What is spinal cord injury?

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Spinal cord injury (SCI) is a harmful condition that depending on its severity and location of the damage to the spinal cord may cause many changes in an individual life.

SCI usually happens to active, independent people who at one moment are in control of their lives and in next moment are paralyzed with loss of sensation and body function which leads on dependence on others for their daily activities.

SCI occurs when the spinal cord is damaged as a result of trauma, disease process, inadequate blood supply to spinal cord or congenital neural tube defect.

Spinal cord injury: Causes

SCI may result from damage to spinal cord or damage to vertebrae, ligaments or discs of spinal column.

We can classify spinal cord injury into two types: Traumatic and Non-traumatic.

Traumatic SCI may be caused due to sudden traumatic blow of spine that may leads to fractures, dislocations, crushes or compression of one or more than one of vertebrae.

It may also result from knife wounds that penetrate spinal cord or gunshot. Associated problem due to traumatic spinal cord injury usually occurs over days to weeks due to bleeding, swelling, inflammation and fluid accumulation in and around spinal cord.

Non traumatic spinal cord injury is caused by- Arthritis, cancer, inflammation, infections, disk degeneration of spine, myelomeningocele, syringomyelia, multiple sclerosis, amyotrophic lateral sclerosis.

Common causes of spinal cord injuries include:

RTA (Road traffic accidents)- Auto and motorcycle are one of the main cause of traumatic spinal cord injury. It accounts for almost ½ of the spinal cord injury every year.

Falls– It is one of the most frequent causes of SCI. These are generally seen in people above 65 years of age.

Violence- It generally involves spinal cord injury caused due to gunshot and knife wounds.

Sports injuries- Some of the athletic activities also causes spinal cord injury and it accounts for about 10 % of total SCI.

Diseases- Cancer, arthritis, osteoporosis and inflammation of spinal cord also causes SCI.

Spinal cord injury: Symptoms and types

There are two types of spinal cord injury according to the involvement of lesion:-

Incomplete Lesion– Incomplete means partial damage to nerves, nerves are not fully damaged.  There is a chance of recovery of in this condition but not up to normal/Full level.

Complete Lesion– There id total damage of nerves and no motor or sensory function preserved of this point. Rehabilitation is an option after complete SCI.

types of spinal cord injury OTprinciple

Incomplete injuries are classified according to the area of damage: – Central, Lateral, Anterior, Peripheral.

Central cord syndrome- It occurs when there is more damage of spinal cord in the canter than in the peripheral region. There is more paralysis in the upper body because nerves for upper extremity are more centrally located then nerves for lower extremity.

Brown-Sequard Syndrome– IT results when only one side of the spinal cord is damaged. Below the level of injury there is paralysis and loss of proprioception (sense of position of body parts) on the same side of the body and loss of pain, touch, temperature sensation on the other side of the body.

Anterior Spinal cord syndrome– It result from injury that damage anterior part of the spine. This involves paralysis and loss of pain, temperature and touch sensation. Generally there is no loss of proprioception.

Cauda Equina(Peripheral)- It does not directly involve spinal cord but it involves peripheral nerves. In this type of injury there is better recovery because peripheral nerves have regenerating capacity. It generally does not show a similar pattern of symptoms, every Clint has unique symptoms.

Symptoms of spinal cord injury:-

  • Loss of movement
  • Loss or decreased sensation including ability to feel heat, cold, touch and pain
  • Loss of bowel and balder control
  • Reflex activity become exaggerated
  • Changes in sexual function, sexual sensitivity and fertility
  • Extreme back pain on pressure in neck, head or back
  • Problems in breathing
  • Weakness, incoordination or paralysis of any body part
  • Loss of sensation, numbness and tingling in hands, fingers, foot or toes
  • Difficulty with balance and walking

Results of spinal cord injury

Most of the SCI results in quadriplegia (also known as tetraplegia, American spinal cord injury association, ASCIA) or paraplegia.

Tetraplegia is any degree of paralysis of four limbs and also pelvic. In tetraplegia there may be partial upper body function depending on the level of cervical lesion.

Paraplegia mostly affects the function of lower body and pelvic depending on level of lesion.

Complication of spinal cord injury

SCI cause motor and sensory deficits as well as autonomic dysfunction. These includes:-

  • Muscle spasm
  • Flaccidity
  • Bladder distension
  • Constipation/Faecal impaction
  • Urinary tract infection (UTI)
  • Hypostatic pneumonia
  • Hypotension
  • Bed sores
  • Catheter retention
  • Hyperpyrexia
  • Depression
  • Deep vein thrombosis
  • Thermoregulation problems
  • Contractures (Due to muscle imbalance around the joint)
  • Heterotrophic ossification (HO)
  • Osteoporosis and degenerative spinal deformities
  • Metabolic problems

Prevention of spinal cord injury

Awareness is the beginning of prevention.

RTA (Road traffic accidents)

  • Avoid distractions including using phones, talking, eating, etc.) While driving
  • Never drive after drinking alcohol
  • Always wear a seatbelt
  • Always wear helmet while riding motorcycle
  • Properly follow traffic rules such as speed limits etc.

Falls

  • Keep carpet and floor in good condition
  • Always wear footwear with good grip
  • Keep floor and pathway clear

Violence

  • Always avoid any kind of violence
  • Gunshot and knife injuries may cause spinal cord injury

Sports

  • Always wear appropriate clothes, shoes and safety gears
  • Learn proper technique, how to play that particular game?

Diseases

  • Take care of your health. Consult to your doctor/therapist whenever necessary.

Management of spinal cord injury

Unfortunately, there is no why to reverse damage to the spinal cord. Most of the early stage of treatment includes:-

  • Maintaining ability to breathe
  • Preventing shock
  • Immobilising neck and spine to prevent further SCI
  • Avoiding stool and urine retention
  • Avoiding cardiovascular and respiratory difficulties
  • Management of formation of deep vein thrombosis

Medications may be used to manage some of the complications of SCI. These mainly include muscle spasticity and pain, bowel and bladder problems and sexual dysfunctions.

Researches are continuously working on new treatment method and medications that may promote nerve cell regeneration or at least may improve functioning of remaining nerve after spinal cord injury.

Surgery is usually unnecessary to remove fragments of bones, foreign objects, herniated discs or fractured vertebrae that may be compressing the spine. Surgery also stabilizes the joint to prevent further deformity and pain.

Need of rehabilitation in SCI

To reduce negative impact, individuals with SCI need a good, specialised rehabilitation to assist them in maximising the development of skills necessary to live their life and return the individual to highest level of community participation.

The rehabilitation team for SCI includes:

Physician, physiotherapist, occupational therapists, recreation specialist, prosthetics and orthotics, nurses, speech language pathologist, dietician, psychologist, social worker, vocational consular, etc.

types of rehabilitation of spinal cord injury

OT treatment and intervention in SCI

The occupational therapists general objective and goals for treatment of the person with SCI includes:

  • To maintain or increase joint range of motion and prevent deformity through the use of active and passive range of motion exercises, splinting and positioning
  • To increase the strength of weak muscle through the use of enabling and purposeful activity
  • To increase physical endurance through the use of functional activity
  • To make person independent in all aspect of self-care homemaking and mobility
  • To explore leisure interest  and vocational potential
  • To help in psychosocial adjustments to disability
  • To evaluate, suggest and train the patient in use of adaptive devices necessary for them
  • To ensure safe and independent homemaking through home modification suggestion

To know more about occupational therapy treatment methods used in the person with spinal cord injury click here

References:


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