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Spinal Cord Injury

Spinal cord is the continuation of brain running down the spinal canal of vertebral column, and giving rise to spinal nerves for carrying nerve impulses to the peripheral parts of the body.

Spinal cord injury may occur due to trauma (Road traffic accident, falls from heights, dirst violence etc) or pathological (infections TB, tranverse myelitis etc.). Traumatic incidents are more common resulting in complete or incomplete injury.

Complete or partial loss of motor and sensory impulses, occurs lower down the body, starting from just below the site of injury depending on complete or incomplete lesion.

Medical or surgical management includes the decompression and stabilization of the vertebrae.

The role of physiotherapist is to assess the lost and preserved motor function depending on the site of lesion and rehabilitate to his functional ability with the help of assistive devices/ mobility aids.

SPINAL CORD INJURY (SCI) – 02

Every year around the world, between 250000 and 500000 people suffer a spinal cord injury.

The majority of spinal cord injuries are due to preventable causes such as Road traffic accidents, falls or violence.

UNDERSTANDING SCI: The term spinal cord injury refers to damage to the spinal cord resulting from trauma (ex. car crash) or from disease or degeneration (ex. cancer)

There is no reliable estimate of global prevalence, but estimated annual global incidence is 40 to 80 cases per million population. Upto 90% of cases are due to traumatic causes though the proportion of nontraumatic spinal cord injuries appears to be growing.

Symptoms of SCI depend on the severity of injury and its location on the spinal cord. Symptoms may include partial or complete loss of sensory function or motor control of arms, legs and/ or body. The most severe SCI affects the systems that regulate bowel or bladder control, breathing, heart rate and blood pressure. Most people with SCI experience chronic pain.

REHABILITATION OF SCI:

ACUTE PHASE

Rehabilitation process following SCI typically begins in the acute care setting, following post surgical fracture stabilization.

In the acute phase, the focus is done on the patient’s respiratory status, prevention of indirect complications such as pressure sores, Urinary tract infections, DVT, maintaining ROM, temperature regulation, keeping available musculature active.

Depending on the neurological level of impairment, the muscles responsible for expanding the thorax which facilitate inhalation may be affected. If the neurological level of impairment is such that it affects some of the ventilatory muscles, more emphasis will be placed on the muscles with intact function. for ex. the intercostal (rib) muscles receive their innervation from T1-T11, and if any are damaged, more emphasis will be placed on the unaffected muscles which are innervated from higher centres of CNS.

As SCI patients suffer from reduced total lung capacity (total breathing capacity of lung), tidal volume (volume of air inhaled or exhaled per breath), it is pertinent that physical therapy is focussed on teaching accessory breathing techniques.

POST DISCHARGE – IMPROVING LOCOMOTOR FUNCTION

Improvement of locomotor function is one of the primary goal for people with SCI. SCI treatment, focus on specific goal such as to restore walking or locomotion to an optimum level for the individual. Bedmobility, transfers, wheelchair mobility skills,bowel and bladder training, performing other activities of daily living are the interventions that the physical therapists can help the patient with.

Teaching the patient how to transfer from different positions, such as from bed to wheel chair is an important part of therapy.Devices such as gliding transfer boards, grab bars can assist in these tasks.

Safe gait training with the assistive devices such as calipers and walking aids depending on the level of injury is one another important intervention used by physiotherapists for achieving functional independence of the patient. Independence in daily activities like eating, bowel and bladder management and mobility is the goal as obtaining competency in self care tasks contributes significantly to an individual’s sense of self confidence and reduces burden on caregivers. Quality of life issues such as sexual health and function are also addressed.

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