m 6





 Auto and motorcycle accidents are
the leading cause of spinal cord injuries, accounting for more
than 40 percent of new spinal cord injuries each year.
m 

   As many as 15 percent of spinal cord injuries
result from violent encounters, often involving gunshot and knife
wounds, according to the National Institute of Neurological
Disorders and Stroke.
m ©

 Spinal cord injury after age 65 is most often caused by a
fall. Overall, falls cause about one-quarter of spinal cord injuries.
m ’ 




 
 Athletic activities, such as
impact sports and diving in shallow water, cause about 8 percent
of spinal cord injuries.
m     Alcohol use is a factor in about 1 out of every 4 spinal
cord injuries.
m {



 Jancer, arthritis, osteoporosis and inflammation of
the spinal cord also can cause spinal cord injuries.
SJI is classified according to the personǯs type of loss
of motor and sensory function. The following are
the main types of classifications:
m Quadriplegia (quad means four) Ȅ involves loss of
movement and sensation in all four limbs (arms and legs).
It usually occurs as a result of injury at T1 or above.
Quadriplegia also affects the chest muscles and injuries at
J4 or above require a mechanical breathing machine
(ventilator).
m Paraplegia (para means two like parts) Ȅ involves loss of
movement and sensation in the lower half of the body
(right and left legs). It usually occurs as a result of injuries
at T1 or below.
m Triplegia (tri means three) Ȅ involves the loss of
movement and sensation in one arm and both legs and
usually results from incomplete SJI.
m Quadriparesis and paraparesis refer to partial loss of
function.
m 6uscle weakness or paralysis in the trunk, arms or legs
m Loss of feeling in the trunk, arms, or legs
m 6uscle spasticity
m Breathing problems
m Problems with heart rate and blood pressure
m Digestive problems
m Loss of bowel and bladder function
m Sexual dysfunction
m  
Ȅ a diagnostic test that uses invisible electromagnetic
energy beams to produce images of internal tissues, bones, and
organs onto film.
m J  

 






J  J 


Ȅ a diagnostic imaging procedure that uses a combination of x-
rays and computer technology to produce cross-sectional images
(often called slices), both horizontally and vertically, of the body.
A JT scan shows detailed images of any part of the body,
including the bones, muscles, fat, and organs. JT scans are more
detailed than general x-rays.
m 6




6 Ȅ a diagnostic procedure
that uses a combination of large magnets, radiofrequencies, and
a computer to produce detailed images of organs and structures
within the body.
Specific treatment for an acute spinal cord injury will be
determined by your physician based on:
m Overall health, and medical history
m Extent of the SJI
m Type of SJI
m Your tolerance for specific medications, procedures, or
therapies
m Expectations for the course of the SJI
m Your opinion or preference
m SJI requires emergency medical attention on the scene
of the accident or injury. This is accomplished by
immobilizing the head and neck areas to prevent the
patient from moving. This may be very difficult since
the victim and/or bystanders may be very frightened
after the traumatic incident.
m Surgery is sometimes necessary to, stabilize fractured
back bones, decompress (or release) the pressure from
the injured area, and to manage any other injuries that
may have been a result of the accident. Treatment is
individualized, depending on the extent of the
condition and the presence of other injuries.
Treatments may include:
m Observation and medical management in the
intensive care unit (IJ )
m 6edications, such as corticosteroids (to help
decrease the swelling in the spinal cord)
m 6echanical ventilator, a breathing machine (to
help the patient breathe)
m Foley catheter Ȅ a tube that is placed into the
bladder that helps to drain the urine into a
collection bag.
m Feeding tube (placed through the nostril to the
stomach, or directly through the abdomen into the
stomach, to provide extra nutrition and calories)
m èeart function
m Blood pressure
m Body temperature
m Nutritional status
m Bladder and bowel function and
m Spasticity (attempt to control involuntary muscle
shaking)
m Life-long considerations for a person with a SJI
m A traumatic event that results in a SJI is devastating to
the person and the family. The healthcare team
educates the family after hospitalization and
rehabilitation on how to best care for the person at
home and outlines specific clinical problems that
require immediate medical attention by the patientǯs
physician.
m The disabled person requires a focus on maximizing
his/her capabilities at home and in the community.
Positive reinforcement will encourage him/her to
strengthen his/her self-esteem and promote
independence.
m A person with a SJI requires frequent medical
evaluations and diagnostic testing following
hospitalization and rehabilitation to monitor his/her
progress.
1. Impaired bowel elimination r/t loss of nerve
conduction above the level of reflex arc
2. Impaired urinary elimination r/t loss of
nerve conduction above the level of the
reflex arc
3. Impaired physical mobility related to
neuromuscular impairment.
4. Activity intolerance r/t neuromuscular
impairment
m Assisted with physical m To asses causative/
examination (palpation contributing factors
the abdomen)
m Determined clientǯs m To help determine level
usual daily fluid intake, of hydration
noted condition of skin
and mucous membrane
m Ascertained clients
m For comparison with
previous pattern of
elimination current situation
m Encouraged fluid intake m For hydration
up to 3000 or more m/L
per day
m Encouraged client to
m Open expression allows
verbalize fears/concern client to deal with
about his condition feelings and begin
problem solving
m Administered m To help bowel
medication as ordered elimination
m Palpated for bladder
distention and observed
for over flow
m Encouraged to increase
his oral fluid intake up to
3,000 or more mL per
day
m Kept bladder deflated by
use of an IFJ
m Bladder dysfunction is
variable but may include
loss of bladder
contraction
m To maintain renal
function and to prevent
infection and formation
of urinary stones
m To empty the bladder
m Emphasized importance m To reduce risk of
of keeping area clean and infection
dry
m Demonstrated proper m To facilitate drainage and
positioning of catheter to prevent reflux
drainage tubing and bag
m Jontinually asses motor
function by requesting
patient to perform certain
actions.
m Assist in range of motion
exercises on all extremities
and joints, using slow,
smooth movements.
m Evaluates status of
individual situation
(motor-sensory
impairment may be mixed
and/ or not clear) for a
specific level of injury,
affecting type and choice of
intervention.
m Enhances circulation,
restores or maintains
muscle tone and joint
mobility, and prevent
disuse contractures and
muscle atrophy.
m Plan activities to provide m Prevents fatigue,
uninterrupted rest allowing opportunity for
periods. Encourage maximal efforts or
involvement within participations by patient.
individual tolerance or
ability.
m Reposition periodically
m Reduces pressure areas,
even when sitting in promotes peripheral
chair. Teach patient how circulation.
to use weight-shifting
techniques.
m Inspect the skin daily.
Observe for pressure m Altered circulation, loss
areas, and provide of sensation, and
meticulous skin care. paralysis potentiate
m pressure sore formation.
m Jonsult with physical m èelpful in planning and
therapist. implementing
individualized exercise
program and identifying
or developing assistive
devices to maintain
function enhance
mobility and
independence.
m Evaluated clients actual
and perceive limitations/
degree of deficit in light
of usual status
m Symptoms may results
m Noted clientǯs report of
weakness, fatigue, pain
and difficulty
accomplishing his task.
m To provide comparative
baseline and provide
information about
needed education/
intervention regarding
quality of life
of/or contribute to
intolerance of activity
m Ascertained ability to m To determined current
move about and degree status and needs
of assistance necessary associated with
use of equipment participation in needed
desired activities.
m Assist with activities m To protect from injury
and provide/ monitor
clients use of assistive
devices
m Promote comfort
m To enhanced the ability
measures and provide to participate in activities
relief of pain
m
m Repositioning every 2 m To prevent bedsore and
hours to maintain body
alignment all the time.
m 6ade repositioning m To prevent bedsore and
schedule and post at to promote circulation.
bedside and educated
the patientǯs S.O in
proper turning the
patient
[







The spinal disc is a soft cushion that sits between
each vertabrae of the spine. This spinal disc
becomes more rigid with age. In a young
individual, the disc is soft and elastic, but like so
many other structures in the body, the disc
gradually looses its elasticity and is more
vulnerable to injury. In fact, even in individuals as
young as 30, 6RIs show evidence of disc
deterioration in about 30% of people.
[









As the spinal disc becomes less elastic, it can
rupture. When the disc ruptures, a portion of the
spinal disc pushes outside its normal boundary--
this is called a herniated disc. When a herniated
disc bulges out from between the vertebrae, the
spinal nerves and spinal cord can become pinched.
There is normally a little extra space around the
spinal cord and spinal nerves, but if enough of the
herniated disc is pushed out of place, then these
structures may be compressed.
[







 




When the herniated disc ruptures and pushes out,
the nerves may become pinched. A herniated disc
may occur suddenly in an event such as a fall or an
accident, or may occur gradually with repetitive
straining of the spine. Often people who
experience a herniated disc already have spinal
stenosis, a problem that causes narrowing of the
space around the spinal cord and spinal nerves.
When a herniated disc occurs, the space for the
nerves is further diminished, and irritation of the
nerve results.
m Π
’ 

Pressure on the nerve can cause abnormal sensations,
commonly experienced as electric shock pains. When the
compression occurs in the cervical (neck) region, the
shocks go down your arms, when the compression is in the
lumbar (low back) region, the shocks go down your legs.
m   


Patients often have abnormal sensations such as tingling,
numbness, or pins and needles. These symptoms may be
experienced in the same region as painful electric shock
sensations.
m 6
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Because of the nerve irritation, signals from the brain may
be interrupted causing muscle weakness. Nerve irritation
can also be tested by examining reflexes.
m 0   0
 

These symptoms are important because it may be a
sign of cauda equina syndrome, a possible condition
resulting from a herniated disc. 




! and your should V



  




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m All of these symptoms are due to the irritation of the
nerve from the herniated disc. By interfering with the
pathway by which signals are sent from your brain out
to your extremities and back to the brain, all of these
symptoms can be caused by a herniated disc pressing
against the nerves.