Spinal Cord Injury

Altruism

Unselfish concern for the welfare of others as described in the AOTA Code of Ethics

Dignity

Valuing the inherent worth and uniqueness of each person in the AOTA Code of Ethics

Equality

The ethical principle that ensures all individuals are perceived as having the same fundamental human rights and opportunities

Prudence

The ability to govern and discipline oneself through the use of reason in ethical decision-making

Create (Bloom's Taxonomy)

The highest level of cognitive processing involving generating new ideas, products, or perspectives

Remember (Bloom's Taxonomy)

The level of cognition involving recognizing and recalling facts and basic concepts

Social Determinants of Health (SDH)

Non-medical factors that influence health outcomes according to the World Health Organization

Examples of Social Determinants of Health

Income and social protection, education, and unemployment or job insecurity

Critical thinking

The process of purposeful, self-regulatory judgment as defined by the Delphi Report (1990)

Elements of Thought (Paul & Elder)

Eight components used to analyze and improve critical thinking

Assumptions

Presuppositions or beliefs taken for granted within the Elements of Thought model

Interpretation and Inference

The element of thought involving conclusions or solutions drawn from data

Cervical vertebrae

Seven vertebrae located in the neck region of the spine

Thoracic vertebrae

Twelve vertebrae located in the mid-back associated with the rib cage

Lumbar vertebrae

Five vertebrae located in the lower back responsible for weight bearing

Cervical nerves

Spinal nerves that innervate the head, neck, diaphragm, arms, and hands

Thoracic nerves

Spinal nerves that primarily innervate the chest and upper abdominal muscles

Sacral nerves

Spinal nerves responsible for bowel, bladder, and sexual functioning

Leading cause of traumatic SCI

Vehicle crashes since 2015

SCI gender distribution

Approximately 79 percent of new traumatic spinal cord injury cases are male

Spinal shock

A temporary state of flaccid paralysis and loss of reflexes and autonomic function following SCI

Neurological Level of Injury (NLI)

The lowest spinal segment with normal bilateral sensory and antigravity motor function

ASIA Impairment Scale

The international standard tool for neurological classification of spinal cord injury

Dermatome

A skin segment that receives sensory innervation from a single spinal nerve

Tetraplegia

Impairment or loss of motor and sensory function in the cervical segments affecting arms, trunk, legs, and pelvic organs

Paraplegia

Impairment of motor and sensory function in thoracic, lumbar, or sacral segments with arm function spared

ASIA Grade A

Complete injury with no sensory or motor function preserved in sacral segments S4-S5

ASIA Grade E

Normal sensory and motor function in all spinal segments

Motor level determination in SCI

Assessed by testing ten key muscles on each side using manual muscle testing

SCI recovery timeline

Most neurological recovery occurs within three months following injury

Central Cord Syndrome

An incomplete SCI characterized by greater weakness in upper extremities than lower extremities

Brown-Sequard Syndrome sensory pattern

Ipsilateral loss of proprioception and vibration with contralateral loss of pain and temperature

Cause of Central Cord Syndrome in older adults

Falls or cervical stenosis

Laminectomy

A surgical procedure that removes part of a vertebra to relieve pressure on the spinal cord

SOMI brace

Sternal Occipital Mandibular Immobilizer used for cervical stabilization

Post-spinal surgery precautions

No bending past 90 degrees, no lifting typically greater than five to ten pounds, and no twisting

Respiratory intervention for high cervical SCI

Tracheostomy is commonly required

Orthostatic hypotension

A sudden drop in blood pressure when moving to an upright position

SCI level associated with orthostatic hypotension

Lesions at T6 and above

Signs of deep vein thrombosis

Unequal leg size, redness, swelling, warmth, and pain

Heterotopic ossification

Abnormal bone formation in soft tissue around a joint after SCI

Autonomic dysreflexia

A life-threatening condition involving sudden severe hypertension due to noxious stimuli below the lesion

SCI level associated with autonomic dysreflexia

Lesions at T6 and above

Common triggers of autonomic dysreflexia

Bladder distension, fecal impaction, and pressure ulcers

Primary symptom of autonomic dysreflexia

Pounding headache

First OT intervention for autonomic dysreflexia

Position the patient upright to lower blood pressure

Causes of pressure ulcers

Prolonged pressure, moisture, and shearing or friction

Skin redness time guideline

Redness should resolve within fifteen minutes after pressure relief

Wheelchair pressure relief schedule

One to two minutes of offloading every thirty minutes

Nociceptive pain

Pain caused by normal responses to noxious stimuli

Neuropathic pain

Pain often described as burning, sharp, or pins and needles

ASIA Grade B

Sensory incomplete injury with no motor function preserved more than three levels below the motor level

ASIA Grade D muscle requirement

At least half of key muscles below the NLI have a grade of three or greater

AD relief measures

Loosening abdominal binders and removing TED hose

Contextual factors (ICF)

Environmental factors and personal factors combined

Lateral corticospinal tract

Responsible for voluntary motor movement of the extremities

Lateral spinothalamic tract

Ascending pathway that transmits pain and temperature sensations

Fasciculus gracilis and cuneatus

Pathways responsible for conscious proprioception, vibration, and two-point discrimination

Atlas injury level

C1 dissociation from the occiput

Halo or spinal orthosis duration

Typically worn for ten to twelve weeks after surgical stabilization

T6 injury classification

Paraplegia

OT role in spasticity management

Preventing complications such as contractures, subluxations, and pressure ulcers

SCI and fertility

Women with SCI typically maintain fertility and can become pregnant

Tilt table purpose

Gradual progression from supine to upright to manage orthostatic hypotension

Leg bag check in autonomic dysreflexia

Ensures no obstruction causing bladder distension

Hard end feel in SCI

May indicate heterotopic ossification

ASIA Grade C

Motor incomplete injury with voluntary anal contraction or motor sparing more than three levels below motor level

Average age of SCI

Approximately forty-three years since 2015

Components of neurological assessment

Sensory level, motor level, and ASIA Impairment Scale grade