SPINAL CORD INJURY
Spinal Cord Injury is damage to the spinal cord that
results in a loss of function such as mobility or feeling.
Frequent causes of damage are trauma and disease
Clinical syndromes
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Central cord syndrome: hyperextension(common)
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Anterior spinal artery syndrome: flexion
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Loss of motor function, pain and temperature are lost
Brown sequard syndrome: gun shot or stab wound
causing injury to half of spinal cord
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More impairment in upper limb than lower limb
Ipsilateral motor and position sense and contralateral pain
is lost.
Posterior cord syndrome: injury to posterior spinal
artery all sensation of posterior column is lost. (rare)
Spinal Cord Paralysis Levels
C1-C3
 All daily functions must be totally assisted
 Breathing is dependant on a ventilator
 Motorised wheelchair controlled by sip and puff or chin movements is required
C4
 Same as C1-C3 except breathing can be done without a ventilator
C5
 Good head, neck, shoulder movements, as well as elbow flexion
 Electric wheelchair, or manual for short distances
C6
 Wrist extension movements are good
 Assistance needed for dressing, and transitions from bed to chair and car may
also need assistance
C7-C8
 All hand movements
 Ability to dress, eat, drive, do transfers, and do upper body washes
Spinal Cord Paralysis Levels
T1-T4 (paraplegia)
 Normal communication skills
 Help may only be needed for heavy household work or
loading wheelchair into car
T5-T9
 Manual wheelchair for everyday living
 Independent for personal care
T10-L1
 Partial paralysis of lower body
L2-S5
 Some knee, hip and foot movements with possible slow difficult
walking with assistance or aids
 Only heavy home maintenance and hard cleaning will need
assistance
Medical management
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Pharmacological management: methyleprednisolone
Surgical stabilization:
Phrenic nerve pacing electric stimulation of phrenic nerve –
above C3 lesion
Gardener wells tongs – 5 ponds (cervical)
Hard collar (Philadelphia collar) or SOMI (sterno-occipital
mandibular immobilizer)
6-8 weeks for bony fusion
Halo is used when surgery is not needed
Cervical stabilsation
Philadelphia collar
Halo
Thoracolumbar stabilisation
Jewett brace
EXAMINATION
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History: demographic data , level of activity.
Systemic review: vitals.
Aerobic capacity and endurance: autonomic response to position change.
Anthropometric measurements.
Adaptive devices.
Skin examination.
Motor examination.
Joint mobility.
Flexibility of essential muscles.
Pain
Posture
Reflex integrity.
Functional independence measure.
Respiratory system.
INTERVENTION
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Prevention and management
of joint contractures
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Tenodesis grasp
Hamstring
Shoulder rotators
Prevention and management
of respiratory complications
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Inspiratory muscle training
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Gentle pressure diaphragm
and ,intercostals
Glossopharyngeal breathing
Secretion clearance
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Quad coughing
Early mobilization
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Orthostatic hypotension
Abdominal binders.
Upright position as soon the fracture is stable
Bladder management
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Reflex bladder - low pressure voiding
Nonreflex bladder- intermittent catheterization
Home management
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Bed mobility
Pressure relief
Wheel chair transfer