Spinal Cord Injuries
• A spinal cord injury (SCI) is an injury to the
spinal cord resulting in a change, either
temporary or permanent, in the spinal cord's
normal motor, sensory, or autonomic
function.
Causes
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Traumatic
Motor Vehicle Accidents
Work-related accidents
Sports injuries
Penetrating trauma (Eg: Stab and Gunshot
wounds)
Non-traumatic
Infection (Eg: Transverse Myelitis)
Malignancy (Eg: Spinal tumors)
Spinal cord vascular disease
Classification of SCI
I. Complete Spinal cord Injury (No Motor or
Sensory function present below the level of
Injury)
II. Incomplete Spinal cord Injury (Some Motor
or Sensory function present below the level
of Injury)
Types of Incomplete Spinal cord Injury
1. Central Cord Syndrome : (Caused by Hyperextension of
neck)
 Injury to the center of the cord
 Motor weakness and sensory loss in all extremities (Upper
extremities affected more than Lower extremities)
2. Anterior Cord Syndrome : (Caused by Flexion type injuries
Cervical spine)
 Injury to the anterior portion of the cord
 Below the level of injury –
 There is loss of Motor functions and sensations like Pain,
touch and temperature.
 Proprioceptive sensations are not affected.
Types of Incomplete Spinal cord Injury (Contd)
3. Posterior Cord Syndrome : (Very rare type of injury)
 Injury to the posterior portion of the cord
 Below the level of injury –
 There is loss of Proprioceptive sensations.
 Motor functions and sensations like Pain, touch and
temperature are not affected.
4. Brown –Sequard Syndrome : (Hemisection of the Spinal Cord
Caused by Stab or Gunshot injuries)
 Below the level of injury –
 There is loss of Motor functions and Prioprioceptive
sensations in the same side (Ipsilateral).
 There is loss of sensations like Pain, touch and temperature in
the opposite side (Contralateral).
Spinal Cord Paralysis Levels
C1-C3 Level
• 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 Level
• Same as C1-C3 except breathing can be done without a ventilator
C5 Level
• Good head, neck, shoulder movements, as well as elbow flexion
• Electric wheelchair, or manual for short distances
C6 Level
• Wrist extension movements are good
• Assistance needed for dressing, and transitions from bed to chair
and car may also need assistance
C7-C8 Level
• All hand movements
• Ability to dress, eat, drive, do transfers, and do upper body washes
Spinal Cord Paralysis Levels
T1-T4 Level
• Normal communication skills
• Help may only be needed for heavy household work or
loading wheelchair into car
T5-T9 Level
• Manual wheelchair for everyday living
• Independent for personal care
T10-L1 Level
• Partial paralysis of lower body
L2-S5 Level
• 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
Diagnosis
Neurological Examination
• Motor examination
• Sensory examination
• Reflex examination
Medical Imaging
• X- ray
• CT Scan
• MRI Scan
Management of Spinal Cord Injuries
• Immediate management at the scene is
important.
• Improper handling can cause further damage
• Always assume there is a spinal cord injury until
it is ruled out. So patient should be
– Immobilized
– Prevent flexion, rotation or extension of neck
– Avoid twisting patient
• If conscious, patients will usually mention acute
pain in back or neck which may radiate along
the involved nerve
Physical Therapy Management in
Acute Phase
• Respiratory Management (Removal of
Secretions)
• Maintaining range of Motion
• Prevention of Secondary complications like
Pressure sores and DVT
• Active exercises to un affected muscles.
Post acute Physical Management
This depends upon level of injury
• Abdominal binders and use of Tilt table for
postural hypotension
• Gait rehabilitation using appropriate orthosis and
walking aid (Eg : KAFO and Elbow crutches)
• Wheel chair training and transfers
• Self skin inspection and pressure relief
• Breathing exercises
• Home and environmental modification for wheel
chair access
• Vocational rehabilitation.