Spinal cord injury is a traumatic damage to the spinal cord or nerves at the end of the spinal canal. A person with damage to the spinal cord may suffer from loss of sensation and motor function depending on the level of severity of injury. Damage to the spinal cord can be caused by fractures, compression or disease.
There are two types of spinal cord injuries.
Incomplete lesions
Not all the nerves are severed or the nerves are only slightly damaged. Most of the spinal cord injuries are incomplete. Recovery is possible but never to pre injury level.
Complete lesions
The nerves are preserved and there is no motor or sensory function preserved of this point.
Causes of spinal cord injuries are,
Motor vehicle injuries
Falls
Sport injuries
Violence
Self-harm
Work related accidents
Initial evaluation of the spinal cord injury includes,
️loss of ventilatory functions.
️Signs of hemorrhages.
️Traumatic paraplegia caused by lower thoracic lesions.
️Quadriplegia associated with cervical level lesions.
Complications of spinal cord injuries are
Problems with bowel and bladder function
Respiratory difficulties
Spasticity
Neuropathic pain
Muscle wasting and weakness
In diagnosing spinal cord injury MRI scans standard for imaging neurological tissues, Spinal fractures and bony lesions are better characterized by Computed Tomography and vascular injuries can be detected by using CT scan.
Physiotherapy management.
Physiotherapy Management of Spinal cord injury can be divided into 3 phases.
Acute,
Sub-acute (Rehabilitation) and
Chronic (Long term) phase.
In acute phase.
physiotherapy management is predominantly involved in prevention and management of respiratory and circulatory complications, and minimizing the impact of immobilization such as pressure ulcers, contractures formation.
Treatments in acute phase are
️Strengthening exercise to maintain and strengthen all innervated muscle groups and reduce muscle weakness. Resistance training involves improving muscular strength.
️Range of motion exercise for maintaining the full range of movement of all joints within the limitations determined by the stability of the fracture
️Muscle stretching below the level of injury to help muscle lengthen, reduce stiffness and forming contractures
️Practice Breathing exercise to facilitate ventilation
️Correcting posture and positions to prevent forming pressure ulcers
️Exercise to improve balance
️Support and educate the patient, family and staff
Sub-acute (rehabilitation) phase is mainly focused on improving quality of life of the patient. In individuals with paraplegia most common physiotherapy intervention is transfers followed by range of motion, stretching and strengthening. In individuals with tetraplegia.
Treatments in sub-acute phase are,
Strengthening exercise
Balance training
Gait training
Improve cardiovascular fitness
Pain management
In long term phase is mainly focused on achieving high level mobility goals required for community participation and monitor the recovery function.
References
https://www.physio.co.uk/what-we-treat/neurological/conditions/spinal-cord-injury.php
Yashoda Madurangi.
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