along the spinal tract.
Lower motor neurons (LMNs) branchout from the spinal cord to the other
parts of the body. Sensory portions of theLMN carry messages about sensation
from the skin and other body parts and
organs to the brain.
The motor portions of the LMNsend messages from the brain to
the various body parts to initiate
actions such as muscle movement.
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GREY MATTERcontains cell bodies (dendrites
and terminals, Spinal reflex
integrating centers)Sensory and Motor Nerve cells
WHITE MATTERconsists of :A.) Myelinated axons that
occur in bundles called tracts
Ascending tracts-sensoryDescending tracts-motor
B.) Dorsal rootsC.) Ventral rootsD.) Ventral roots
CENTRAL CANAL
contains CSF
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Stimuli
I
Nerve impulse from sensory receptor
I
Inter neurons in the spinal cord
I
Nerve impulse from motor neurons
I
Skeletal muscle contraction
I
Response to stimuli
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PATHOPHYSIOLOGY:
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DERMATOMES
Area of skin innervated by sensoryaxon within a particular segmental
nerve root.
Essential in determining level of injury
and assessing the improvement
or deterioration
MYOTOMES Segmental nerve root innervating a
muscle
Important in determining level of injury
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Normal
Post SCI
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Areas affected post in SCI:
QUADRILEGIA/ TETRAPLEGIA-injury in cervical region
-4 extremities involvement
PARAPLEGIA-Injury in the thoracic, lumbar,
and sacral segments
-2 extremities involvement
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TYPES OF SPINAL CORD INJURY:
COMPLETE:--Loss of voluntary movement of parts innervated by segments/ innervation
--Loss of sensation / Spinal shock
Ex. Central Cord Syndrome, Anterior Cord Syndrome, Posterior Cord Syndrome,
Cauda Equina Syndrome
INCOMPLETE:--Some function is present below the site of injury
--Favorable prognosis
--Pattern of injury varies
S/Sx: Loss of power, decrease pain below lesion
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CLASSIFICATION OF SCI:(according to American Spinal Injury Association)
A COMPLETE-no sensory/ motor fxn preserved in sacral
segment S4-S5
B INCOMPLETE-sensory but no mo-tor fxn in sacral segment
C INCOMPLETE-motor fxn preserved below and powergraded
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Loss of normal bowel and bladder control (may include constipation, incontinence,
bladder spasms)
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Numbness
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Sensory changes
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Weakness, paralysis
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Pain
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Abnormal sweating,altered temperature and BP(chest injury)
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Difficulty in breathing( neck injury)
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