MANAGEMENT OF SPINAL CORD INJURIES

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MANAGEMENT OF SPINAL CORD INJURIES
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REHABILITATION

• AIM
• TO ASSIST THE PATIENT TO ACHIEVE THE HIGHEST
  DEGREE OF INDEPENDENCE.
• This may be verbal or physical

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FUNCTIONAL OUTCOMES
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FACTORS AFFECTING OUTCOME

• Level of Injury
• Pre morbid conditions
• Other Associated Injuries
• Complications
• Age

• Sex
• Body Proportions
• Motivation
• Family Support
• Cultural Factors

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REHABILITATION PHYSIOTHERAPY

• Assessment
• Stretches
• Muscle Strengthening and Endurance
• Bed Mobility
• Balance Re-Education
• Posture and Pressure

• Transfers
• Wheelchairs and Wheelchair Skills
• Hydrotherapy
• Sport
• Gait
• Patient, Relative and Carer Education

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MUSCLE STRENGTHENING
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Factors Affecting Exercise Prescription During
Initial Rehab

• Spinal Instability- bracing, surgical fixation
• Pain- associated with fracture site
• Post Traumatic Syringomyelia- weakened area in
  cerebro-spinal fluid track. Dangerous for max
  effort training
• Muscle Imbalance- instability, impingement

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Physiological Factors Affecting Exercise Provision
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Heart Rate Response

• Above T6 -altered sympathetic nervous system
• People with quadriplegia max heart rate 100-125bpm

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Thermoregulation

• Above T6 difficulty regulating temperature due to
  inability to control blood vessel diameter and
  inability to sweat
• Take on ambient temp - overheat or hypothermia

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Blood Pressure Response

• Postural hypotension with change in position
• Exercise hypotension can also occur due to blood
  vessels dilating without a corresponding increase
  in cardiac output
• Blood can pool in lower limbs

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Autonomic Hyperreflexia

• Potentially dangerous situation for people with
  high SCI - CVA or death can occur
• Noxious stimulus eg bladder distension, fracture,
  pressure sore, pain
• Unopposed increase in blood pressure
• Symptoms include pounding headache, flushing
• Get into upright position to reduce BP with
  gravitational force

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Respiratory Performance

• Deficient aerobic capacity in high SCI due to
  reduced VC and decreased stroke volume from lack
  of innervation in intercostal and abdominal
  muscles and sympathetic control

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Lack of Sensation

• Care needs to be taken when transferring on to
  equipment
• Care with strapping hands to machines
• Pressure sores a major complications for people
  with SCI

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Spasticity

• Most people above L1 have a degree of spasticity
• Care required during transfer or maximal
  resistive exercise

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Balance

• Poor balance will occur due to lack of
  innervation of trunk and leg muscles
• Also due to lack of sensation and proprioception
• Care required with starting positions of exercises

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Exercise Prescription

• In general programs for endurance eg 10-20 reps
• Easy to understand for people with limited
  experience
• Aerobic and strengthening

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Overuse

• Common compliant of wheelchair users
• Important to strengthen posterior element of
  shoulder and lateral rotation. Specific
  exercises, also isometric contractions
• Attention required to quality of exercise
  performed
• Ensure good muscle length in all directions

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HYDROTHERAPY

• Decrease Muscle Tone
• Increase Range of Movement
• Improve Muscle Strength
• Increase Cardiovascular Endurance
• Re-educate Swimming