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CHAPTER 2
Water related 9%
Sports related 8%
Figure 2.1 Incidence of Spinal Cord Injury from traumatic causes by external cause of injury (major groupings), Australia 2007-2008. Australian Institute of Health and Welfare (2010)
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Spinal Cord Injury bowel or sexual dysfunction and may be seen in the outpatient department by one of the doctors).
We add the lesion level as well, e.g. C6 AIS A, C7 AIS C, T12 AIS D - to indicate level of cord lesion and degree of completeness. The cord lesion may improve a bit over a few weeks or months e.g. C5 AIS A may improve to C6 or even C7 because there can be a bit of recovery in the nervous system. Unfortunately this doesn't always happen.
Pattern of Injury
If we look within the spinal cord, we find that it has a very specific organisation. Sensory nerves travel with other sensory nerves, motor nerves likewise. Additionally, the nerves to particular body parts also travel bundled together in specific parts of the spinal cord. This means that some injuries to the spinal cord lead to injuries to specific nerve paths producing characteristic patterns of weakness and numbness. Well review two common patterns of SCI.
Central Cord Syndrome The Central Cord Syndrome results from an injury to the central part of the spinal cord in the cervical (neck) region leading to tetraplegia. As the nerves which supply the arms lie more centrally in the cord, the arms tend to be more affected than other areas of the body.
Cauda Equina Syndrome The spinal cord actually ends at the L-2 vertebral level however the nerve roots continue 14th Edition Dec 2012 2-4
Spinal Cord Injury past this level and resemble a horses tail, or cauda equina in Latin. Injury to this area may cause weakness and/or loss of sensation in the lower limbs (e.g. at the hips, knees, ankles and/or the back of the legs and buttocks) as well as bowel, bladder and sexual dysfunction.
Interesting Facts: Your spinal cord is about the same circumference as your little finger Your spinal cord contains roughly 20 million nerve fibres Your spinal cord is roughly 45 cm [18 inches] long
The time for recovery to occur is variable, depending on the injury. In some cases most recovery occurs within the first 3 months, while with others it can take as long as 18 months. Typically, most recovery occurs in the first few months after SCI. As time goes by, fewer gains are seen. It is very important to do all you can to help your body to heal. Your medical care helps, certainly. Surgery, if necessary, is typically done to make the bony spinal column stable, 14th Edition Dec 2012 2-5
Spinal Cord Injury reduce compression to the spinal cord, and/or prevent further damage. Medications may be given at certain periods following the SCI to attempt to minimise the nerve damage. Further medical support is given to prevent serious complications, and allow the body maximum health and nutrition for healing.
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FUNCTIONAL ABILITIES (Based on complete injury) Assisted breathing (with ventilator). Use of motorised wheelchair with head control. Use of voice-activated computer. Environmental control systems used to operate appliances, eg TV, stereo. Independent breathing. Use of motorised wheelchair with head control. Use of computer and environmental control systems. Use of motorised wheelchair with hand control and manual wheelchair on flat ground surfaces. Independent in most aspects of grooming, eating and drinking, typing, writing and computer use with the aid of splints/devices. Using an overhead strap may assist with rolling in bed. Use of manual wheelchair. Transfer to and from bed with or without slide board, possibly with assistance. Independent bed mobility. Increased independence with personal care, including bladder management, most aspects of showering and dressing and management of bowel care with device. Basic food and drink preparation. May achieve driving using hand-controls. Independent transfers, including in and out of car. Independence with personal care (as noted above) with aids/adaptations. Basic food and drink preparation. Driving using hand-controls, possibly including lifting wheelchair in and out of car.
C4
C5
C6
C7
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FUNCTIONAL ABILITIES (Based on complete injury) Independent transfers, possibly including floor to wheelchair. Independent personal care, including managing buttons and shoe laces. Management of bowel care with or without use of an aid. Independence with food and drink preparation and some household tasks. Driving, including lifting wheelchair in and out of car. Advanced transfers: wheelchair to floor and return. Managing wheelchair up and down curbs, steps, escalators. Therapeutic standing between bars with leg splints. Independent in all aspects of personal care and most household activities. Independent transfers, possibly including floor to wheelchair. Independent transfers, including floor to wheelchair. Improved trunk stability and balance. Advanced wheelchair skills. Therapeutic walking with long leg braces and crutches. Increasing use of legs and therefore, walking with varying amounts of external support. Normal gait. Increasing voluntary control over bladder, bowel, and sexual functions.
T1-6
T6-L2
L3-S1 S2-5
Spinal Cord Injury It is unlikely that any treatment developed in the near future will provide a complete cure for SCI. However, promising developments may lead to treatments that can reduce the effects of SCI and increase the recovery of functional abilities after SCI. Treatments that are developed in the future may not work for all people with SCI. If you would like to know more about this, you are encouraged to attend the Patient Education sessions which will be held during your rehabilitation. The Patient Education session that is presented by the medical staff includes information about current research in SCI and provides an opportunity to ask any questions you may have. For those seeking further information, you might like to visit some of the websites listed in this handbook or ask your doctor about the most up to date developments.
It may be tempting to say, Why go to therapy? Ill sit back and wait for a cure. Any future treatment is likely to be most effective for those who have kept their bodies and minds healthy.
You may hear about unusual or controversial treatments for paralysis and SCI. Keep in mind that some people might be selling more than they can deliver. Its a good idea to ask your doctor for an opinion about these treatments.
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