Spinal Cord Injuries Nicole Curreri Erin Marts Alisa

Spinal Cord Injuries Nicole Curreri, Erin Marts, Alisa Kastern, Domenick Clement HCSV 320

Spinal Cord Injuries ● ● Definition : A spinal cord injury (SCI) is Nicole causes damage to the spinal cord that changes in its function, either temporary or permanent. Can lead to: ○ loss of muscle function, sensation, or autonomic function in parts of the body served by the spinal cord below the level of the lesion. ● Spinal cord injuries are not chronic but they are lifelong and typically permanent ● Two types: complete and incomplete

Complete spinal cord injuries Complete injuries occur when the spinal cord is fully severed, eliminating function. Though, with treatment and physical therapy, it may be possible to regain some function. Nicole ● Grade scale: “A” indicates that the spinal cord injury is complete, with no motor function or sensations below S 4 -S 5. “B” indicates an incomplete spinal cord injury where sensory perception is preserved below the neurological level, but motor function is not. “C” indicates an incomplete spinal cord injury with motor function continuing to exist below the neurological level, and more than half of muscles able to actively move. “D” suggests a spinal cord injury where motor function is preserved and half or more of muscles have a muscle grade of three or higher. “E” indicates normal motor and sensory scores. It's possible to still have a spinal cord injury at grade E, but paralysis and loss of sensation will not occur. Instead, there may be neurological or muscular deficits.

Incomplete Spinal Injury ● The cord is only partially severed, allowing the injured person to retain some function. In these cases, the degree of function depends on the extent of the injuries: Nicole Anterior cord syndrome: causes injury to the front of the spinal cord, interfering with sensations of touch, pain, and temperature. Most anterior cord injury survivors can recover some movement. Central cord syndrome: occurs when the center of the cord is injured. Loss of sensation is common, and survivors rarely recover movement in their arms, but movement in the legs may be possible. Posterior cord syndrome: causes injuries to the back of the spinal cord. Most posterior injury survivors maintain good posture and muscle tone, as well as some movement but struggle with poor coordination. Cauda equina lesion: damages the nerves between the first and second lumbar regions of the spine, resulting in a loss of sensation, but not a loss of movement. It may be possible to repair or regenerate some nerves to improve function.

Interesting Facts / History ● Interesting Facts: ○ Nicole In the past 35 years there has been research being conducted to see if people can actually regrow nerve fibers and cells ● History: ○ Dating back to Egyptian times, medical persons believed that SCI’s were irreversible and that the nerves could not regrow ○ In the 1980’s, a rat experiment showed that regrowth of central nervous system nerve fibers could regrow 1990’s: scientist’s begin to treat SCIs with substances that promote axon growth Today: scientists continue to study regeneration of axons and central nervous system nerves ○ ○

Etiology Common causes: ● ● ● ● Motor vehicle accidents Falls Alcohol use Acts of violence Sports and recreation injuries Diseases Damage to nerve fibers Risk Factors: ● ● ● Nicole Being male Being between the ages of 18 and 30 Being older than 65 Engaging in risky behavior Having a bone or joint disorder Being an athlete

Symptoms Standard Symptoms ● Pain and numbness, or burning sensation ● Inability to move the extremities or walk ● Inability to feel pressure, heat, or cold ● Muscle spasms ● Loss of bladder or bowel control ● Difficulty breathing Symptoms by Region ● Cervical (C 1 -C 8) ○ Most severe and lifethreatening. ○ Affects arms, legs, mid-body, and sometimes ability to breathe. ○ The higher up, the worse it is. ○ Felt on one or both sides of body. ● Thoracic (T 1 -T 12) ○ Affects the legs ○ If injury is higher up, it may affect blood pressure ● Lumbar (L 1 -L 5) ○ Affects one or both legs. ○ Trouble controlling bladder and/or bowel function Alisa

Diagnosis MRI Magnetic Resonance Imaging: uses magnetic field and radio waves CT Scan Computerized Tomography: combines a series of X -Ray images from different angles and uses computer processing to create cross-sectional image of bones, blood vessels and soft tissues Myelogram Uses contrast dye and X-rays or CT to look for problems in the spinal canal (cord, nerve roots, and other tissues Somatosensory evoked potential (SSEP) Shows electrical signals of sensation going from body to brain (pain temperature, and touch) Spine X-rays Regular X-ray, usually to see the displacement of vertebrae greater than 4 mm, which is considered abnormal. Alisa

Treatment/ Home Care -Early and Immediate Treatment: ● ● ● Alisa immobilized on a board to stabilize the neck collar and prevent further damage, shock, and other complications maintain person’s ability to breathe, surgery to remove fluid, bone fragments, or place spinal brace Medrol is sometimes administered to reduce swelling near injury and reduce nerve cell damage -Continuing Care and Rehabilitation: ● ● multidisciplinary team will assess the needs of the individual and assign therapists and specialists to work on various key skills, such as maintaining muscle strength and function, learning how to perform basic tasks, and addressing any mental health concerns. wheelchairs, walker, or leg braces are used

Prevention Most spinal cord injuries occur through accidents (e. g. motor vehicle, sports, falls and some violence) ERin Primary Prevention: ● ● ● Motor vehicle: ○ Wear a seatbelt and use car seats ○ Avoid distraction while operating a vehicle Falls: Be aware of medications that may impact balance and/or cause dizziness Firearm Safety: Keep guns locked, out of site, and unloaded Diving: Never dive into bodies of water unless it is clearly indicated you can do so Recreation: (e. g. trampolines and playgrounds) ○ Always have supervision ○ Make sure the area is being properly maintained ○ Make sure the is equipment that meets safety standards Sports: Wear appropriate clothes, shoes, and safety gear

Prevention Cont. erin Secondary Prevention: Clinical Evaluation - Examined by physician Radiological Evaluation ● ● ● X-Rays CT/CAT Scan (good for viewing bony anatomy and fractures) MRI (good for spinal cord, blood clots, herniated discs, or other masses compressing the spinal cord) Tertiary Prevention: ● ● Immediate immobilization upon injury during ambulatory transport Surgery (most common for incomplete SCI or progressive neurological deterioration

Factors affecting quality of life Health: ● Economic: ● Erin Risks associated with development of secondary conditions ○ Urinary tract infections (UTI’s) ○ Management of bladder and bowel function ○ Deep vein thrombosis (blood clot in a deep vein - usually legs) ○ Osteoporosis (weakened bones) ○ Muscle spasms ○ Pressure ulcers (resulting from prolonged pressure on skin) ○ Anxiety and depression (as of 2013 - estimated 20 -30%) ○ Postoperative wound infection ○ Breathing complications As of 2009, the avg. employment rate for patients after SCI was ~35% ○ The level and severity of injury has influence on cost (the higher the injury, the higher the cost) ○ Direct costs are higher the first year of obtaining a SCI then decrease as time progresses ○ Costs of SCI are higher than those for dementia, cerebral palsy, and multiples sclerosis (MS)

Factors Affecting Quality of Life Cont. Erin Social: ● ● ● Dependence on caregivers Assistive technology for: ○ Facilitation of mobility ○ Communication ○ Self care ○ Domestic activity Misconceptions of condition/disability and negative attitudes Accessibility in home, school, and work environments Discrimination in educational and employment settings PDF on General Etiquette for Interacting with People with Disabilities https: //www. aasf. org/info/general_etiquette. pdf Video “More than being unable to walk” - 4: 12 https: //vimeo. com/76515031

Psychosocial support United Spinal Association Dom Mission : United Spinal Association is dedicated to enhancing the quality of life of all people living with spinal cord injuries and disorders (SCI/D), including veterans, and providing support and information to loved ones, care providers and professionals. Each year, United Spinal helps thousands of wheelchair-users , veterans, and people with multiple sclerosis and other spinal cord disorders overcome the daily challenges of living with a disability. There are more than 60 local chapters and support groups nationwide connecting people with SCI/D to their peers and fostering an expansive grassroots network that enriches lives. United Spinal is committed to advancing public policies that lead to greater civil rights and independence for people with disabilities.

Societal impacts Dom Misconceptions, negative attitudes and physical barriers to basic mobility result in the exclusion of many people from full participation in society. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to economic participation, with a global unemployment rate of more than 60%. ● Every year, around the world, between 250, 000 and 500, 000 people suffer a spinal cord injury (SCI). ● The majority of spinal cord injuries are due to preventable causes such as road traffic crashes, falls or violence. ● People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries. ● Spinal cord injury is associated with lower rates of school enrollment and economic participation, and it carries substantial individual and societal costs.

Health Education - tips for dealing with an sci ● ● ● ● Call 9 -1 -1 immediately Assess the scene of the accident and determine if it is safe Let the person know not to move (if they’re conscious) Depending on the person’s position, hold their C-Spine stable Let them know to ONLY verbally answer questions and refrain from nodding yes or no Ask a series of questions to see if there will be verbal response ○ Questions include: ● Can you feel your toes/move them ● Do you have any pain anywhere Wait for EMS to arrive and hold person as still as possible, with a firm, stable grip on their head as seen below

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References/ Sources for More Information 1. https: //medlineplus. gov/spinalcordinjuries. html 2. http: //www. mayoclinic. org/diseases-conditions/spinal-cordinjury/basics/definition/con-20023837 3. http: //www. spinalcord. com/signs-symtoms-of-spinal-cord-injuries 4. https: //www. christopherreeve. org/research/history-of-spinal-cord-research 5. http: //www. spinalcord. com/treatment-for-brain-spinal-cordinjuries? __hstc=39089148. 368547 cd 151 fc 59 abc 72 b 0 efa 93 ceb 19. 1490725944748. 1&__hssc=39089148. 1. 1490725944751&__hsfp=4214120547 6. http: //www. spinalcord. org/about/ 7. http: //www. who. int/mediacentre/factsheets/fs 384/en/ 8. https: //www. shrinershospitalsforchildren. org/education/spinal-cord-injury-awareness 9. http: //asia-spinalinjury. org/wp-content/uploads/2016/06/ASIA-Watch-Your-Back-Pamphlet -2016. pdf 10. https: //www. aans. org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord. Injury 11. http: //www. who. int/mediacentre/factsheets/fs 384/en/ 12. https: //www. betterhealth. vic. gov. au/health/servicesandsupport/acquired-brain-injuries -and-spinal-cord-injuries 13. https: //www. aasf. org/info/general_etiquette. pdf