Physioth. Theory: spinal cord injury
introducTION
A Spinal Cord Injury (SCI) is damage or trauma to the spinal cord that results in a loss or impaired function
causing reduced mobility or feeling
Paraplegia: impaired function in trunk and lower limbs
Tetraplegia: impaired function in upper limbs, trunk and lower limbs
- = quadriplegia
ETIOLOGY
Incidence: 1- 000 a year
- = ± 200 in Belgium
Tetra/paraplegia: 50/50
Complete/Incomplete: 50/50
Tendency towards more tetra, more incomplete
LOSS OF FUNCTION
MOTOR FUNCTION
Usually the upper limb were you will see the clear cut
Welke spieren aangedaan op welk level
SENSIBILITY
Touch
Pressure
Temperature
Pain
Proprioception
Vibration
AUTONOMIC
Cranial nerves are usually in tact
Nala Melis Pagina 1
, Physioth. Theory: spinal cord injury
SPINAL CORD ANATOMY
Complete transection = complete
loss of function
- Maar 30% complete leasie
Incomplete transection
- Amount of damage
- Neuro-anatomy
Posterior or anterior cord syndrome
- Posterior
Proprio + vibration + touch
- Anterior
Motor + pain + crude touch
- Vascularisation: specific symptoms as it is vascularised by its specific arteries
Sustained pressure: central cord
- Nerve roots that are about to exit the …
- C4-C6 lesion: arms are affected
- C5 is ernstig aangedaan
Aangedaanheid mindert naarmate verder naar distaal
o C6 minder
o C7 nog minder,…
Kan dus armen niet gbruiken of deze zijn het meeste aangedaan
C5 is in midden RM
o Door inhibiting bloedflow àhoe dieper deze moet gaan hoe moeilijker te bevoeien
Cauda equina (L2-S5)
- = lower motor neuron lesion
- Lage leasie
- Lijkt meer op perfire zenuwaandoening maar is wel aandoening van RM
- Geen spasticiteit à refexboog niet aangedaan
CONSEQUENCES
FUNCTIONALITY
Everything is going to happen in a different way!
RESPIRATORY
Inspiratory = innervated high
Expiratory = innervated lower
- most problems in SCI
- Meeste aangedaan
- Hoesten ook bemoeilijjkt
Central cord
- inspiratory functions > expiratoir
Higher risk of:
- Insufficiency
- mucus production
- obstructive sleep apnea (OSA)
- atelectasis
- pneumonia / bronchitis (lange termijjn)
second most common cause of death
SPASTICITY
Nala Melis Pagina 2
, Physioth. Theory: spinal cord injury
Definition: “spasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch reflexes
(muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflexes, as one
component of the upper motor neuron syndrome.”
70% of patients:
- Loss of inhibiting nerve tracts
- Acute: spinal shock
First 2-3 weeks everything will be hypotonia
- Big differences between patients and compared to patients with other upper motor pathologies
- Hoe vroeger de spasticiteit komt, hoe hoger deze gaat evolueren
Negative effects Positive effects
- Functional - Trophicity
- Pain - Blood perfusion
- Contractures - Functional àin balans krijgen om functioneel te gebruiken
- Decubitus àdoor willekeurige bewegingen Extension spasticity can be handy to stand up
- Relaxation/sleep muscles working so they ask for blood perfusion
Not the goal to get rid of spasticity, but to find the balance between negative and positive effects
1. TREATMENT
Oral (Lioresal, …)
- Small effects, long way to get to muscle
- Veel effectiviteit verloren door lange weg af te leggen
- Veel bijwerkingen
Intrathecal baclofen
- Less side effects, higher dose at the level it is needed
- It is an invasive treatment! It needs to be filled (4-5m) and pump needs to be replaced (8-10y)
- It is all or nothing, so it is good for P with not so much functionality
- Best for P that are not walking, and it works best for trunk and LL because the catheter is not able to be
places really high
- Rechtstreeks in RM
- Hogere dosis geven zonder de bijwerkingen
- Geen specifieke spieren behandelen
- Meer werking op benen dan armen & handen
Botox
- Works for 6 months
- Zeer spier specifiek
- Maar beperkte hoeveelheid geven want wordt indine te hoog toxisch
Mobilization?
- It does work, it lower spasticity for a short term of time
- Kan helpen voor verlagen
- Stijgt terug na een paar uur
- Doen als voorbereiding op oefentherapie
Functional electrostimulation (FES)?
- Short term, for few hours it works, but no long term effect
Shockwave ?
- It works a bit longer (days – weeks) but not sure what the LT effects are
- Main benefit = choose what muscle you want to have an effect on (~botox)
- nu experimeneren
- LT-effecten nog onderzoeken
- Doet wa hetzelfde als botox
Neurotomy / rhizotomy
Nala Melis Pagina 3
introducTION
A Spinal Cord Injury (SCI) is damage or trauma to the spinal cord that results in a loss or impaired function
causing reduced mobility or feeling
Paraplegia: impaired function in trunk and lower limbs
Tetraplegia: impaired function in upper limbs, trunk and lower limbs
- = quadriplegia
ETIOLOGY
Incidence: 1- 000 a year
- = ± 200 in Belgium
Tetra/paraplegia: 50/50
Complete/Incomplete: 50/50
Tendency towards more tetra, more incomplete
LOSS OF FUNCTION
MOTOR FUNCTION
Usually the upper limb were you will see the clear cut
Welke spieren aangedaan op welk level
SENSIBILITY
Touch
Pressure
Temperature
Pain
Proprioception
Vibration
AUTONOMIC
Cranial nerves are usually in tact
Nala Melis Pagina 1
, Physioth. Theory: spinal cord injury
SPINAL CORD ANATOMY
Complete transection = complete
loss of function
- Maar 30% complete leasie
Incomplete transection
- Amount of damage
- Neuro-anatomy
Posterior or anterior cord syndrome
- Posterior
Proprio + vibration + touch
- Anterior
Motor + pain + crude touch
- Vascularisation: specific symptoms as it is vascularised by its specific arteries
Sustained pressure: central cord
- Nerve roots that are about to exit the …
- C4-C6 lesion: arms are affected
- C5 is ernstig aangedaan
Aangedaanheid mindert naarmate verder naar distaal
o C6 minder
o C7 nog minder,…
Kan dus armen niet gbruiken of deze zijn het meeste aangedaan
C5 is in midden RM
o Door inhibiting bloedflow àhoe dieper deze moet gaan hoe moeilijker te bevoeien
Cauda equina (L2-S5)
- = lower motor neuron lesion
- Lage leasie
- Lijkt meer op perfire zenuwaandoening maar is wel aandoening van RM
- Geen spasticiteit à refexboog niet aangedaan
CONSEQUENCES
FUNCTIONALITY
Everything is going to happen in a different way!
RESPIRATORY
Inspiratory = innervated high
Expiratory = innervated lower
- most problems in SCI
- Meeste aangedaan
- Hoesten ook bemoeilijjkt
Central cord
- inspiratory functions > expiratoir
Higher risk of:
- Insufficiency
- mucus production
- obstructive sleep apnea (OSA)
- atelectasis
- pneumonia / bronchitis (lange termijjn)
second most common cause of death
SPASTICITY
Nala Melis Pagina 2
, Physioth. Theory: spinal cord injury
Definition: “spasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch reflexes
(muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflexes, as one
component of the upper motor neuron syndrome.”
70% of patients:
- Loss of inhibiting nerve tracts
- Acute: spinal shock
First 2-3 weeks everything will be hypotonia
- Big differences between patients and compared to patients with other upper motor pathologies
- Hoe vroeger de spasticiteit komt, hoe hoger deze gaat evolueren
Negative effects Positive effects
- Functional - Trophicity
- Pain - Blood perfusion
- Contractures - Functional àin balans krijgen om functioneel te gebruiken
- Decubitus àdoor willekeurige bewegingen Extension spasticity can be handy to stand up
- Relaxation/sleep muscles working so they ask for blood perfusion
Not the goal to get rid of spasticity, but to find the balance between negative and positive effects
1. TREATMENT
Oral (Lioresal, …)
- Small effects, long way to get to muscle
- Veel effectiviteit verloren door lange weg af te leggen
- Veel bijwerkingen
Intrathecal baclofen
- Less side effects, higher dose at the level it is needed
- It is an invasive treatment! It needs to be filled (4-5m) and pump needs to be replaced (8-10y)
- It is all or nothing, so it is good for P with not so much functionality
- Best for P that are not walking, and it works best for trunk and LL because the catheter is not able to be
places really high
- Rechtstreeks in RM
- Hogere dosis geven zonder de bijwerkingen
- Geen specifieke spieren behandelen
- Meer werking op benen dan armen & handen
Botox
- Works for 6 months
- Zeer spier specifiek
- Maar beperkte hoeveelheid geven want wordt indine te hoog toxisch
Mobilization?
- It does work, it lower spasticity for a short term of time
- Kan helpen voor verlagen
- Stijgt terug na een paar uur
- Doen als voorbereiding op oefentherapie
Functional electrostimulation (FES)?
- Short term, for few hours it works, but no long term effect
Shockwave ?
- It works a bit longer (days – weeks) but not sure what the LT effects are
- Main benefit = choose what muscle you want to have an effect on (~botox)
- nu experimeneren
- LT-effecten nog onderzoeken
- Doet wa hetzelfde als botox
Neurotomy / rhizotomy
Nala Melis Pagina 3
