Spinal Cord Injury

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John Harmsen
Spinal Cord Injury Introduction

John Harmsen BSc (OT) 2013
3
We acknowledge
the Traditional Owners of
this Land, the Nyungar
people, and pay respect to
the Elders of their
community.
Learning Objectives
Know the types and causes of spinal
cord injury
Understand the functional implications
of injury to the spinal cord at varying
levels

Essential reading:
. Goshgarian, H. G. (2003). Anatomy and function of the spinal cord. In
V. Lin, D. D. Cardenas, N. C. Cutter, F. S. Frost, & N. C. Hammond
(Eds.), Spinal Cord Medicine: Principals and Practice (pp 15-22).
Available as an eBook from Curtin library.

http://reader.eblib.com.au.dbgw.lis.curtin.edu.au/(S(5rie3difo3khtnah3empgwg0))/Reader.aspx?p
=289785&o=94&u=Efbo%2ff0lJKvmLJUX81yYhA%3d%3d&t=1360043188&h=B9DA8771186630
22B9DFB74A13F5A72B0B88C896&s=7466361&ut=240&pg=1&r=img&c=-1&pat=n#

Spinal Injuries in Australia
(based on 2005/2006 data)
300-400 new cases of SCI per year
9000 individuals with SCI living in Australia
$500 million AUD for SCI population/year
(Norton, 2010)

WA
151 new spinal admissions per year
of these 125 injury through trauma
60-65 people w. neurological deficit requiring intensive rehabilitation
per year
(Norton, 2010)

Demographics
Average age group: 15-29 years
Gender: 5 males to 1 female
Increasing number of older people with SCI as the
population ages and technology improves
(Norton, 2010)

Mechanism of injury
22%
15%
9%
12%
21%
8%
9%
4%
On-road motor vehicle
occupant
Unprotected on-road user
Off Road (trail bike, 4WD,
beach)
Low falls (<1m)
High falls (>1m)
Collision with person/object
(contact sport, machinery)
Water (diving, body surfing,
water skiing)
Other (gun shots, assault,
surgical complications)
(Norton, 2010)

Image retrieved from: http://www.yalemedicalgroup.org/stw/images/168601.jpg
Types of SCI
Paraplegia

Damage to the spinal cord at/below T1
Affects lower portion of the body, including the legs and
some or all of the trunk.
Results in partial or complete motor/sensory loss
(Norton, 2010)

Image retrieved from:
http://www.yalemedicalgroup.org/stw/images/168601.jpg

Types of SCI
Tetraplegia
Is damage to the spinal cord above C7 (neck)
Affects upper and lower portion of the body, including the
legs, trunk, arms and hands.
Results in partial or complete motor/sensory loss
More preferred term than Quadriplegia
(combining tetra + plegia, both from Greek, rather than quadri +plegia, Latin/Greek)
(Norton, 2010)

Image retrieved from:
http://www.yalemedicalgroup.org/stw/images/168601.jpg

Types of SCI - Complete
Complete injury:
No neural messages can travel past the level of cord
lesion.
Results in total loss of movement and sensation below the
level of lesion.

Image retrieved from: http://www.spinalinjuries.ie/wp-content/uploads/2012/04/Spine.gif

Types of SCI - Incomplete
Incomplete injury:
Some parts of the spinal cord are spared at the level of
lesion allowing some neural messages through.

Some movement and sensation below the level of lesion is
preserved. The amount of resultant function can be
minimal (Toe flickers) or substantial (ambulation)
Other Types of SCI
Anterior cord syndrome
affects pain, temperature and touch only

Central Cord Syndrome
affects upper limbs more than lower limbs

Posterior Cord Syndrome
affects coordinated movement of limbs

Brown-Squard syndrome
impairs movement unilaterally
Images retrieved from: http://www.spinalcordsociety.org/2007/whatissci/typesofparalysis.php

What is affected in SCI?
Motor systems
Sensory systems
Bladder
Bowel
Sexual function
Reflexes - Spasms
Image retrieved from: http://medical.cdn.patient.co.uk/images/om1314b.jpg
What is affected in SCI?
Injury Above T6:
Temperature regulation
Blood pressure
Heart Rate
Circulation
Breathing and Coughing
Can suffer Autonomic Dysreflexia

Levels of Injury
The level of injury relates to the lowest functioning level of
spinal nerves.
For example: C6 injury results in function of the nerves at C6 level, but not
C7
Level of injury can differ from level of bony damage.
For example: a person may fracture T8 but may have damaged to the cord
at T6. They have T6 paraplegia.
Tetraplegia
C1-4 Tetraplegia
C1 to C3 - head and neck movement
Able to use the following muscles:
sternocleidomastoid
upper trapezius
levator scapulae
C4 - shoulder shrug
In addition to the above is able to use:
diaphragm
trapezius

Muscles C5
C5 - shoulder control, elbow flexion, supination (rotate
forearm inwards)
In addition to previously mentioned muscles is able to use:
deltoids
biceps
supinator
rotator cuff

Muscles C6
C6 - wrist extension, pronation (rotate forearm
outwards)
extensor carpi radialis longus and brevis
pronator teres
pectoralis major
Tenodesis Action
Muscles C7

C7 - elbow extension, finger flexion / extension, wrist
flexion
triceps
latissimus dorsi
flexor digitorum
extensor digitorum
flexor carpi radialis
pectoralis major

Muscles C8-T1
C8 - T1 - MP flexion, finger abduction and adduction,
thumb movements
interossei
lumbricals
thenar and hypothenar muscles

Expected Functional Outcomes
Feeding, grooming with
setup & adaptive aids.
Assists UL dressing
SELF-CARE
Independent with
upper/lower limb
dressing with aids
TRANSFERS MOBILITY
C5
C6
C7
C8
Independent with
aids, LL dressing
very difficult.
INDEPENDENT
Maximal assist
with hoist or
board transfer
Independent all
transfers, except
floor transfers
Potentially
independent with
sliding board
INDEPENDENT
Motorised W/Chair
(indoors manual W/C
with capstan rims)
Independent in
manual W/Chair,
except kerbs
Manual W/Chair (indoors
& even ground outdoors)
Motorised W/Chair
INDEPENDENT
LEVEL
C4
DEPENDENT DEPENDENT DEPENDENT
Head and
neck
Shoulder shrug
Shoulder control, elbow
flexion, Supination
Wrist Extension, Pronation
Elbow Extension, Wrist flexion,
finger flexion and extension
Finger Abduction/adduction, thumb
movements
C6
C5
C4
C1-3
C7

T1
Functional upper limb movement by level of innervation
Paraplegia
Thoracic Paraplegia

Individuals witha T1-T12 paraplegia have
innervation and function of all upper extremity
muscles, including those for hand function.
Can achieve functional independence
Individuals with a T2-T9 injury have variable trunk
control
Persons with a T10-T12 injury have better trunk
control than do patients with a higher injury
Lumbar/ Sacral Paraplegia

Individuals with lumbar or sacral paraplegia can
achieve functional independence for all mobility,
self-care, and bladder and bowel skills.

Factors impacting on independence
PHYSICAL
Level of injury
Completeness
Age
Co-morbidities (other injuries or
medical conditions)

Pain
UTI
Pressure areas
Spasm
Factors impacting on independence
PSYCHOSOCIAL
Mental health diagnosis
Pre-injury personality
Motivation
Socioeconomic background
Perception of Disability

Social Supports
Adjustment / Coping
Values / beliefs
Problem solving
Ability to set goals
References
Adler, C. (2006). Spinal cord injury. In H. M. Pendleton &
W. Schultz-Krohn, Occupational Therapy for
Physical Dysfunction (pp. 903- 930). Mosby-
Elsevier, St Louis, Missouri.
Norton, L. (2010). Spinal cord injury, Australia 200708.
Injury research and statistics series, no. 52. Cat. no.
INJCAT 128. Canberra: AIHW.


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CRICOS Provider Code 00301J

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