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John Harmsen Spinal Cord Injury Introduction Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 3 We acknowledge the Traditional Owners of this Land, the Nyungar people, and pay respect to the Elders of their community. John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Learning Objectives Know the types and causes of spinal cord injury Understand the functional implications of injury to the spinal cord at varying levels
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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.
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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)
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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)
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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) John Harmsen BSc (OT) 2013
Image retrieved from: http://www.yalemedicalgroup.org/stw/images/168601.jpg Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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)
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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)
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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.
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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) John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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 John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J What is affected in SCI? Injury Above T6: Temperature regulation Blood pressure Heart Rate Circulation Breathing and Coughing Can suffer Autonomic Dysreflexia
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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. John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Tetraplegia Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Muscles C6 C6 - wrist extension, pronation (rotate forearm outwards) In addition to previously mentioned muscles is able to use: extensor carpi radialis longus and brevis pronator teres pectoralis major Tenodesis Action John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Muscles C7
C7 - elbow extension, finger flexion / extension, wrist flexion In addition to previously mentioned muscles is able to use: triceps latissimus dorsi flexor digitorum extensor digitorum flexor carpi radialis pectoralis major
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Muscles C8-T1 C8 - T1 - MP flexion, finger abduction and adduction, thumb movements interossei lumbricals thenar and hypothenar muscles
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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 John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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 John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Paraplegia Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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 John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Lumbar/ Sacral Paraplegia
Individuals with lumbar or sacral paraplegia can achieve functional independence for all mobility, self-care, and bladder and bowel skills.
John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Factors impacting on independence PHYSICAL Level of injury Completeness Age Co-morbidities (other injuries or medical conditions)
Pain UTI Pressure areas Spasm John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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 John Harmsen BSc (OT) 2013 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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.