NCM 116a – Perception

and Coordination

SPINAL CORD
INJURY

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SPINAL CORD
− is a thick length of
nerve tissue that
extends from the base
of the brain, down the
back, through the
spinal column.

SPINAL COLUMN
− is made up of bones
called vertebrae that
protect the spinal cord.
Anatomy of Spinal Cord

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SPINAL CORD

Motor nerves
➢are grouped together and transmit
motor commands from the brain to
the muscles and initiate movement.

Sensory nerves
➢are also grouped together. They
carry information about sensations,
such as pain and temperature, to the
brain. 4
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Anatomy of Spinal Cord

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Anatomy of Spinal Cord

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Spinal Cord Injury

➢ A spinal cord injury usually begins with a sudden,

traumatic blow to the spine that fractures or
dislocates vertebrae.

➢ 250,000 to 500,000 suffers from SCI (WHO)

➢ Preventable causes such as road traffic crashes,

fall and violence

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Etiology & Risk Factors
Traumatic causes:

Auto mobile or Motor Falls

cycle Accidents

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Etiology & Risk Factors
Traumatic causes:

violence primarily from Sports

gunshot wounds

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Risk Factors

Males (young adulthood) – 20-29

years old and older age (70+)

Females (Adolescents – 15 – 19
years old and older age (60+)

2:1 (Male: Female)

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 Risk Factors

The feeling of Use of Alcohol

immortality (in & Illicit drugs
adolescents & while -
young) • Operating moving
vehicle
• Diving
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Recreational Occupations
activities
without
proper safety
measures

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Causes:

Direct trauma Compression

Ischemia from
damage /
impingement on
the spinal arteries

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Mechanisms causing spinal injury
Mechanisms causing spinal injury
Mechanisms causing spinal injury
Mechanisms causing spinal injury
Mechanisms causing spinal injury
Mechanisms causing spinal injury
Mechanisms causing spinal injury
 Etiology & Risk Factors

Non – Traumatic causes:

Cervical
• spinal canal narrowing with
Spondylosis progressive injury to the cord & roots
with myelopathy

Myelitis • infective or non infective

• causing vertebral compression

Osteoporosis fractures

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 • Fluid-filled cyst in spinal
Syringomyelia cord

• both infiltrative &

Tumors compressive

Vascular • usually infarction &

diseases hemorrhage

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 Types of Spinal Injury
Transection Cord Injury
Injury that partially or completely severs the spinal cord

COMPLETE INCOMPLETE

Central Cord Syndrome

Cervical
Below T-1
Spine
Anterior Cord Syndrome

Quadriplegia Paraplegia

Brown-Sequard’s Syndrome
Incontinence incontinence

Respiratory paralysis
Bulbocavernosus Reflex
• The test involves monitoring internal/external
anal sphincter contraction in response to
squeezing the glans penis or clitoris, or
tugging on an indwelling Foley catheter.

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 Types of
Spinal Injury

COMPLETE INJURY

• there is no function
below the
"neurological" level,
defined as the lowest
level that has intact
neurological function.

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INCOMPLETE INJURY

−retains some
sensation or
movement below
the level of the
injury.

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 Incomplete Transection Cord Injury
1. Anterior Cord Syndrome
▪ Anterior vascular
disruption

▪ Loss of motor
function and
sensation of pain,
light touch, &
temperature below
injury site

▪ Retain motor,
positional and
vibration sensation 36
2. Central Cord Syndrome

▪ Hyperextension
of cervical
spine

▪ Motor
weakness
affecting upper
extremities

▪ Bladder
dysfunction

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3. Brown-Sequard’s Syndrome

▪ Penetrating
injury that
affects one side
of the cord

▪ Ipsilateral
sensory and
motor loss

▪ Contralateral
pain and
temperature
sensation loss

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ASIA Impairment Scale

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Clinical Manifestations

• It will depend
on the level of
injury.

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 Cervical (neck)
Injuries

• Breathing
difficulties
• Loss of normal
bowel and bladder
control
• Numbness
• Sensory changes
• Spasticity
(increased muscle
tone)
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 Cervical (neck)
Injuries

• Breathing
difficulties
• Loss of normal
bowel and bladder
control
• Numbness
• Sensory changes
• Spasticity
(increased muscle
tone)
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THORACIC (CHEST
LEVEL) INJURIES

• Loss of normal
bowel and bladder
control
• Numbness
• Sensory changes
• Spasticity
• Weakness,
paralysis
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 LUMBAR SACRAL
(LOWER BACK)
INJURIES

• Loss of normal
bowel and bladder
control
• Numbness
• Pain
• Sensory changes
• Weakness and
paralysis

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Diagnostic Examination

MRI
CT- Scan
Myelography

X-Ray
Emergency Management
✓ the patient must be in a neutral position

✓ control the patient’s head to prevent

flexion, extension, or rotation (cervical
collar

✓ slide the victim carefully into a board

when transferring to avoid any twisting
movement
Emergency Management
✓ maintain the extremities in an
extended position

✓ patient can be moved to a

conventional bed or placed in a
cervical collar and on a firm mattress
with a bed board under it
 Emergency Management
➢ Common emergent interventions (ABC)
• Provision of oxygen
• Insertion of IV line
• Infusion of normal saline
• Administration of potent steroids
• Administration of vasoactive medications to
maintain systolic BP
• Insertion of indwelling Catheter
• Insertion of Nasogastric tube
• Once patient is stabilized can be shifted to
ICU
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 Emergency Management

➢ Skeletal Traction is applied for a patient who is having

severe cervical injury to immobilize & to reduce the
fracture & dislocation
• Crutchfield tongs
• Gardner-wells tongs 55
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 Medical Management
PHARMA
➢ Methylprednisolone 30mg/kg within 8hrs after injury
✓ Lipid peroxidation
➢ Dexamethasone for older injuries
✓ Help decrease the amount of damage to the spinal
cord by reducing inflammation and swelling.

OXYGEN THERAPY
➢ Oxygen is administered to maintain a high partial
pressure of oxygen (PaO2), because hypoxemia can
create or worsen a neurologic deficit of the spinal cord.

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Surgical Management
- Foraminotomy is a type of spine surgery
performed to decompress (remove pressure)
on a spinal nerve root.

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Surgical Management

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Surgical Management
Laminectomy
• Removal of part or
all of the vertebral
bone (lamina).
• This helps ease
pressure on the
spinal cord or the
nerve roots that may
be caused by injury,
herniated disk,
narrowing of the
canal (spinal
stenosis), or tumors.
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Surgical Management

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Surgical Management
Spinal Disc Replacement
• Involves replacin
g a worn or
degenerated disk
in the lower part
of spine with
an artificial
disk made of
metal or a
combination of
metal and plastic.
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Surgical Management
Spinal Fusion
• Surgery to join two
or more vertebrae
into one single
structure.
• The goal is to stop
movement
between the two
bones and
prevent back pain.

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Complications

• Respiratory arrest
Immediate • Spinal Shock

• Autonomic Dysreflexia
• Pressure Injury
Long-term • Contractures
• RTI

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Complications
Spinal Shock
• a sudden depression of reflex activity in
the spinal cord (areflexia) below the
level of injury.
o Paralytic Ileus → NGT
o Bulbocavernosus Reflex
o 24-72hours monitoring

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 Complications
Neurogenic Shock
• develops as a result of the loss of autonomic
nervous system function below the lesion.
✓ Sympathetic activity is blocked →
less perspiration → hyperthermia
✓ Hypo, Brady
✓ Bulbocavernosus Reflex (-)

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 Complications
Deep Vein Thrombosis (DVT)
• is a potential complication of immobility
• PE – life- threatening
❑ low dose anti-coagulation
❑ anti-embolic stockings

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 Complications

Autonomic Dysreflexia
• AKA Hyperrelfexia

• Over-active Autonomic Nervous System

which causes an abrupt onset of
excessively high blood pressure. It is
more common in people with spinal cord
injuries that involve the thoracic nerves
of the spine or above (T6 or above).
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Nursing Diagnosis
Ineffective breathing patterns related to weakness or
paralysis of abdominal and intercostal muscles and
inability to clear secretions

Ineffective airway clearance related to weakness of

intercostal muscles

Impaired bed and physical mobility related to motor

and sensory impairments

Disturbed sensory perception related to motor and

sensory impairment
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Risk for impaired skin integrity related to
immobility and sensory loss

Impaired urinary elimination related to

inability to void spontaneously

Constipation related to presence of atonic

bowel as a result of autonomic disruption

Acute pain and discomfort related to

treatment and prolonged immobility

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Nursing Interventions
✓ Promote Adequate Breathing and
Airway Clearance
✓ Improve Mobility
✓ Promote Adaptation to Sensory and
Perceptual Alterations
✓ Maintain Skin Integrity
✓ Maintain Urinary Elimination
✓ Improve Bowel Function
✓ Provide Comfort Measures
✓ Promoting Home and Community-
Based Care
 Nursing Interventions

1. Promoting Adequate Breathing and Airway Clearance

✓ CPT
✓ Assisted coughing/ Coughing exercises

2. Improving Mobility
✓ Proper Body alignment
✓ ROM exercises to prevent contractures

3. Promote Adaptation to Sensory and Perceptual

Alterations
✓ Intact senses are stimulated 74
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 Nursing Interventions

4. Maintain Skin Integrity

✓Pressure injury prevention/ treatment

5. Maintain Urinary Elimination

✓ Catheterization
✓ MIO

6. Improve Bowel Function

✓↑ caloric, ↑ CHON, ↑ fiber diet
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 Nursing Interventions

7. Provide Comfort Measures

8. Prevent/ Monitor Complications

9. Promoting Home and Community-Based

Care
✓ Teaching patients self-care
✓ Continuing care

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