REHABILITATION OF SPINAL

CORD INJURY PATIENT

 SCI leads to :
Primary Prevention
IMPAIRMENT

Functional limitation
Activity restriction Secondary Prevention

DISABILITY

Tertiary Prevention
HANDICAP

Years Life long Bedbrook, 1985

EPIDEMIOLOGY ( USA ):

Incidence : 29.4 50 / 1000.000 pop

Mostly striking the vibrant, young active
and well-educated people
Age : > 50% under 30
Male : Female : 2.4 4 : 1
ETIOLOGY :
1.Vehicle crashes : 45.4 %
2.Falls : 16.8 %
3.Sport injuries : 16.3 %
4.Violence
NEUROLOGICAL CLASSIFICATION
OF SCI :

SCI are classified according to the

International Standards for Neurological
and Functional classification of SCI
( ASIA and IMSOP )

Sensory function
Motor function
 TERMINOLOGIES :
1. TETRAPLEGIA
injury to SC in the cervical region

2. PARAPLEGIA :
injury in the Thoracic,Lumbar or Sacral segments

Notes : Tetraplegia and Paraplegia do not

include lesions to peripheral
nerves outside the neural canal
Quadriparesis and Paraparesis are
imprecise and should not be used
SCALE FOR MOTOR TESTING :

0 : Total paralysis
1 : Trace
2 : Poor
3 : Fair
4 : Good
5 : Normal
NT : Not Testable
Scale for Sensory testing :
( Pin prick and Light touch )

0 : Absent
1 : Impaired
2 : Normal
NT: Not testable
International Standards for Neurological and
Functional Classification of SCI ( ASIA / IMSOP ):

10 MYOTOMES
28 DERMATOMES
THE NEUROLOGICAL LEVEL :

Is the most caudal neurological

segment of the SC retains normal
sensory and motor on both sides of
the body

e.g.

T 10 Paraplegia - A
IMPAIRMENT SCALE :
A : Complete. No motor or sensory function is pre-
served in the sacral segments S4-S5
B : Incomplete. Sensory but not motor function is
preserved below the neurological level S4-S5
C : Incomplete. Motor function is preserved below
the neurological leve. Majority of key muscles
below the level : < 3
D : Incomplete. ~ C , majority of key muscles > 3
E : Normal. Motor and sensory function is normal
CLINICAL SYNDROMES IN SCI :
Central Cord Syndrome
Brown Sequard Syndrome
Anterior Cord syndrome
Conus Medullaris Syndrome
Cauda Equina Syndrome
 COMPLICATIONS :
UTI, Impaired kidney function, following
neurogenic bladder dysfunction
Constipation following neurogenic bowel
Pressure sore following paralysis
Contracture and deformity following spasticity
Pain
Sexual dysfunction and infertility
Depression and other psychosocial problems
Goals of Rehabilitation in Acute Care :
TO PREVENT COMPLICATIONS DUE TO
PROLONGED IMMOBILIZATION
Prevent pressure ulceration
Maintain joint ROM
Begin Bowel and Bladder Programs Begin
Sitting Program
Prevent Pulmonary complications
Prevent Autonomic dysreflexia, etc
Prevent DVT
 Hyperreflexic detrusor
Spastic sphincter
Type A Type B

Hyperreflexic detrusor
Areflexic sphincter

Areflexic detrusor

Type C Spastic sphincter Type D

Areflexic detrusor
Areflexic sphincter
BLADDER IN ACUTE SCI :

Consequences : Securing of bladder

emptying
Methods : Intermittent catheterization ( IC )
Indwelling catheterization ( IDC )
Suprapubic catheterization
Spontaneous voiding
AUTONOMIC DYSREFLEXIA :

An acute syndrome of massive sympathetic discharge

May occur in SCI above T6
Most common causes : Bladder and Bowel distention
Characterized by : Paroxysmal hypertension,
pounding headache, sweating, nasal congestion, facial
flushing, piloerection, reflex bradycardia
Management : patient should be placed in sitting
position to decrease cerebral blood pressure
Medications : Nifedipine, Glyceryl trinitrate
FUNCTIONAL INDEPENDECE LEVEL
( FIM ) :
SELF CARE :Eating, Grooming, Bathing,
Dressing, Toileting

SPINCTER CONTROL : Bladder, Bowel

TRANSFER :Bed-Chair-WC, Toilet, Tub-Shower
LOCOMOTION : Walk / WC, Stairs
COMMUNICATION : Comprehension, Expression
SOCIAL COGNITION : Social interaction,Problem
solving, Memory