Spinal Cord & Column Information
The spinal column,
more commonly called the backbone, is made up primarily of vertebrae, discs,
and the spinal cord. Acting as a communication conduit for the brain, signals
are transmitted and received through the spinal cord.
When an injury to the
spinal cord occurs the flow of information from that point down is stopped.
This break in instructions to the arms, legs, and other parts of the body will
prevent the individual from moving, sometimes breathing, and obstructs or stops
any sense of feeling or touch.
General Overview
Spinal
Cord & Column
The spinal column is
separated into 5 specific functional areas.
• Cervical / C 1-7
• Thoracic / T 1 - 12
• Lumbar / L 1 - 5
• Sacral
• Coccyx
The spinal cord is a
bundle of nerve cells and fibers wrapped together extending down from the brain
stem to the lower back. The cord is protected by a kind of bone tunnel made up
of vertebrae which are separated by membranes called discs. The brain sends
electrical signals through the spinal cord, giving instructions to the legs,
arms, and other areas of the body.
Vertebrae
There are 33 vertebrae
that make up the bone structure of the spinal column, with the last four being
fused together to make the tailbone.
Discs
Each vertebrae is
separated by a soft bone substance, called a disc, which acts as a cushion and
a seal at the same time.
Complete &
Incomplete SCI
An SCI is categorized
as either "complete" or "incomplete". A
"complete" SCI means a total loss of function and sensation below the
affected vertebrae, and an "incomplete" SCI means only partial loss
of function or
sensation.
BONY ANATOMY
Cervical
Spine
There are seven
cervical bones or vertebrae. The cervical bones are designed to allow flexion,
extension, bending, and turning of the head. They are smaller than the other
vertebrae, which allows a greater amount of movement.
Each cervical vertebra
consists of two parts, a body and a protective arch for the spinal cord called
the neural arch. Fractures or injuries can occur to the body, lim pedicles, or
processes. Each vertebra articulates with the one above it and the one below
it.
Thoracic
Spine
In the chest region
the thoracic spine attaches to the ribs. There are 12 vertebrae in the thoracic
region.
The spinal canal in
the thoracic region is relatively smaller than the cervical or lumbar areas.
This makes the thoracic spinal cord at greater risk if there is a fracture.
The motion that occurs
in the thoracic spine is mostly rotation. The ribs prevent bending to the side.
A small amount of movement occurs in bending forward and backward.
Lumbosacral
Spine
The lumbar vertebrae
are large, wide, and thick. There are five vertebrae in the lumbar spine. The
lowest lumbar vertebra, L5, articulates with the sacrum. The sacrum attaches to
the pelvis.
The main motions of
the lumbar area are bending forward and extending backwards. Bending to the
side also occurs.
NEUROANATOMY
Just like the spinal
column is divided into cervical, thoracic, and lumbar regions, so is the spinal
cord. Each portion of the spinal cord is divided into specific neurological
segments.
The cervical spinal
cord is divided into eight levels. Each level contributes to different
functions in the neck and the arms. Sensations from the body are similarly
transported from the skin and other areas of the body from the neck, shoulders,
and arms up to the brain.
In the thoracic region
the nerves of the spinal cord supply muscles of the chest that help in
breathing and coughing. This region also contains nerves in the sympathetic
nervous system.
The lumbosacral spinal
cord and nerve supply legs, pelvis, and bowel and bladder. Sensations from the
feet, legs, pelvis, and lower abdomen are transmitted through the lumbosacral
nerves and spinal cord to higher segments and eventually the brain.
Nerve
Pathways
There are many nerve
pathways that transmit signals up and down the spinal cord. Some supply
sensation from the skin and outer portions of the body. Others supply sensation
from deeper structures such as the organs in the belly, the pelvis, or other
areas. Other nerves transmit signals from the brain to the body. Still others
work at the level of the spinal cord and act as "go betweens" in the
signal transmission process.
The
Motor Neuron
The upper motor neuron
refers to injuries that are above the level of the anterior horn cell. This
results in a spastic type of paralysis. Conversely, the lower motor neuron
injury refers to an injury at or below the anterior horn cell that results in
the flaccid type paralysis. The terms neurogenic bowel and neurogenic bladder
are used to describe abnormal bowel and bladder function and can be classified
as either an upper motor neuron or lower motor neuron type of problem. In
general, those patients with an upper motor neuron paralysis will have an upper
motor neuron bowel and bladder, and those with lower motor neuron injuries will
have a lower motor neuron picture of the bowel and bladder. Adequate bowel and
bladder management is critical for adequate reintegration of the patient/client
into the community and hopefully into the work place.
Sensory
Pathways
Feelings from the body
such as hot, cold, pain, and touch, are transmitted to the skin and other parts
of the body to the brain where sensations are "felt". These pathways
are called the sensory pathways.
Once signals enter the
spinal cord, they are sent up to the brain. Different types of sensation are
sent in different pathways, called "tracts". The tracts that carry
sensations of pain and temperature to the brain are in the middle part of the
spinal cord. These tracts are called the "spinothalamic". Other
tracts carry sensation of position and light touch. These nerve impulses are
carried along the back part of the spinal cord in what are called "dorsal
columns" of the spinal cord.
Autonomic
Nerve Pathways
Another type of
special nerves are the autonomic nerves. In spinal cord injuries, they are very
important. The autonomic nerves are divided into two types: the sympathetic and
parasympathetic nerves.
The autonomic nervous
system influences the activities of involuntary (also known as smooth) muscles,
the heart muscle, and glands that release certain hormones. It controls
cardiovascular, digestive, and respiratory systems. These systems work in a generally
"involuntary" fashion. The primary role of the autonomic nervous
system is to maintain a stable internal environment within the body. The heart
and blood vessels are controlled by the autonomic nervous system. The
sympathetic nerves help to control blood pressure based on the physical demands
placed on the body. It also helps to control heart rate. The sympathetic
nerves, when stimulated, cause the heart to beat faster.
Sympathetic
Nerves
The sympathetic nerves
also cause constriction of the blood vessels throughout the body. When this
happens, the amount of blood that is returned to the heart increases. These
effects will increase blood pressure. Other effects include an increase in
sweating and increased irritability or a sensation of anxiety.
When spinal cord
injury is at or above the T6 level the sympathetic nerves below the injury
become disconnected from the nerves above. They continue to operate
automatically once the period of spinal shock is over. Anything that simulates
the sympathetic nerves can cause them to become overactive. This over-activity
of the sympathetic nerves is what is called autonomic dysreflexia.
Parasympathetic
Nerves
The parasympathetic
nerves act in an opposite manner to the sympathetic nerves. These nerves tend
to dilate blood vessels and slow down the heart. The most important nerve that
carries parasympathetic fibers is the vagus nerve. This nerve carries
parasympathetic signals to the heart to decrease heart rate. Other nerves
supply the blood vessels to the organs of the abdomen and skin.
The parasympathetic
nerves arise from two areas. The fibers that supply the organs of the abdomen,
heart, lungs, and skin above the waist begin at the level of the brain and very
high spinal cord. The nerves that supply the reproductive organs, pelvis, and
leg begin at the sacral level, or lowest part of the spinal cord. After a
spinal cord injury, the parasympathetic nerves that begin at the brain continue
to work, even during the phase of spinal shock. When dysreflexia occurs, the
parasympathetic nerves attempt to control rapidly increasing blood pressure by
slowing down the heart.
Spinal Cord Injury Facts & Statistics
Who Do Spinal Cord Injuries Affect in the United States?
•
250,000 Americans are spinal cord injured.
•
52% of spinal cord injured individuals are considered
paraplegic and 47% quadriplegic.
•
Approximately 11,000 new injuries occur each year.
•
82% are male.
•
56% of injuries occur between the ages of 16 and 30.
•
The average age of spinal cord injured person is 31.
•
SCI injuries are most commonly caused by:
•
Vehicular accidents 37%
•
Violence 28%
•
Falls 21%
•
Sports-related 6%
•
Other 8%
•
The most rapidly increasing cause of injuries is due to
violence; vehicular accident injuries are decreasing in number.
•
89% of all SCI individuals are discharged from hospitals
to a private home, 4.3% are discharged to nursing homes.
•
Only 52% of SCI individuals are covered by private
health insurance at time of injury.
What Do Spinal Cord Injuries Really Cost?
•
Length of initial hospitalization following injury in
acute care units: 15 days
•
Average stay in rehabilitation unit: 44 days
•
Initial hospitalization costs following injury: $140,000
•
Average first year expenses for a SCI injury (all
groups): $198,000
•
First year expenses for paraplegics: $152,000
•
First year expenses for quadriplegics: $417,000
•
Average lifetime costs for paraplegics, age of injury
25: $428,000
•
Average lifetime costs for quadriplegics, age of injury
25: $1.35 million
•
Percentage of SCI individuals who are covered by private
health insurance at time of injury 52% - Compare health insurance atprivatemedicalhealthinsurance.org.uk
•
Percentage of SCI individuals unemployed eight years
after injury 63%. (Note: unemployment rate when this article was written was
4.7%)
•
Source:
The University of Alabama National Spinal Cord Injury Statistical Center -
March 2002
Spinal Cord Injury Statistical Information - NSCIA, 8/95
Although
there is more information available about people who have a spinal cord injury
than ever before, much of it is incomplete. Some of the statistical data is
summarized below per 8/95.
Number of New Injuries Per Year
32
injuries per million population or 7800 injuries in the US each year
Most
researchers feel that these numbers represent significant under- reporting.
Injuries not recorded include cases where the patient instantaneously or soon
after the injury, cases with little or no remaining neurological deficit, and
people who have neurologic problems secondary to trauma, but are not classified
as SCI. Researchers estimate that an additional 20 cases per million (4860 per
year) die before reaching the hospital.
Total Number of People with SCI
•
82% male, 18% female
•
Highest per capita rate of injury occurs between ages
16-30
•
Average age at injury - 33.4
•
Median age at injury - 26
•
Mode (most frequent) age at injury 19
•
Motor vehicle accidents are the leading cause of SCI
(44%), followed by acts of violence (24%),falls (22%) and sports (8%), other
(2%)
•
2/3 of sports injuries are from diving
•
Falls overtake motor vehicles as leading cause after age
45
•
Acts of violence and sports cause less injuries as age
increases
•
Acts of violence have overtaken falls as the second most
common source of spinal cord injury
•
Marital status at injury:
•
Single 53%
•
Married 31%
•
Divorced 9%
•
Other 7%
•
5 years post-injury:
•
88% of single people with SCI were still single vs. 65%
of the non-SCI population
•
81% of married people with SCI were still married vs.
89% of the non-SCI population
•
Employment status among persons between 16 and 59 years
of age at injury:
•
Employed 58.8%
•
Unemployed 41.2%
(includes: students, retired, and homemakers)
•
Employed 8 years post-injury:
•
Paraplegic 34.4%
•
Quadriplegic 24.3%
People
who return to work in the first year post-injury usually return to the same job
for the same employer. People who return to work after the first year
post-injury either worked for different employers or were students who found
work.
How are spinal injuries caused?
Until
the most recent figures were released by NSCIA in August, 1995, these were
considered as the major causes of spinal cord injuries. See Answer to # 4 and
Dr. Wise YoungÃs statistics in Section 2 for all the most recent
demographics. One of the most surprising findings is that acts of violence
have now overtaken falls as the second most common source of spinal cord
injury, as of the 1995 findings.
Previous To 1995:
· Motor
vehicles 48%
· Falls
21%
· Sports
14% (66% of which are caused in diving accidents)
· Violence
15%
· Other 2%
The Injury
Since
1988, 45% of all injuries have been complete, 55% incomplete. Complete injuries
result in total loss of sensation and function below the injury level.
Incomplete injuries result in partial loss. "Complete" does not
necessarily mean the cord has been severed. Each of the above categories can
occur in paraplegia and quadriplegia.
Except
for the incomplete-Preserved motor (functional), no more than 0.9% fully
recover, although all can improve from the initial diagnosis.
Overall,
slightly more than 1/2 of all injuries result in quadriplegia. However, the
proportion of quadriplegics increase markedly after age 45, comprising 2/3 of
all injuries after age 60 and 87% of all injuries after age 75.
92% of
all sports injuries result in quadriplegia.
Most
people with neurologically complete lesions above C-3 die before receiving
medical treatment. Those who survive are usually dependent on mechanical
respirators to breathe.
50% of
all cases have other injuries associated with the spinal cord injury.
Most Frequent Neurological Category
Quadriplegia,
incomplete 31.2%
Paraplegia,
complete 28.2%
Paraplegia,
incomplete 23.1%
Quadriplegia,
complete 17.5%
Hospitalization
(Important:
This section applies only to individuals who were admitted to one of the hospitals
designated as "Model" SCI centers by the National Institute of
Disability and Rehabilitation Research.)
Over 37%
of all cases admitted to the Spinal Cord Injury System sponsored by the NIDRR
arrive within 24 hours of injury. The mean time between injury and admission is
6 days.
Only
10-15% of all people with injuries are admitted to the NIDRR SCI system. The
remainder go to CARF facilities or to general hospitals in their local
community.
It is
now known that the length of stay and hospital charges for acute care and
initial rehabilitation are higher for cases where admission to the SCI system
is delayed beyond 24 hours. Average length of stay (1992):
Quadriplegics
95 days
Paraplegics
67 days
All 79
days
Average
charges (1990 dollars) Note: Specific cases are considerably higher.
Quadriplegics
$118,900
Paraplegics
$ 85,100
All $
99,553
Source
of payment acute care:
Private
Insurance 53%
Medicaid
25%
Self-pay
1%
Vocational
Rehab 14%
Worker's
Comp 12%
Medicare
5%
Other 2%
Ongoing
medical care: (Many people have more than one source of payment.)
Private
Insurance 43%
Medicare
25%
Self-pay
2%
Medicaid
31%
Worker's
Compensation 11%
Vocational
Rehab 16%
After the Hospital
Residence
at discharge
Private
Residence 92%
Nursing
Home 4%
Other
Hospital 2%
Group
Home 2%
There is
no apparent relationship between severity of injury and nursing home admission,
indicating that admission is caused by other factors (i.e. family can't take
care of person, medical complications, etc.) Nursing home admission is more
common among elderly persons.
Each
year 1/3 to 1/2 of all people with SCI are re-admitted to the hospital. There
is no difference in the rate of re-admissions between persons with paraplegia
and quadriplegia, but there is a difference between the rate for those with
complete and incomplete injuries.
Survival
Overall,
85% of SCI patients who survive the first 24 hours are still alive 10 years
later, compared with 98% of the non-SCI population given similar age and sex.
Causes of Death
The most
common cause of death is respiratory ailment, whereas, in the past it was renal
failure. An increasing number of people with SCI are dying of unrelated causes
such as cancer or cardiovascular disease, similar to that of the general population.
Mortality rates are significantly higher during the first year after injury
than during subsequent years.
Spinal
Cord Injury Levels & Classification
Wise Young, Ph.D., M.D.
W. M.
Keck Center for Collaborative Neuroscience
Rutgers University, Piscataway, NJ
When people are injured, they are often told that they
have an injury at a given spinal cord level and are given a qualifier
indicating the severity of injury, i.e. "complete" or
"incomplete". They may also be told that they are classified
according to the American Spinal Injury Association (ASIA) Classification, as a
ASIA A, B, C, or D. They may also be told that they have a bony fracture or
involvement of one or more spinal segments or vertebral levels. What most
people do not know is doctors are frequently confused about the definition of
spinal cord injury levels, the definition of complete and incomplete injury,
and the classification of spinal cord injury. In the early 1990's, when I
co-chaired the committee that helped define the currently accepted ASIA
Classification, there was no single definition of level, completeness of
injury, or classification. In this article, I will briefly address the issue of
spinal cord injury levels, the definition of "complete" spinal cord
injury, and the ASIA Classification approach towards spinal cord injury.
Vertebral vs. Cord
Segmental Levels
The spinal cord is situated within the spine. The spine
consists of a series of vertebral segments. The spinal cord itself has
"neurological" segmental levels which are defined by the spinal roots
that enter and exist the spinal column between each of the vertebral segments.
As shown in the figure the spinal cord segmental levels do not necessarily
correspond to the bony segments. The vertebral levels are indicated on the left
side while the cord segmental levels are listed for the cervical (red),
thoracic (green), lumbar (blue), and sacral (yellow) cord.
Vertebral segments. There are 7 cervical (neck), 12 thoracic (chest), 5 lumbar
(back), and 5 sacral (tail) vertebrae. The thoracic vertebrae are defined by
The spinal cord segments are not necessarily situated at the same vertebral
levels. For example, while the C1 cord is located at the C1 vertebra, the C8
cord is situated at the C7 vertebra. While the T1 cord is situated at the T1
vertebra, the T12 cord is situated at the T8 vertebra. The lumbar cord is
situated between T9 and T11 vertebrae. The sacral cord is situated between the
T12 to L2 vertebrae.
Spinal Roots. The spinal roots for C1 exit the spinal column at the
atlanto-occiput junction. The spinal roots for C2 exit the spinal column at the
atlanto-axis. The C3 roots exit between C2 and C3. The C8 root exits between C7
and C8. The first thoracic root or T1 exits the spinal cord between T1 and T2
vertebral bodies. The T12 root exits the spinal cord between T1 and L1. The L1
root exits the spinal cord between L1 and L2 bodies. The L5 root exits the cord
between L1 and S1 bodies.
The Cervical Cord. The first and second cervical segments are special because
this is what holds the head. The lower back of the head is called the Occiput.
The first cervical vertebra, upon which the head is perched is sometimes called
Atlas, after the Greek mythological figure who held up earth. The second
cervical vertebra is sometimes called the Axis, upon which Atlas pivots. The
interface between the occiput and the atlas is therefore called the
atlanto-occiput junction. The interface between the first and second vertebra
is called the atlanto-axis junction. The C3 cord contains the phrenic nucleus.
The cervical cord innervates the deltoids (C4), biceps (C4-5), wrist extensors
(C6), triceps (C7), wrist extensors (C8), and hand muscles (C8-T1).
The Thoracic Cord. The thoracic vertebral segments are defined by those that
have a rib. These vertebral segments are also very special because they form
the back wall of the pulmonary cavity and the ribs. The spinal roots form the
intercostal (between the ribs) nerves that run on the bottom side of the ribs
and these nerves control the intercostal muscles and associated dermatomes.
The Lumbosacral Cord. The lumbosacral vertebra form the remainder of the
segments below the vertebrae of the thorax. The lumbosacral spinal cord,
however, starts at about T9 and continues only to L2. It contains most of the
segments that innervate the hip and legs, as well as the buttocks and anal
regions.
The Cauda Equina. In human, the spinal cord ends at L2 vertebral level. The
tip of the spinal cord is called the conus. Below the conus, there is a spray
of spinal roots that is frequently called the cauda equina or horse's tail.
Injuries to T12 and L1 vertebra damage the lumbar cord. Injuries to L2
frequently damage the conus. Injuries below L2 usually involve the cauda equina
and represent injuries to spinal roots rather than the spinal cord proper.
In summary, spinal vertebral and spinal cord segmental
levels are not necessarily the same. In the upper spinal cord, the first two
cervical cord segments roughly match the first two cervical vertebral levels.
However, the C3 through C8 segments of the spinal cords are situated between C3
through C7 bony vertebral levels. Likewise, in the thoracic spinal cord, the
first two thoracic cord segments roughly match first two thoracic vertebral
levels. However, T3 through T12 cord segments are situated between T3 to T8.
The lumbar cord segments are situated at the T9 through T11 levels while the
sacral segments are situated from T12 to L1. The tip of the spinal cord or
conus is situated at L2 vertebral level. Below L2, there is only spinal roots,
called the cauda equina.
Sensory versus Motor
Levels
A dermatome is a patch of skin that is innervated by a
given spinal cord level. Figure 2 is taken from the ASIA classification manual,
obtainable from the ASIA web site. Each dermatome has a specific point
recommended for testing and shown in the figure. After injury, the dermatomes
can expand or contract, depending on plasticity of the spinal cord.
C2 to C4. The
C2 dermatome covers the occiput and the top part of the neck. C3 covers the
lower part of the neck to the clavicle (the horizontal bone that goes to the
shoulder. C4 covers the area just below the clavicle.
C5 to T1. These
dermatomes are all situated in the arms. C5 covers the lateral arm at and above
the elbow. C6 covers the forearm and the radial (thumb) side of the hand. C7 is
the middle finger, C8 is the lateral aspects of the hand, and T1 covers the
medial side of the forearm.
T2 to T12. The
thoracic covers the axillary and chest region. T3 to T12 covers the chest and
back to the hip girdle. The nipples are situated in the middle of T4. T10 is
situated at the umbilicus. T12 ends just above the hip girdle.
L1 to L5. The
cutaneous dermatome representating the hip girdle and groin area is innervated
by L1 spinal cord. L2 and 3 cover the front part of the thighs. L4 and L5 cover
medial and lateral aspects of the lower leg.
S1 to S5. S1
covers the heel and the middle back of the leg. S2 covers the back of the
thighs. S3 cover the medial side of the buttocks and S4-5 covers the perineal
region. S5 is of course the lowest dermatome and
represents the skin immediately at and adjacent to the
anus.
Ten muscle groups represent the motor innervation by the cervical and
lumbosacral spinal cord. The ASIA system does not include the abdominal muscles
(i.e. T10-11) because the thoracic levels are much easier to determine from
sensory levels. It also excludes certain muscles (e.g. hamstrings) because the
segmental levels that innervate them are already represented by other muscles.
Arm and hand muscles. C5 represents the elbow flexors (biceps), C6 the wrist
extensors, C7 the elbow extensors (triceps), C8 the finger flexors, and T1 the
little finger abductor (outward movement of the pinky finger).
Leg and foot muscles. The leg muscles represent the lumbar segments, i.e. L2 are
the hip flexors (psoas), L3 the knee extensors (quadriceps), L4 the ankle
dorsiflexors (anterior tibialis), L5 the long toe extensors (hallucis longus),
S1 the ankle plantar flexors (gastrocnemius).
The anal sphincter is innervated by the S4-5 cord and represents the end of
the spinal cord. The anal sphincter is a critical part of the spinal cord
injury examination. If the person has any voluntary anal contraction,
regardless of any other finding, that person is by definition a motor
incomplete injury.
It is important to note that the muscle groups specified
in the ASIA classifications represent a gross over simplication of the
situation. Almost every muscle received innervation from two or more segments.
In summary, the
spinal cord segment serve specific motor and sensory regions of the body. The
sensory regions are called dermatomes with each segment of the spinal cord
innervating a particularly area of skin. The distribution of these dermatomes
are relatively straightforward except on the limbs. In the arms, the cervical
dermatomes C5 to T1 are arrayed from proximal radial (C5) to distal (C6-8) and
proximal medial (T1). In the legs, the L1 to L5 dermatomes cover the front of
the leg from proximal to distal while the sacral dermatomes cover the back of
the leg.
Spinal Cord Injury
Levels
Differences between neurological and rehabilitation
definitions of spinal cord injury levels.
Doctors use two different definitions for spinal cord
injury levels. Given the same neurological examination and findings,
neurologists and physiatrists may not assign the same spinal cord injury level.
In general, neurologists define the level of injury as the first spinal
segmental level that shows abnormal neurological loss. Thus, for example, if a
person has loss of biceps, the motor level of the injury is often said to be
C4. In contrast, physiatrists or rehabilitation doctors tend to define level of
injury as the lowest spinal segmental level that is normal. Thus, if a patient
has normal C3 sensations and absent C4 sensation, a physiatrist would say the
sensory level is C3 whereas a neurologist or neurosurgeon would call it a C4
injury level. Most orthopedic surgeons tend to refer to the bony level of
injury as the level of injury.
EXAMPLE. The
most common cervical spinal injuries involve C4 or C5. Take, for example, a
person who has had a burst fracture of the C5 vertebral body. A burst fracture
usually indicates severe trauma to vertebral body that typically injures the C6
spinal cord situated at the C5 vertebrae and also the C4 spinal roots that
exits the spinal column between the C4 and C5 vertebra. Such an injury should
cause a loss of sensations in C4 dermatome and weak deltoids (C4) due to injury
to the C4 roots. Due to edema (swelling of the spinal cord), the biceps (C5)
may be initially weak but should recover. The wrist extensors (C6), however,
should remain weak and sensation at and below C6 should be severely
compromised. A neurosurgeon or neurologist examining the above patient usually
would conclude that there is a burst fracture at C5 from the x-rays, an initial
sensory level at C4 (the first abnormal sensory dermatome) and the partial loss
of deltoids and biceps would imply a motor level at C4 (the highest abnormal
muscle level). Over time, as the patient recovers the C4 roots and the C5
spinal cord, both the sensory level and motor level should end up at C6. Such
recovery is often attributed to "root" recovery. On the other hand, a
physiatrist would conclude that the patient initially has a C3 sensory level, a
C4 motor level, and a C5 vertebral injury level. If the patient recovers the C4
root and the C5 cord, the physiatrist would conclude that both the sensory and
motor levels are C5.
Discrepant lower thoracic vertebral and cord levels. The spinal vertebral and cord segmental levels
become increasingly discrepant further down the spinal column. For example, a
T8 vertebral injury will result in a T12 spinal cord or neurological level. A
T11 vertebral injury, in fact, will result in a L5 lumbar spinal cord level.
Most patients and even many doctors do not understand how discrepant the
vertebral and spinal cord levels can get in the lower spinal cord.
EXAMPLE. The
most common thoracic spinal cord injury involves T11 and T12. A patient with a
T11 vertebral injury may have or recover sensations in the L1 through L4
dermatomes which include the front of the leg down to the mid-shin level. In
addition, such a patient should recover hip extensors, knee extensors, and even
ankle dorsiflexion. However, the sacral functions, including bowel and bladder
and many of the flexor functions of the leg may be absent or weak. As in the
case of cervical and thoracic spinal cord injury, it is important to assess
both sensory and motor function.
Conus and Cauda Equina Injuries. Injuries to the spinal column at L2 or lower will
damage the tip of the spinal cord, called the conus, or the spray of spinal
roots that are descending to the appropriate spinal vertebral levels to exit
the spinal canal or the caudal equina. Please note that the spinal roots for L2
through S5 all descend in the cauda equina and injury to these roots would
disrupt sensory and motor fibers from these segments. Strictly speaking, the
spinal roots are part of the peripheral nervous system as opposed to the spinal
cord. Peripheral nerves are supposed to be able to regenerate to some extent.
However, the spinal roots are different from peripheral nerves in two respects.
First, the neurons from which sensory axons emanate are situated in the dorsal
root ganglia (DRG) which are located just outside the spinal column. One branch
of the DRG goes into the spinal cord (called the central branch) and the other
is the peripheral branch.
Thus, a spinal root injury is damaging the central
branch of the sensory nerve whereas peripheral nerve injury usually damages the
peripheral branch. The sensory axon must grow back into the spinal cord in
order to restore function and they generally will not do so because of axonal
growth inhibitors in the spinal cord and particular at the so-called PNS-CNS
junction at the dorsal root entry zone. Second, the cauda equina contains the
ventral roots of the spinal cord, through which the motor axons of the spinal
cord pass to innervate muscles. If the injury to the ventral root is close to
the motoneurons that sent the axons, the injury may damage the motoneuron
itself. Both of these factors significantly reduce the likelihood of
neurological recovery in a cauda equina injury compared to a peripheral nerve
injury.
Complete versus
Incomplete Injury
Most clinicians commonly describe injuries as
"complete" or "incomplete".
Traditionally, "complete" spinal cord injury
means having no voluntary motor or conscious sensory function below the injury
site. However, this definition is often difficult to apply. The following three
example illustrate the weaknesses and ambiguity of the traditional definition.
The ASIA committee considered these questions when it formulated the
classification system for spinal cord injury in 1992.
•
Zone of
partial preservation. Some people have some function for several segments below
the injury site but below which no motor and sensory function was present. This
is in fact rather common. Many people have zones of partial preservation. Is
such a person "complete" or "incomplete", and at what
level?
•
Lateral
preservation. A person may have partial preservation of function on one side
but not the other or at a different level. For example, if a person has a C4
level on one side and a T1 level on the other side, is the person complete and
at what level?
•
Recovery
of function. A person may initially have no function below the injury level but
recovers substantial motor or sensory function below the injury site. Was that
person a "complete" spinal cord injury and became
"complete"? This is not a trivial question because if one has a
clinical trial that stipulates "complete" spinal cord injuries, a
time must be stipulated for when the status was determined.
Most clinicians would regard a person as complete if the
person has any level below which no function is present. The ASIA Committee
decided to take this criterion to its logical limit, i.e. if the person has any
spinal level below which there is no neurological function, that person would
be classified as a "complete" injury. This translates into a simple
definition of "complete" spinal cord injury: a person is a
"complete" if they do not have motor and sensory function in the anal
and perineal region representing the lowest sacral
cord (S4-S5).
The decision to make the absence and presence of
function at S4-5 the definition for "complete" injury not only
resolved the problem of the zone of partial preservation but lateral
preservation of function but it also resolved the issue of recovery of
function. As it turns out, very few patients who have loss of S4/5 function
recovered such function spontaneously. As shown in figure 3 below, while this
simplifies the criterion for assessing whether an injury is
"complete", the ASIA classification committee decided that both motor
and sensory levels should be expressed on each side separately, as well as the
zone of partial preservation.
In the end, the whole issue of "complete"
versus "incomplete" injury may be a moot issue. The absence of motor
and sensory function below the injury site does not necessarily mean that there
are no axons that cross the injury site. Many clinicians equate a
"complete" spinal cord injury with the lack of axons crossing the
injury site. However, much animal and clinical data suggest that an animal or
person with no function below the injury site can recover some function when
the spinal cord is reperfused (in the case of an arteriovenous malformation
causing ischemia to the cord), decompressed (in the case of a spinal cord that
is chronically compressed), or treated with a drug such as 4-aminopyridine. The
labeling of a person as being "complete" or "incomplete",
in my opinion, should not be used to deny a person hope or therapy.
Classification of
Spinal Cord Injury Severity
Clinicians have long used a clinical scale to grade
severity of neurological loss. First devised at Stokes Manville before World
War II and popularized by Frankel in the 1970's, the original scoring approach
segregated patients into five categories, i.e. no function (A), sensory only
(B), some sensory and motor preservation (C), useful motor function (D), and
normal (E).
The ASIA Impairment Scale is follows the Frankel scale
but differs from the older scale in several important respects. First, instead
of no function below the injury level, ASIA A is defined as a person with no
motor or sensory function preserved in the sacral segments S4-S5. This
definition is clear and unambiguous. ASIA B is essentially identical to Frankel
B but adds the requirement of preserved sacral S4-S5 function. It should be
noted that ASIA A and B classification depend entirely on a single observation,
i.e. the preservation of motor and sensory function of S4-5.
The ASIA scale also added quantitive criteria for C and
D. The original Frankel scale asked clinicians to evaluate the usefulness of
lower limb function. This not only introduced a subjective element to the scale
but ignored arm and hand function in patients with cervical spinal cord injury.
To get around this problem, ASIA stipulated that a patient would be an ASIA C
if more than half of the muscles evaluated had a grade of less than 3/5. If
not, the person was assigned to ASIA D.
ASIA E is of interest because it implies that somebody
can have spinal cord injury without having any neurological deficits at least
detectable on a neurological examination of this type. Also, the ASIA motor and
sensory scoring may not be sensitive to subtle weakness, presence of
spasticity, pain, and certain forms of dyesthesia that could be a result of
spinal cord injury. Note that such a person would be categorized as an ASIA E.
These changes in the ASIA scale significantly improved
the reliability and consistency of the classification. Although it was more
logical, the new definition of "complete" injury does not necessarily
mean that it better reflects injury severity. For example, is there any situation
where a person could be an ASIA B and better off the ASIA C or even ASIA D?
The new ASIA A categorization turns out to be more
predictive of prognosis than the previous definition where the presence of
function several segments below the injury site but the absence of function
below a given level could be interpreted as an "incomplete" spinal
cord injury.
The ASIA committee also classified incomplete spinal
cord injuries into five types. A central cord syndrome is associated with
greater loss of upper limb function compared to the lower limbs. The
Brown-Sequard syndrome results from a hemisection lesion of the spinal cord.
Anterior cord syndrome occurs when the injury affects the anterior spinal
tracts, including the vestibulospnal tract. Conus medullaris and cauda equina
syndromes occur with damage to the conus or spinal roots of the cord.
Conclusion
Much confusion surrounds the terminology associated with
spinal cord injury levels, severity, and classification. The American Spinal
Injury Association tried to sort some of these issues and standardize the
language that is used to describe spinal cord injury. The ASIA Spinal Cord
Injury Classification approach has now been adopted by almost every major
organization associated with spinal cord injury. This has resulted in more
consistent terminology being used to /describe the findings in spinal cord
injury around the world.
Sci-info-pages.com/levels.html
Functional Goals
|
Level
|
Abilities
|
Functional
Goals
|
||
|
C1-C3
|
Limited movement of
head and neck
|
Breathing: Depends on a
ventilator for breathing.
|
||
|
Communication: Talking is
sometimes difficult, very limited or impossible. If ability to talk is
limited, communication can be accomplished independently with a mouth stick
and assistive technologies like a computer for speech or typing. Effective
verbal communication allows the individual with SCI to direct caregivers in
the person's daily activities, like bathing, dressing, personal hygiene,
transferring as well as bladder and bowel management.
|
||||
|
Daily tasks: Assistive
technology allows for independence in tasks such as turning pages, using a
telephone and operating lights and appliances.
|
||||
|
Mobility: Can operate an
electric wheelchair by using a head control, mouth stick, or chin control. A
power tilt wheelchair also for independent pressure relief.
|
||||
|
|
||||
|
C3-C4
|
Usually has head and
neck control. Individuals at C4 level may shrug their shoulders.
|
Breathing: May initially
require a ventilator for breathing, usually adjust to breathing full-time
without ventilator assistance.
|
||
|
Communication: Normal.
|
||||
|
Daily tasks: With
specialized equipment, some may have limited independence in feeding and
independently operate an adjustable bed with an adapted controller.
|
||||
|
|
||||
|
C5
|
Typically has head
and neck control, can shrug shoulder and has shoulder control. Can bend
his/her elbows and turn palms face up.
|
Daily tasks: Independence
with eating, drinking, face washing, brushing of teeth, face shaving and hair
care after assistance in setting up specialized equipment.
|
||
|
Health care: Can manage
their own health care by doing self-assist coughs and pressure reliefs by
leaning forward or side -to-side.
|
||||
|
Mobility: May have
strength to push a manual wheelchair for short distances over smooth
surfaces. A power wheelchair with hand controls is typically used for daily
activities. Driving may be possible after being evaluated by a qualified
professional to determine special equipment needs.
|
||||
|
|
||||
|
C6
|
Has movement in
head, neck, shoulders, arms and wrists. Can shrug shoulders, bend elbows,
turn palms up and down and extend wrists.
|
Daily tasks: With help of
some specialized equipment, can perform with greater ease and independence,
daily tasks of feeding, bathing, grooming, personal hygiene and dressing. May
independently perform light housekeeping duties.
|
||
|
Health care: Can
independently do pressure reliefs, skin checks and turn in bed.
|
||||
|
Mobility: Some
individuals can independently do transfers but often require a sliding board.
Can use a manual wheelchair for daily activities but may use power wheelchair
for greater ease of independence.
|
||||
|
|
||||
|
C7
|
Has similar movement
as an individual with C6, with added ability to straighten his/her elbows.
|
Daily tasks: Able to
perform household duties. Need fewer adaptive aids in independent living.
|
||
|
Health care: Able to do
wheelchair pushups for pressure reliefs.
|
||||
|
Mobility: Daily use of
manual wheelchair. Can transfer with greater ease.
|
||||
|
|
||||
|
C8-T1
|
Has added strength
and precision of fingers that result in limited or natural hand function.
|
Daily tasks: Can live
independently without assistive devices in feeding, bathing, grooming, oral
and facial hygiene, dressing, bladder management and bowel management.
|
||
|
Mobility: Uses manual
wheelchair. Can transfer independently.
|
||||
|
|
||||
|
T2-T6
|
Has normal motor
function in head, neck, shoulders, arms, hands and fingers. Has increased use
of rib and chest muscles, or trunk control.
|
Daily tasks: Should be
totally independent with all activities.
|
||
|
Mobility: A few
individuals are capable of limited walking with extensive bracing. This
requires extremely high energy and puts stress on the upper body, offering no
functional advantage. Can lead to damage of upper joints.
|
||||
|
|
||||
|
T7-T12
|
Has added motor
function from increased abdominal control.
|
Daily tasks: Able to
perform unsupported seated activities.
|
||
|
Mobility: Same as above.
|
||||
|
Health care: Has improved
cough effectiveness.
|
||||
|
|
||||
|
L1-L5
|
Has additional
return of motor movement in the hips and knees.
|
Mobility: Walking can be
a viable function, with the help of specialized leg and ankle braces. Lower
levels walk with greater ease with the help of assistive devices.
|
||
|
|
||||
|
S1-S5
|
Depending on level
of injury, there are various degrees of return of voluntary bladder, bowel
and sexual functions.
|
Mobility: Increased
ability to walk with fewer or no supportive devices.
|
||
TR Implications
Stress reduction - Reducing stress can improve physical and mental well-being.
Overall well-being - People with spinal cord injuries who participate in active recreational activities have fewer SCI-relatedhealth problems, such as skin breakdown.
Social contacts
-Participation in community based and group activities can help a person with a
spinal cord injuryovercome feelings of social isolation and self-consciousness.
Increased endurance
-Participation in active recreational activities increase your cardiovascular
endurance, which cangive you more energy for returning to work or school.
Skill development
-Participation in recreational activities can enhance skills, such as fine motor use
and sitting balance, which are used in other areas of life, such as dressing.
Increase confidence and self-esteem Independence in recreational activities can increase
independence in other activities.
interpersonal skills Communication skills, such as assertiveness, can be practiced in the
non-threatening environment ofrecreational activities.
Community reintegration Independence in mobility and social interaction, which can be achieved through recreationparticipation, leads to increased self confidence and self reliance
Adaptive Technologies
Assistive
Technology
Resources for SCI
Hospitals
and Rehabilitation Centers
·
http://www.sci-info-pages.com/rehabs.html
- This website provides a listing for spinal cord injury hospitals and
rehabilitation centers for many of the United States.
Support
and Financial Assistance
·
http://www.sci-info-pages.com/spinal-cord-injury-help.php
- Many organizations exist to provide individuals living with spinal cord
injuries and family members of those individuals with grants, equipment
donations and other supports.
State
Resources
Medical,
Rehabilitation and Nurses Aids
•
Aging With Spinal Cord Injury
Craig Hospital focuses on different body systems, how a
person with SCI, and how SCI may modify the aging process.
•
Back and Neck Disorders Sourcebook
Basic information about disorders and injuries of the
spinal cord and vertebrae, including facts on chiropractic.
•
Basic and Clinical Anatomy of the
Spine, Spinal Cord, and ANS
Textbook on
the anatomy of the spine, spinal cord, and autonomic nervous system, for
students in chiropractic, osteopathy, or physical therapy.
•
Catastrophic Injuries in High School
and College Sports (Hk Sport Science Monograph Series, V. 8)
Discusses the results of a 10-year study of serious
injury among young athletes, providing recommendations for reducing
catastrophic injuries, preventing deaths, and making sports programs safer.
•
Diagnosis and Management of Disorders
of the Spinal Cord
Review of
current clinical literature for neurologists of spinal cord disorders.
•
Functional Electrical Rehabilitation:
Technological Restoration After Spinal Cord Injury
Development over the past decade of functional
electrical rehabilitation. It shows how paralyzed muscle can be stimulated to
perform in the physical reconditioning of an afflicted person.
•
Functional Electrical Stimulation:
Standing and Walking After SCI
Covers
the fundamental knowledge and principles of functional electrical stimulation
as applied to the spinal cord injured patient.
•
In Search of the Lost Cord: Solving
the Mystery of Spinal Cord Regeneration
Presents a history of research and provides
insight into current developments that may offer the paralyzed hope for the
future.
•
Management of Spinal Cord Injuries: A
Guide for Physiotherapists
For students
and junior physiotherapists with little experience in the area of spinal cord
injury and a general understanding of the principles of physiotherapy. Also a
useful tool for experienced clinicians.
•
Management of Spinal Cord Injury
Textbook for rehabilitation nurses and other
rehabilitation specialists. A "Must read" for nurses working in
Spinal Cord Injury areas - acute or rehab.
•
Neurobiology of Spinal Cord Injury
(Contemporary Neuroscience)
Covers the
major areas of basic science research in which progress is currently being made
in the battle against the problem of spinal cord injury.
•
Nursing Practice Related to Spinal
Cord Injury and Disorders: A Core Curriculum
A comprehensive tool for educating a broad audience of
nurses in areas ranging from emergency nursing to rehabilitation.
•
Nursing Spinal Cord Injuries
Composed of articles written by trained spinal cord
injury nurse practitioners, offers valuable insights and practical information
on the rehabilitation period and its critical aspects. A reference and teaching
tool for victims and their families as well as to medical professionals.
•
Outcome After Head, Neck and Spinal
Trauma: A Medicolegal Guide
Text on the
principles and clinical assessment of cranio-spinal trauma. For physicians who
must provide medical reports or act as expert witnesses for possible
outcomes/prognoses of injury.
•
Spinal Cord Injury: A Guide to
Functional Outcomes in Occupational Therapy The Rehabilitation Institute of Chicago
Publication Series explains spinal cord injuries in great detail.
•
Spinal Cord Injury: Clinical Outcomes
from the Model Systems
University
of Alabama, Birmingham. Clinical research on the rehabilitation of spinal cord
injury drawn from the Model Systems Uniform Database.
•
Spinal Cord Injury: Functional
Rehabilitation (2nd Edition)
Clinical
and basic research developments and includes strategies for delivering quality
rehabilitative services.
•
Spinal Cord Injury: Medical
Management and Rehabilitation
Rehabilitation
Institute of Chicago, Illinois. Manual for the physicians, nurses, and physical
or occupational therapists on the spinal cord injury team on maximizing the
outcome potential of the spinal cord injury patient.
•
The Child With a Spinal Cord Injury
Provides 68 sections on etiology and prevention,
management, medical issues, orthopedic problems, upper extremity management,
rehabilitation, discharge and transition, habilitation, research and technological
applications, and special considerations.
•
The Quest for Cure: Restoring
Function After Spinal Cord Injury
Published by
Paralyzed Veterans of America, Research & Education Department.
Spinal Cord Injury Associations & Organizations
(USA)
Group of medical and other professionals engaged in
treatment of spinal cord injury: to promote and establish standards for health
care, education, to foster research and to facilitate communication between
members.
An alliance of the CSRO and ASRO to help us maximize
research and the fund raising efforts. Dedicated to the improvement of the
physical quality of life for persons with a spinal cord injury through targeted
medical and scientific research.
The Center for Paralysis Research at Purdue University
was founded to both develop and test promising methods of treatment for spinal
cord injuries.
A merger of the American Paralysis Association and the
Christopher Reeve Foundation. Supports research to develop effective treatments
and a cure for paralysis caused by spinal cord injury. Includes the Paralysis
Resouce Center which provides a comprehensive, national source of information
for people living with paralysis and their caregivers to promote health, foster
involvement in the community, and improve quality of life.
Exists to prevent, provide for and ultimately cure
spinal cord injuries and other debilitating illnesses. To expedite specific
cures, the Foundation assists in the funding of targeted research. Also helps
improve the quality of life for those already afflicted with injury or illness,
by providing necessary equipment or special services.
A web resource with more than 1,000 videos drawn from
interviews of people with spinal cord injuries, their families, caregivers and
experts.
FSCIPCC is a non-profit educational group dedicated to
the prevention, care and cure of spinal cord injuries through public awareness,
education and funding research.
An affiliation of organizations working to fund research
into cures for paralysis caused by spinal cord injury. This site has been
created as an information resource for interested individuals, organizations
and governments who wish to understand more about, and perhaps, contribute to
spinal cord injury research.
A subsidiary of the Christopher & Dana Reeve
Foundation, dedicated to improving the quality of life for young people
affected by spinal cord injury, and utilizes action sports as a platform to
inspire infinite possibilities despite paralysis.
University of Miami School of Medicine, is the world's
largest, most comprehensive research center dedicated to finding more effective
treatments and, ultimately, a cure for paralysis that results from spinal cord
injury.
Committed to providing financial support of selected
research, rehabilitation and education programs on spinal cord injuries. The
Foundation seeks financial assistance through special events, fund-raising, and
corporate and individual support throughout the United States and Canada.
Organization dedicated to finding a cure for spinal cord
injuries by raising money for spinal cord injury research. In its brief
history, it has raised over $1 million despite being in all-volunteer
organization. Because of that efficiency, nearly 100% of every dollar donated
goes directly to research. The MCPFuses a peer review process of experts
to allocate its funds to the projects that offer the most potential for moving
science forward.
Mission is to enable people with SCI to make choices and
take actions to achieve their highest level of independence and personal
fulfillment. Includes current articles/news, injury information, chat, message
boards, a quarterly publication and other areas.
This site is a resource center for veterans and for all
American with a spinal cord injury or disease, as well as their families and
the professional communities who serve them.
Involved in research activities to enhance the lives of
those affected by SCI and TBI. Part of the Santa Clara Valley Medical Center.
Provides support and funding for the research in the
field of spinal cord injury and regenerative medicine — being conducted by
leading universities, scientists and institutions — in the quest for a cure for
paralysis.
Helps individuals overcome spinal cord injuries and
other neurological disorders by funding scientific research, medical treatment,
rehabilitation and technological advances.
Located at the University of Kentucky College of
Medicine,SCoBIRC was established in 1999 to promote both individual and
collaborative studies on injuries to the spinal cord and brain that result in
paralysis or other loss of neurologic function.
Provides news and events, research projects, general
information and statistics.
SCINI is a non-profit organization dedicated to
facilitating access to quality health care by providing information and
referral services to spinal-cord-injured individuals and their families.
An international organization for cure research and
treatment of spinal cord injury paralysis and related problems. Site includes
headlines from the SCS newsletter on cure research, current SCS research
projects, and other information on SCS. 100% of its research funding goes for
research!
Formerly the Eastern Paralyzed Veterans Association, a
nonprofit that provides information and services to individuals with spinal
cord injury and disease regarding benefits, disability rights advocacy,
wheelchairs and barrier-free design.
The Center is situated at Rutgers, the State University
of New Jersey. The SCI Project encompasses the research program devoted to care
and cure of spinal cord injury. This site describes the people, the research
programs, and the mission of the Center. Also provides support and information
for the community, including the forum.
Spinal Cord Injury Glossary
Abdominal Binder -
Wide elastic binder use to help prevent a drop in blood pressure or used for
cosmetic purposes to hold in abdomen. A rigid (non-elastic) binder is used to
help empty the bladder in some patients.
Aces -
Elastic bandage used to wrap extremities to help support and prevent blood
pressure from lowering.
Acute rehabilitation program - Primary emphasis on the early rehabilitation
phase which usually begins as soon as a person is medically stable. The program
is designed to be comprehensive and based in a medical facility with a typical
length of stay of 2-3 months. Treatment is provided by and identifiable team in
a designated unit.
Adipose tissue - Fatty
tissue.
ADL -
Activities of daily living: eating, dressing, grooming, shaving, etc. Nurses,
occupational and physical therapists are the main coaches for ADL, which is
sometimes called DLS or daily living skills.
Afferent -
Sensory pathway proceeding toward the central nervous system from the
peripheral receptor organs.
Ambulation -
"Walking" with braces and/or crutches.
Ankylosis -
Fixation of a joint leading to immobility, due to ossification or bony deposits
of calcium at joints.
Anterior - The
front of anything. Before or toward the front.
Anterior Cord Syndrome -An
incomplete spinal injury in which all functions are absent below the level of
injury except proprioception and sensation.
Anterior Spinal Artery Syndrome - (also known as Anterior Cord Syndrome) Anterior
spinal artery syndrome refers to the anterior spinal artery that originates
from the vertebral arteries and basal artery at the base of the brain and
supplies the anterior two-thirds of the spinal cord to the upper thoracic
(chest) region. The lesion produces variable loss of motor function and of
sensitivity to pinprick and temperature, while preserving proprioception
(position sense).
Anterio-lateral - To
the front and to the side.
Antero-posterior -
To the front and to the back.
Antibody - A protein,
carried in the blood, produced by the immune to system which will attack germs,
viruses, and other invading agents.
Anticholinergic - A
drug often prescribed for those with indwelling catheters to reduce spasms of
smooth muscle, including the bladder. Anticholinergics block certain receptors
(acetylcholine), resulting in inhibition of certain nerve impulses
(parasympathetic). Brand names include Daricon, ProBanthine, Urispas, Ditropan,
and Cystospaz. Side effects may include constipation, nausea, dry mouth, and
blurred vision. Caution: combined with alcohol, anticholinergics can cause
extreme drowsiness.
Antidepressant - A
drug prescribed to treat depression; standard tricyclic antidepressants include
Tofranil, Imvate, Elavil, Norpramin, and Adapin.
Aphasia - The
change, or loss, in language function due to an injury.
Apraxia - The
inability to produce voluntary speech due to a deficit in motor (muscle)
programming caused by brain damage.
Arachnoid Membrane -
The middle of three membranes protecting the brain and spinal cord.
Arachnoiditis -
Inflammation and scarring of the membranes covering the spinal cord.
ASIA Score - A
measure of function after spinal cord injury, used by physicians. "A"
means complete injury; "E" means full recovery.
Astrocyte -
Star-shaped glial cells which provide the necessary chemical and physical
environment for nerve regeneration.
Ataxia -
Failure or irregularity of muscle coordination.
Atelectasis - Loss
of breathing function characterized by collapsed lung tissue.
Atrophy - A
wasting away or decrease in size of a cell, tissue, organ, or part of the body
due to lack of nourishment.
Augmentative and Alternative Communication (AAC) - Forms of communication that supplement or
enhance speech or writing, including electronic devices, picture boards, and
sign language.
Autoimmune Response -
The body produces a response against itself.
Autonomic Dysreflexia (Hyperreflexia) - A syndrome attributed to interruption of spinal
cord sympathetic pathways. It is a condition that can occur in anyone who has a
spinal cord injury at or above the T6 level. It is related to disconnections
between the body below the injury and the control mechanisms for blood pressure
and heart function. It causes the blood pressure to rise to potentially
dangerous levels.
Autonomic Nervous System - The part of the nervous system that controls
involuntary activities, including heart muscle, glands, and smooth muscle
tissue. The autonomic nervous system is subdivided into the sympathetic and
parasympathetic systems.
Axon - The
nerve fiber that carries an impulse from the nerve cell to a target, and also
carries materials from the nerve terminals back to the nerve cell. A long,
slender part of a neuron that carries the electrochemical signal to another
neuron. It's the main or core nerve fiber which generally conducts impulses
away from the cell body.
Bacterial infection -
Infection by minute, one-celled organisms which multiply by dividing in one or
more directions.
Balkan Frame - A
rectangular frame which may be placed over a hospital bed to position or
increase mobility. Loops or a trapeze are often hung from the Balkan frame to
assist a patient in bed activities and wheelchair transfers to and from the
bed.
Bilateral -
Refers to using both sides of the body or extremities on both sides.
Bilateral sensory stimulation - Stimulation of both sides of the body
simultaneously, using touch, hearing, or vision, in order to determine whether
an individual imperceives the stimulus on one side or the other.
Bilateral transfer -
Facilitation of performance of a task by one hand as a result of having
practiced the task with the other hand.
Biofeedback - A
process that provides sight or sound information about functions of the body,
including blood pressure, muscle tension, etc. The use of sensory feedback to
help provide some self-control over autonomic functions, such as blood
pressure.
Biotechnology - In
the most general terms, biotechnology describes guiding natural occurrences to
develop useful products. More specifically, it involves using living organism
to make products and solve problems.
Bladder Training -
Method by which the bladder is trained to empty (micturition) without the use
of an indwelling catheter. Involves drinking measured amounts of fluid, and
allowing the bladder to fill and empty at timed intervals. See intermittent
catheterization.
Body Jacket (TLSO) -
A support made of plastic that fits over the chest, abdomen and upper pelvis,
used to support an unstable or recently fused spine.
Bowel program - The
establishment of a "habit program" or a specific time to empty the
bowel - also known as a "dil" - so that regularity can be achieved.
Bradycardia - Slow
pulse (< 60 beats per minute)
Brain stem -
Composed of midbrain, pons and medulla.
Brown-Sequard Syndrome -
An incomplete spinal cord injury where half of the cord has been damaged. The
Brown-Sequard syndrome is caused by a functional section of half of the spinal
cord. This results in motor loss on the same side as the lesion and sensory
loss on the opposite side. This syndrome is very often associated with fairly
normal bowel and bladder function and does not prevent the person from being
able to walk, although some functional bracing or ambulatory device such as a
cane or crutch may be necessary.
Calculi -
Stones that may form in either kidney or bladder.
Carpal Tunnel Syndrome -
A painful disorder in the hand caused by inflammation of the median nerve in
the wrist bone.
Catheter - A
flexible rubber or plastic tube for withdrawing or introducing fluids into a
cavity of the body, usually the bladder.
CT Scan -
Computerized axial Tomography is a cross-sectional X-ray enhancement technique
that greatly benefits diagnosis with high-resolution video images.
Cauda Equina - The
collection of spinal roots descending from the lower part of the spinal cord.
Cauda Equina Syndrome -
Injury to the nerves still within the spinal cord as they form a "horse's
tail" to exit the lumbar and spinal regions. This usually occurs with
fractures below the L2 level and results in flaccid-type paralysis. The type of
bladder and bowel impairment that results from such an injury depends on the
level of the injury and can be problematic, particularly for women, who may
have difficulty with urinary drainage and incontinence.
Central Cord Syndrome -
A lesion, occurring almost exclusively in the cervical region, that produces
sacral sensory sparing and greater weakness in the upper limbs than in the
lower limbs. A central cord syndrome indicates there is an injury to the
central structures of the spinal cord. This is most commonly seen in older
patients with cervical arthritis and may occur in the absence of spinal
fracture.
Central Nervous System (CNS) - The CNS includes the brain and spinal cord.
Cerebrospinal Fluid (CSF) - A colorless solution similar to plasma
protecting the brain and spinal cord from shock. A lumbar puncture (spinal tap)
is used to draw CSF.
Cervical - The
upper spine (neck) area of the vertebral column. Cervical injuries often result
in quadriplegia (tetraplegia).
Collateral sprouting -
Intact axons located near damaged areas may sprout to reestablish connections
with, and in place of damaged areas; cannot be assured that the new connections
function exactly as their damaged neighbors did.
Complete Lesion - An
injury with no motor or sensory function below the area of the spinal cord that
was damaged.
Contracture - The
stiffening of a body joint to the point that it can no longer be moved through
its normal range.
Condom Catheter -
External urine collecting device used by males.
Conus Medullaris Syndrome - Injury of the sacral cord (conus) and lumbar
nerve roots within the neural canal, which usually results in an areflexic
bladder, bowel and lower limbs. Sacral segments may occasionally show preserved
reflexes with higher lesions.
Creatinine Clearance -
A 24-hour urine collection test to assess how the kidneys are functioning.
Crede - A
technique of pressing down and inward over the bladder to facilitate voiding.
Pronounced "cruh-day."
Cyst (post traumatic cystic myelopathy) - A collection of fluid within the spinal cord,
which may increase pressure and lead to increased neurological deterioration,
loss of sensation, pain, and dysreflexia.
Cystogram (CG) - X-ray
taken after injecting dye into bladder.
Cystometric Examination - An exam measuring the pressure of forces to
empty, or resisting to empty, the bladder.
Decubitus Ulcer - See
pressure sore.
Demyelination - The
loss of nerve fiber "insulation" due to trauma or disease, which
reduces the ability of nerves to conduct impulses (as in multiple sclerosis and
some kinds of SCI).
Denial -
Avoiding physical or emotional conflict or loss; many rehab professionals
over-ascribe denial to their patients. Hoping for functional improvement should
not be misunderstood as denying disability.
Dendrite -
Microscopic tree-like fibers extending from a nerve cell (neuron). They are
receptors of electrochemical nervous impulse transmissions. A fine branching
process of the nerve cell which conducts a nerve impulse from the cell body to
the structure(s) supplied by the nerve, or toward the cell body.
Depression (dysthymia) -
An abnormal lowering of mood of psychologic or physiologic origin which is more
prolonged than mourning and is time-limited and related to a specific loss.
Dermatome - A map
that shows typical function for various levels of spinal cord injury. May also
refer to the area of the skin innervated by the sensory axons with each
segmental nerve (root).
Derotational Splints -
Long splints on legs and feet used to prevent foot drop and external rotation
of the hips. These splints are used when a patient is supine.
Disability - Any
restriction or lack (resulting from an impairment) of ability to perform an
activity in a manner or within the range considered normal for a human being.
Discharge Planning -
Planning and preparation for life rehab. has been completed.
DLS (Daily Living Skills) - See 'ADL".
Dorsal Root - The
collection of nerves entering the dorsal section (on the back) of a spinal cord
segment.
Dura Mater - The
outermost of three membranes protecting the brain and spinal cord, it is tough
and leather-like. The fibrous outer sheath surrounding the brain and spinal
cord.
Dysphagia -
Difficulty in swallowing.
Edema -
Swelling; most commonly present in legs and feet. Edema occurs when the body
tissues contain an excessive amount of fluid (plasma), increasing skin
sensitivity and risk of pressure sores.
Egg-crate Mattress -
Foam mattress, resembling egg cartons, that helps distribute pressure and
prevent pressure sores.
Effector neuron - The
output nerve component of the reflex arc which transmits a reaction to the end
of the organ to which the effector neuron connects.
Efferent - Motor
pathway proceeding from the central nervous system toward the peripheral end
organs.
Electromyogram (EMG) -
A test that records the responses of muscles to electrical stimulation.
Electro-ejaculation -
A means of extracting sperm from men with erectile dysfunction by using an
electrical probe in the rectum. The sperm can be used to fertilize eggs in the
uterus or in a test tube.
Environment - The
context in which development takes place, including physical properties of
stimuli.
Exacerbation - A
recurrence or worsening of symptoms.
Extension -
Movement which brings the body or limbs into straight position. Outward
movements of body parts away from the center of the body (straightening).
External Continence Device (ECD) – Male external urine control device that attaches
to tip of penis.
Fairley Test - A
urine test to determine the site of infection. For instance, it can determine
whether infection exists in the bladder only or in a kidney as well.
FES (Functional Electric Stimulation) - The application of low-level, computer-controlled
electric current to the neuromuscular system, including paralyzed muscle.
Flaccidity - A
form of paralysis in which muscles are soft and limp.
Flexion -
Movement which brings body or limbs into a bent position. Inward movements of
body parts toward the center of the body (bending).
Foley Catheter - A
rubber tube placed in the urethra, extending to the bladder, in order to empty
the bladder. It is held in place with a small fluid-filled balloon.
Functional - The
ability to carry out a purposeful activity.
Gait Training -
Instruction in walking, with or without equipment.
Ganglioside -
Complex, carbohydrate-rich lipids found in cell membranes, most concentrated at
the surface of brain cells.
Glial Cells - From
the Greek for "glue," glial cells are supportive cells associated
with neurons. Astrocytes and oligodendrocytes are central nervous system glial
cells. In the peripheral nervous system the main glial cells are called Schwann
cells.
Glossopharyngeal breathing (GPB) - A means of forcing extra air into the lungs to
expand the chest and achieve a functional cough. Also called "frog
breathing."
Halo Traction - The
process of immobilizing the upper body and cervical spine with a traction
device. The device consists of a metal ring around the head, held in place with
pins into the skull. A supporting frame is attached to the ring and to a body
jacket or vest to provide immobilation.
Hand Splint - See
"tenodesis".Handicap - A disadvantage that limits or prevents
fulfillment of a role that is normal (depending on age, sex, and social and
cultural factors).
Handicap dimensions -
Physical independence, mobility, roles and activities, social integration, and
economic self-sufficiency.
Harrington Rods - Metal
braces fixed along the spinal column for support and stabilization.
Hemiparesis -
Partial paralysis of loss of movement on one side of the body.
Heterotopic Ossification (HO) - The formation of new bone deposits in the
connective tissue surrounding the major joints, primarily the hip and knee. A
disorder characterized by the deposition of large quantities of calcium at the
site of a bone injury. Often the result of prolonged immobilization. [heterotopic
bone].
Hubbard Tank - A
large full-body tank of water used for wound care and range of motion.
Hydronephrosis - A
kidney distended with urine to the point that its function is impaired. Can
cause uremia, the toxic retention of blood nitrogen.
Hyperreflexia - See
"autonomic dysreflexia".
Hyperesthesia -
Grossly exaggerated tactile stimuli.
Hypothermia - An
extreme lowering of the body temperature. A technique used to cool the spinal
cord after injury.
Hypoxia - Lack
of blood oxygen due to impaired lung function.
Immune Response - The
body's defense function that produces antibodies to foreign antigens. It is
important in organ and tissue transplantation since the body is likely to
reject new tissues.
Impairment - Any
loss or abnormality of psychological, physiological, or anatomical structure or
function.
Incomplete Injury -
Some sensation or motor control preserved below spinal cord lesion.
Incomplete Lesion -
A spinal cord lesion in which some sensation or muscle function below the level
of injury is preserved.
Incontinence - Lack
of bowel and/or bladder control.
Indwelling Catheter -
A flexible tube retained in the bladder, used for continuous urinary draining
to a leg bag or other device.
Informed Consent -
A patient's right to know the risks and benefits of a medical procedure.
Intermittent Catheterization (ICP) - Using a catheter for emptying the bladder on a
regular schedule. See self-catheterization.
Intrathecal Baclofen -
Administration of the anti-spasm drug Baclofen directly to the spinal cord by
way of a surgically implanted pump.
Intravenous Pyelogram (IVP) - An X-ray of the kidney to determine function.
Ischemia - A
reduction of blood flow that is thought to be a major cause of secondary injury
to the brain or spinal cord after trauma.
KUB - An
X-ray of the abdomen, showing the kidneys, ureters, and bladder.
Laminectomy - An
operation used to relieve pressure on the spinal cord, or used to examine the
extent of damage to the cord.
Late Anterior Decompression - Surgical procedure to reduce pressure on the
spinal cord by removing bone fragments.
Lateral - Side.
Leg Bag - External
bag which is strapped to the leg for collection of urine.
Lesion - An
injury or wound, any pathologic or traumatic injury to the spinal cord.
Lipid Peroxidation -
Lipids are the backbone of nerve cell membranes.
Lithotripsy - A
non-invasive treatment for kidney stones. Shock waves, generated under water by
a spark plug, crumble stones into pieces that will pass with urine.
Log Roll -
Method of turning a patient without twisting the spine, used when a person's
spine is unstable.
Lower Motor Neurons -
These nerve fibers originate in the spinal cord and travel out of the central
nervous system to muscles in the body. An injury to these nerve cells can
destroy reflexes and may also affect bowel, bladder and sexual function.
Lower Motor Neuron Lesion - Any damage to the lower motor neuron or its axon
(peripheral nerve) that separates the lower motor neuron from control of its
muscle fibers. This type of lesion leads to flaccidity and muscle atrophy.
Lumbar -
Pertaining to that area immediately below the thoracic spine; the strongest
part of the spine, the lower back.
Malingering -
Faking or conscious deception; voluntary production of symptoms for a
rationally considered goal, such as financial recompense, avoidance of
responsibility, etc.
Medicaid - A
state-funded insurance program that varies by state, and may vary within a
state if a managed care product is present. Individuals are eligible and can
receive the insurance for free if they meet maximal income limits, are
pregnant, are <21 years of age, or have sufficient enough medical bills.
Pays for all rehabilitation care, equipment, custodial and skilled nursing home
care, home personal care services, and medications (a co-pay is usually needed
for medications). All Medicaid in Virginia is managed care (as of 4/99).
Medicare - A
Federally-funded insurance program that offers standard services nationwide,
that may vary if a managed care product is present. Individuals are eligible
and can receive for free Part A (pays for inpatient care, all rehabilitation
care, equipment) if they have been employed for 10 or more years and are either
65 and older, disabled for 2 years or more, or have end-stage renal disease.
Individuals are eligible for Part B (pays for physician services) if they have
Part A, but must pay a monthly fee (around $50). Medicare does not pay for
medications, personal care services at home, or custodial nursing home care,
but does provide for skilled nursing facility (rehabilitation or medical) in a
nursing home for 100 days (per each medical or rehabilitation incident
separated by 60 days).
Molecular genetics -
The study of how genes function to control cellular activies. (Genetic
engineering involves the application of knowledge about molecular genetics in
order to change living things by modifying their DNA, so they will produce
desired strains).
Motoneuron (motor neuron) - A nerve cell whose cell body is located in the
brain and spinal cord and whose axons leave the central nervous system by way
of cranial nerves or spinal roots. Motoneuron supply information to muscle. A
motor unit is the combination of the motoneuron and the set of muscle fibers it
innervates.
Motor- Referring
to nerves that give signals to muscles or glands in the body.
Motor development -
The gradual acquisition of full control of all voluntary motor movements common
to the species.
MRI (Magnetic
Resonance Imaging) - A high-tech diagnostic tool to display tissues unseen in
X-rays or by other techniques.
Multiple Sclerosis (MS) - A chronic disease of the central nervous system
where myelin, the insulation on nerve fibers, is lost. MS is thought to be an
autoimmune dysfunction in which the body turns on itself for some unknown
reason.
Myelin - A
white, fatty insulating material for axons which produced in the peripheral
nervous system by Schwann cells, and in the central nervous system by
oligodendrocytes. Myelin is necessary for rapid signal transmission along nerve
fibers, ten to one hundred times faster than in bare fibers lacking its
insulation properties. It insulates axons giving the "white matter"
of the central nervous system its characteristic color.
Myelogram - A
diagnostic test in which an opaque liquid is injected into the spinal canal,
producing an outline of it on X-rays or fluoroscope.
Myoclonus -
Involuntary, sharp, jerking muscular contractions, often painful.
Myotome - The
collection of muscle fibers innervated by the motor axons within each segmental
nerve (root).
Neurapraxia - The
first level of nerve injury. The large motor fibers are predominately affected
and anatomic continuity of the nerve is preserved. The prognosis for recovery
is excellent and usually complete within a few days to weeks.
Nerve Growth Factor (NGF) - A "vitamin" for nerve cells. NGF, a
protein, supports survival of embryonic neurons, and regulates
neurotransmitters.
Nerve Impulse - An
electrical current is carried along the plasma membrane (outer skin) nerve, and
it may "start" in one of three ways: a) spontaneous
"ignition" of the nerve cell body, b) removal of a suppressor
impulse, and c) reception of an electrical impulse from other nerve cells.
Neurogenic Bladder -
Any bladder disturbance due to an injury of the nervous system.
Neurological Level -
Refers to the lowest segment of the spinal cord with normal sensory and motor
function on both sides of the body. In fact, the segments at which normal
function is found often differ by side of body and in terms of sensory vs.
motor testing. Thus, up to four different segments may be identified in
determining the neurological level. In cases such as this, generally each of
these segments is separately recorded and a single "level".
Neurolysis -
Destruction of peripheral nerves by radio frequency, heat, cutting or by
chemical injection. Used to treat spasticity.
Neuron - A
nerve cell that can receive and send information by way of synaptic connections
consisting of the cell body and extensions of the nerve called axons and
dendrites.
Neuropathic / Spinal Cord Pain - Neuropathic (nerve-generated) pain is a problem
experienced by SCI patients. A sharp, almost electrical shock, type of pain
will be felt to the left of the injury and is the result of damage to the spine
and soft tissue surrounding the spine. Phantom limb pain or radiating pain from
the level of the lesion is related to the injury or sysfunction at the nerve
root or spinal cord.
Neurotmesis - The
most severe form of nerve injury. There is complete disruption within the nerve
and/or an actual severing of the nerve. This injury needs surgical repair.
There is wallerian degeneration of the nerve distal to the site of the injury
and the prognosis for recovery is far poorer than in the case of neurapraxia or
axonotmesis (the other 2 classes of nerve injuries). A nerve may not always
have only one type of injury. It is possible to have combined types of injuries
within a given nerve.
Neurotransmitter -
A chemical released from a neuron ending, at a synapse, to either excite or
inhibit the adjacent neuron or muscle cell. A chemical synthesized within the
nerve cell body, characteristic for this type of nerve, and stored at the
nerves in pods as granules. Release of these chemicals into the synaptic cleft
between axons facilitates nerve transmissions.
Nucleic acid -
Complex organic acids found in the nucleus of all living cells that contain the
genetic code essential to life.
Occupational Therapist (OT) - The member of the rehabilitation team who helps
maximize a person's independence.
Occupational Therapy (OT) - Structured activity focused on activities of
daily living skills (feeding, dressing, bathing, grooming), arm flexibility and
strengthening, neck control and posture, perceptual and cognitive skills, and
using adaptive equipment to facilitate ADL’s.
Oligodendrocyte - A
central nervous system glial cell. Oligodendrocytes are the site of myelin
manufacture for central nervous system neurons (the job of Schwann cells in the
peripheral nervous system).
Omentum -
Well-vascularized tissue of the gut.
Osteoporosis - Loss
of bone density, common in immobile bones after SCI.
Ostomy - An
opening in the skin to allow for a suprapubic cystostomy (catheter drainage),
for elimination of intestinal contents (colostomy or ileostomy) or for passage
of air (tracheostomy).
Papavarine - A
drug injected into the penis to produce an erection which acts by increasing
blood flow.
Paralytic Ileus - Loss
of movement in the small intestine, resulting in gas and fluid build-up. It
usually lasts a few days after injury.
Paraplegia -
Refers to impairment of loss of motor and/or sensory function in the thoracic,
lumbar or sacral (but not cervical) segments of the spinal cord, secondary to
damage of neural elements within the spinal canal. WIth paraplegia, arm
functioning is spared, but, depending on the level of injury, the trunk, legs,
and pelvic organs may be involved. There are some types of paralysis involving
the legs that are described by the impairment they cause (see Clinical
Syndromes).
Paraplegic - One
who has loss of function below the cervical spinal cord segments, wherein the
upper body retains most function and sensation.
Paresis -
Weakness in voluntary muscle or slight paralysis.
Passive Standing -
Standing on one's feet while being propped up in a standing frame or other
device. It is said to benefit bone strength.
Percussion -
Forceful tapping on congested parts of the chest to facilitate postural
drainage in persons with people with high-level tetraplegia.
Peripheral -Nerve
tissue not found in the brain or spinal cord.
Peripheral Nervous System - Nerves outside the spinal cord and brain (not
part of the central nervous system). If damaged, peripheral nerves have the
ability to regenerate.
Personal Care Services -
Non-skilled assistance (bathing, dressing, light housework) provided to
individuals in their homes.
Phrenic Nerve Stimulation - Electrical stimulation of the nerve that fires
the diaphragm muscle, facilitating breathing in people with injury at the C1 or
C2 level.
Physiatrist - A
doctor whose specialty is physical medicine and rehabilitation.
Physical Therapist (PT) - A key member of the rehabilitation team.
Physical Therapy (PT) -
Structured activity focused on mobility skills (bed, transfers, wheelchair use,
walking), leg flexibility and strengthening, trunk control and balance,
endurance training, and using adaptive equipment to facilitate mobility.
Piloerection -
"goose bumps"
Plasticity -
Long-term adaptive mechanism by which the nervous system restores or modifies
itself toward normal levels of function.
Posterior - Back.
Postural Drainage -
Using gravity to help the clear lungs of mucus by positioning the head lower
than chest.
Postural Hypotension -
The reduction of blood pressure resulting in light-headedness.
Preservation - The
repetition of an idea or activity without an appropriate stimulus.
Pressure Release -
Relieving pressure from the ischial turberosities (bones on which we sit) every
15 min. in order to prevent pressure sores.
Pressure Sore - Also
known as decubitus ulcer. A potentially dangerous skin breakdown due to
pressure on skin resulting in infection, tissue death.
Priapism - A
dangerous condition where the penis remains erect due to retention of blood.
Prone - Lying
on stomach.
Proprioception - The
sense of movement and position.
Prosthesis -
Replacement device for a body part, for example an artificial limb.
PVR (Post Void Residual) - The volume left in bladder after the patient
voids (urinates).
Quad -
Generally, a high quad is someone with an injury at C1, C2, and C3. some
doctors also group c4 quads into this category. Mid-level quads are those
injured at C5. Low-level quads are those injured at C6 & C7. This isn't
written in stone, and some doctors consider C4, C5, and C6 all as mid-level,
with C7 being low-level.
Quad Cough - A
method of helping a patient with tetraplegia cough by applying external
pressure to diaphragm, thus increasing the force and clearing the respiratory
tract.
Quadriparesis -
Partial loss of function all four (4) extremities of the body.
Quadriplegia - Loss
of function of any injured or diseased cervical spinal cord segment, affecting
all four body limbs. Outside the U.S. the term tetraplegia is used (which is
etymologically more accurate, combining tetra + plegia, both from the Greek,
rather than quadri + plegia, a Latin/Greek amalgam).
Range of Motion (ROM) -
The normal range of movement of any body joint. Range of Motion also refers to
exercises designed to maintain this range and prevent contractures.
Receptor (afferent) neuron - The input nerve component of the reflex arc
which conducts stimuli from the environment toward the CNS.
Reciprocating Gait Orthosis (RGO) - A type of long-leg brace used for ambulation by
paralyzed people. Uses cables across the back to transfer energy from leg to
leg, thereby simulating a more natural gait.
Reflex - An
involuntary response to a stimulus involving nerves not under control of the
brain.
Reflex arc - In
its simplest form, three components. Receptor, association, and effector
(efferent) neurons facilitate one-way transmission of nerve impulses in a
repetitive manner.
Reflux - The
backflow of urine from the bladder into the ureters and kidney.
Regeneration - The
regrowth of a cell or nerve fiber.
Rehabilitation -
Retraining to normal functionality or training for new functionality.
Residual Urine - Urine
that remains in the bladder after voiding. Too much left can lead to a bladder
infection.
Restorative Nursing (NRS) - Replication of activities initiated by PT, OT,
and SLP performed by nursing staff (range of motion, dressing, hygiene,
walking, feeding).
Retrograde Pyelogram (RP) - Insertion of contrast material directly into the
kidney through an instrument.
Rhizotomy - The
cutting, or interruption, of spinal nerve roots.
Sacral - The
fused vertebrae and spinal cord below the lumbar level.
Schwann Cells -
Responsible in the peripheral nervous system for myelinating axons they also
provide trophic support in injury situation.
Secondary Injury -
The biochemical and physiological changes that occur in the injured spinal cord
after the initial trauma has done its damage.
Self-Catheterization -
Intermittent catheterization, the goal of which is to empty the bladder as needed,
on one's own, minimizing risk of infection.
Sensory Level and Motor Level - When the term "sensory level" is used,
it refers to the lowest segment of the spinal cord with normal sensory function
on both sides of the body; the motor level is similarly defined with respect to
motor function. These "levels" are determined by neurological
examination of (1) a key sensory point with in each of 28 dermatomes on the
right and 28 dermatomes on the left side of the body, and (2) a key muscle
within each of 10 myotomes on the right and 10 myotomes on the left side of the
body.
Shunt - A
tube used to drain a cavity. In the spinal cord, a shunt is used to treat a
syrinx by equalizing pressures between the syrinx and the spinal fluids. In
spinal bifida, it is used to reduce pressure of hydrocephalus.
Skin Breakdown - Skin
breakdowns (also termed "decubitus ulcers") occurs as a result of
excessive pressure, primarily over the bones of the buttock.
Social Work (SW) -
Supportive service for psychosocial adjustment and intervention, financial
resources, and discharge planning.
Space Boots -
Plastic boots with foam linens worn on the feet when lying on your side.
Spasticity -
Hyperactive muscles that move or jerk involuntarily. There are some benefits to
spasticity:
1. Warning mechanism to identify pain or problems in areas
of no sensation.
2. Helps in spotting an oncoming urinary tract infection.
3. Helps to maintain muscle size and bone strength.
4. Helps to maintain circulation.
5. Helps to prevent osteoporosis.
Speech and Language Pathology (SLP) - Structured activity focused on communication
skills, perceptual and cognitive skills, and swallowing.
Sphincterotomy - The
cutting of the bladder sphincter muscle to eliminate spasticity and related
voiding problems.
Spinal accessory nerve -
Cranial Nerve XI. Largely motor, this nerve supplies sternomastoid and
trapezius muscles.
Spinal nerves -
Sensory and motor nerves which connect the spinal cord to the periphery of the
body.
Spinal Shock -
Similar to a concussion in the brain, spinal shock causes the system shuts
down.
Subluxation -
Complete or partial dislocation (as in shoulder).
Suctioning -
Removal of mucus and secretions from lungs. It is important for people with
high-level tetraplegia who lack ability to cough.
Suprapubic Catheter -
A catheter surgically inserted into the bladder by incision above the pubis.
Suprapubic Cystostomy -
A small opening made in the bladder and through the abdomen, sometimes to
remove large stones, more commonly to establish a catheter urinary drain.
Synapse - The
specialized junction between a neuron and another neuron or muscle cell for
transfer of information such as brain signals, sensory inputs, etc., along the
nervous system. These are the junctions between the "sending" fibers
of one nerve cell, to the "receiving" fibers of other nerve cells.
The axon (sending fiber) ends in multiple branches, each of which has a
button-like enlargement that nearly touches the "receiving" fibers of
the other nerve cell bodies. Nerve cells "talk" to each other via
synapses. Basically the connection between the end of a nerve and the adjacent
structure, such as a muscle cell or another nerve ending. Various transmitter
chemicals liberated into the synapse make nerve transmissions possible.
Syringomyelia - The
formation of a fluid-filled cavity (a syrinx) in an injured area of the spinal
cord, which is a result of nerve fiber degradation and necrosis. It sometimes extends
upward, extending also the neurological deficit. Treatment often includes
surgery to insert a shunt for drainage of the cavity.
Syringomyelocele -
A congenital neural tube defect which can cause spinal bifida in which spinal
fluid fills a sac of spinal membrane.
Syrinx - A
cyst; a cavity.
Tendon Lengthening -
A procedure, usually involving the Achilles tendon, to treat contractures
caused by spasms.
Tenodesis (Hand Splint) - Metal or plastic support for hand, wrist and/or
fingers. Used to facilitate grater function to a disabled hand by transferring
wrist extension into grip and finger control.
Tetraplegia -
(Quadriplegia) Refers to impairment or loss of motor and/or sensory
function in the cervical segments of the spinal cord due to damage of neural
elements within the spinal canal. Tetraplegia results in impairment of function
in the arms as well as in the trunk, legs, and pelvic organs. It does not
include brachial plexus lesions or injury to peripheral nerves outside the
neural canal.
Thoracic -
Pertaining to the chest, vertebrae or spinal cord segments between the cervical
and lumbar areas.
Thrombophlebitis -
A clot in a vein due to diminished blood flow which can occur in a paralyzed
leg. Symptoms include swelling and redness.
Tilt Table - A
table which is used to gradually increase patients tolerance to being in a
standing position. Also used to teach partial weight bearing and to give
prolonged stretch in each position.
Tracheostomy -
Opening in windpipe to facilitate breathing.
Upper Motor Neurons -
Long nerve cells that originate in the brain and travel in tracts through the
spinal cord. Any injury to these nerves cuts off contact with brain control.
Reflex activity is still intact, however resulting in spasticity. For men with
upper motor neuron injuries, reflex erections are possible.
Urinary Tract Infection (UTI) - Bacterial invasion of the urinary tract, which
includes bladder, bladder neck and urethra. Symptoms of UTI include urine that
is cloudy, contains sediment and smells foul, and fever. UTI involving the
kidneys is preventable but dangerous. Medications often prescribed for UTI
include Keflex, Macrodantin, Furadantin, Septra, Bactim, Mandelamine,
penicillin, and amoxicillin. Side effects vary, and may include nausea and
vomiting, skin rash or hives.
Ventilator -
Mechanical device to facilitate breathing in persons with impaired diaphragm
function.
Vertebrae - The
bones that make up the spinal column.
Vital Capacity - The
measure of air in a full breath. It is an important consideration for people
with high-level tetraplegia who also have impaired pulmonary function.
Vital Signs -
Consist of taking blood pressure, pulse, respiration and temperature.
Weaning -
Gradual removal of mechanical ventilation, as patient's lung strength and vital
capacity increases.
Zone of Partial Preservation - Refers to those dermatomes and myotomes below
the neurological level that remain partially innervated. When some impaired
sensory and/or motor function is found below the lowest normal segment, the
exact number of segments so affected make up the ZPP. The term is used only
with incomplete injuries.
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