Ch. 5 - SCI

What percentage of spinal cord injuries (SCIs) are classified as "complete"?

"About 45%"

What defines a "complete" spinal cord injury?

"Total loss of sensorimotor and autonomic function below the level of injury"

What percentage of SCIs are classified as "incomplete"?

"About 55%"

What defines an "incomplete" spinal cord injury?

"Partial loss of function, resulting in a lot of variation between individuals"

What are the two major exercise-related problems caused by spinal cord injury?

"Reduced ability to voluntarily perform large-muscle-group aerobic exercise, and inability to stimulate the autonomic/cardiovascular systems to support higher aerobic metabolism

What does FES-LCE stand for?

"Functional electrical stimulation-leg cycle ergometry"

Why is FES-LCE used in people with SCI?

"To allow voluntary large-muscle-group aerobic exercise using paralyzed leg muscles"

What thermoregulatory issue is common after SCI?

"Thermoregulation may be impaired"

What does impaired autonomic/cardiovascular stimulation translate to during exercise after SCI?

"It restricts exercise cardiac output (CO) to subnormal levels"

What is excessive venous pooling?

"A condition where venous walls and/or valves in the leg veins do not work effectively, making it difficult for blood to return to the heart from the legs"

Name four common secondary complications during exercise after SCI.

"Excessive venous pooling, venous atrophy, orthostatic and exercise hypotension, and exercise intolerance"

What important term describes a drop in blood pressure during rest or exercise after SCI?

"Orthostatic and exercise hypotension"

What is autonomic dysreflexia?

"A sudden onset of excessively high blood pressure"

In which spinal cord injury population is autonomic dysreflexia most common?

"People with SCI involving the thoracic nerves at or above T6"

At what spinal level is autonomic dysreflexia most likely to occur?

"T6 or above"

What overall lifestyle pattern commonly develops with tetraplegia?

"A sedentary lifestyle with profound deconditioning of many physiologic systems"

Name three physiologic effects of deconditioning in people with tetraplegia.

"Exacerbated mobility impairment, bone demineralization, and myocardial and skeletal muscle atrophy"

What body composition changes occur with tetraplegia-related deconditioning?

"Decreased lean body mass, decreased body water content, decreased blood volume, and increased percentage of body fat"

What percentage of people with spina bifida (SB) develop scoliosis?

"80%"

How is scoliosis in people with SB often treated?

"With spinal fusion"

Why might children with SB who walk with assistive devices need orthopedic surgeries?

"Stress and strain on spinal and lower-extremity joints can cause deformities requiring correction"

Name three orthopedic deformities that may require surgery in people with SB.

"Scoliosis, hip subluxation or dislocation, and Achilles tendon contracture"

What upper-extremity overuse conditions may affect lifelong wheelchair users?

"Carpal tunnel syndrome, tendinitis, and arthritis"

What bone condition is common in people with flaccid paralysis of the lower extremities who use wheelchairs?

"Osteoporosis"

What are the symptoms of painless fractures that osteoporosis can cause in wheelchair users?

"Local redness,deformity, or fever"

What self-care area requires close attention in wheelchair users with SB due to fracture and pressure risk?

"Skin care and hygiene"

What often happens during adolescence in people with SB that interferes with ambulation?

"Weight gain, which precludes efficient upright ambulation and forces reliance on a manual wheelchair"

What vicious cycle can result from weight gain and reduced ambulation in adolescents with SB?

"Further weight gain, inactivity, and progressive deconditioning and declining health/functional independence"

How can extensive lower-extremity paralysis affect exercise in people with SB?

"It can reduce the ability to voluntarily perform large-muscle-group aerobic exercise"

Under what condition is FES usually not an option for people with SB?

"Unless the neurologic level of the lesion is above L1"

What aerobic exercise options exist for ambulatory people with SB?

"Walking or jogging on a treadmill, or arm-crank ergometry, or a combination of both"

What type of exercise is recommended to maintain balanced strength and flexibility in the upper extremities for people with SB?

"Therapeutic exercises"

What conditions do upper-extremity therapeutic exercises help prevent in lifelong wheelchair or crutch users?

"Nerve entrapment syndromes and degenerative joint disease"

What percentage of people with spina bifida have an allergic hypersensitivity to latex?

"About 70%"

What causes autonomic dysreflexia to be a medical emergency?

"It involves a sudden, excessively high spike in blood pressure"

What is the difference between complete and incomplete SCI in terms of function?

"Complete SCI causes total loss of sensorimotor and autonomic function below the injury level, while incomplete SCI causes only partial loss with variable presentation"

Why is voluntary large-muscle aerobic exercise difficult after SCI without FES-LCE?

"Because paralyzed leg muscles cannot be voluntarily engaged for large-muscle-group aerobic activity"

What increases the risk of upper-extremity overuse syndromes in both tetraplegia and SB populations?

"Long-term reliance on a wheelchair or crutches for mobility"

What vascular condition, in addition to venous pooling, contributes to secondary complications during exercise after SCI?

"Venous atrophy"