mod 9- spinal cord injuries

12-18 months

how long after a spinal cord injury for neural axons to regenerate?

heterotrophic ossification

abnormal bone growth in soft tissue, affecting ROM and causing pain and redness

Baclofen

kind of pump that is commonly used for medical treatment of spasticity

autonomic dysreflexia

disconnect between sympathetic and autonomic nervous systems that can cause elevated BP, headaches, stroke, or death

T6

at what level (or above) does a spinal injury have the potential to cause autonomic dysreflexia

time, exercise

what can help improve the symptoms of autonomic dysreflexia over time?

PF, hip extensors, foot

what muscles does a sacral SCI impact?

DF, hamstring, abductors

what muscles does a L5 SCI impact?

quads

what muscles does a L4 SCI impact?

hip flexors, adductors

what muscles does a L3 SCI impact?

L2

injuries at what level can cause paraplegia?

T4

injuries at what level can cause quadriplegia?

hip flexion

what motion is impacted by a L2 injury?

knee extension

what motion is impacted by a L3 injury?

DF

what motion is impacted by a L4 injury?

toe extension

what motion is impacted by a L5 injury?

PF

what motion is impacted by a S1 injury?

elbow flexion

what motion is impacted by a C5 injury?

wrist extension

what motion is impacted by a C6 injury?

elbow extension

what motion is impacted by a C7 injury?

finger flexion

what motion is impacted by a C8 injury?

finger abduction

what motion is impacted by a T1 injury

classification of SCI

what does ASIA score measure?

complete

A on ASIA score

motor loss complete, sensation intact

B on ASIA score

less than half of muscles below the lesion are grade 3 or better

C on ASIA score

more than half of muscles below lesion are grade 3 or better

D on ASIA score

normal

E on ASIA score

central cord syndrome

injury to the central region of the spinal cord, usually by hyperextension of the neck

Brown-Sequard syndrome

damage to one side of the spinal cord, causing motor loss on the affected side and sensory loss on the contralateral side

bullet, knife trauma

most common causes of Brown-Sequard syndrome

motor, sensory

Brown-Sequard syndrome involves (motor/sensory) loss on the side of the injury and (motor/sensory) loss on the contralateral side

anterior cord syndrome

injury that causes full motor loss and partial sensory loss but does NOT impact proprioception. Blood supply may be disrupted and prognosis is poor

proprioception

what sense is not affected in anterior cord syndrome?

posterior cord syndrome

injury that causes loss of vibration and proprioception, but intact motor and pain sensation. Prognosis for ambulation is poor

tumor, disk compression, hyperextension

causes of posterior cord syndrome

L1-2

what level does conus medullaris exit spinal cord

T10

at what level does conus medullaris start to form?

saddle anesthesia, upper and lower motor neuron involvement

symptoms of conus medularis injury

trauma, tumor

causes of conus medularis injury

motor and sensory loss, bowel and bladder may be affected

symptoms of cauda equina injury

good

ambulatory prognosis for cauda equina injury

herniated disc, tumor, lesion

causes of cauda equina injury

spina bifida

open neural tube defect associated with hydrocephalus

motor and sensory loss

neural presentation of spina bifida

hydrocephalus

build-up of fluid inside the head due to myelomeningocele from spina bifida

spina bifida occulta

most mild form of spina bifida

occulta

form of spina bifida where lower back bones fail to form properly. May have a hairy patch, dimple, or birthmark over the area of the defect

meningocele

moderate form of spina bifida

meningocele

form of spina bifida where a fluid-filled sac is visible outside of the back

sac does not contain spinal cord or nerves

key difference between meningocele and myelomeningocele

myelomeningocele

most severe form of spina bifida

myelomeningocele

form of spina bifida where the spinal cord and nerves develop outside of the body in a fluid-filled sac

weakness and loss of sensation below the defect, lack of bowel and bladder

other symptoms of myelomeningocele, besides the sac

lower back

where do 80% of myelomeningoceles occur?

swivel walker

which orthosis uses about 10x as much energy as regular walking to ambulate?

GI function, long bone loading

what can standing help with, in patients with spinal cord injuries?

30-60%

what do we aim for patients to have the speed of, compared to their peers?

sit-stand, independent transfer, independent don/doff, ambulate 75m in 1 minute and 250m without undue stress

functional ambulation goals

5d

what angle of DF is a Scott-Craig usually offset to?

18 mo-4 years

appropriate age range for a swivel walker

40”

up to what height does a swivel walker accommodate?

spina bifida, CP

diagnoses that are most commonly provided with a swivel walker

standing, sitting

movements allowed by ParaPod

swivel walker

what is this?

ParaPod

what is this?

2-6

appropriate age for ParaPod use

spina bifida

common diagnosis for ParaPod use

55 lbs

upper weight limit of Parapod

ParaPod

which of the orthoses covered in this lecture should be physically anchored to something while the patient is standing?

RGO

what is this?

4-12 yrs, or adults for exercise

appropriate age range for RGO

Isocentric

when used in an RGO, this option is very rigid and uses one pivot point

cable-driven

when used in an RGO, this option runs in parallel and is not very efficient

0d

degree of DF set in an RGO

reciprocating gait orthosis

what does RGO stand for?

looped cable

good cabling option for RGO for spina bifida patients if you need room for a meningocele

lean posterior and lateral

how to drive forward RGO

reverse/posterior

good kind of walker to use with an RGO so it doesn’t get in the way

rigidity

requirement for RGO to work properly

inside

in an RGO, do your shoes go inside or outside of the boot?

hip guidance orthosis

what does HGO stand for?

hip guidance orthosis

what kind of an orthosis is the Parawalker?

parawalker

what is this?

very rigid, poor compliance

why are Parawalkers not manufactured in the US anymore?

Walkabout

what is this?

perineal straps, abduction limit makes toileting difficult, slower than RGO

reasons for poor compliant for the Walkabout

lower profile, light, fits in wheelchair

benefits of using a Walkabout

MASP

what kind of joints does a Walkabout use?

C6

at what level of injury can a person still operate a manual wheelchair?

C5

at what level of injury can a person still operate a motor vehicle, with accommodations?

intact neural system

requirement for using FES in combination with an orthosis like an RGO

driven gait orthosis

what does DGO stand for?

powered, not covered by insurance

what makes a DGO unique?

EKSO

FDA-approved powered orthosis capable of 2 mph ambulation and variable terrain. Movements are first controlled by a PT and then adjust to user settings

EKSO

what is this?

Rex, robotic exoskeleton

what is this?

ReWalk

what is this?

wrist unit

what controls a ReWalk?

motor-assisted HKAFO approved by FDA

what is a ReWalk?