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SPINAL CORD INJURY download - Coggle Diagram

- - - - Restrictive pulmonary disease
      - Obstructive pulmonary disease
    - - Osteoporosis
      - Marked sacropenia
    - - Circulatory hypokinesis
      - Adaptive myocardial atrophy
        
        Decreased Cardiac Output
        
        Decreased Cardiac Reserve
      - Neurogenic Hypotension
    - - Obesity
      - Metabolic Syndrome despite normal body weight
- - - - Damages the:
      - • Neural tract
      - • Cell bodies
      - • Vascular structures
      - Machanical Injury
        
        Vasculature disruptions
        
        Cell death
        
        Shearing and compression forces
      - Disruptions
        
        Alterations in ion and neurotransmitter levels
        
        Membrane compromise
        
        Inflammation
        
        Neurogenic Shock
        
        Respiratory difficulties
    - - • Due to haemorrhage and local oedema
      - • Compromise vascular supply
      - • Results in ischemia
      - • Inevitable, necrosis occurs and spread over the one or
      - two vertebral levels above and below the area of trauma
      - Excitotoxicity
        
        Excessive CA leading to ROS production and oxidative stress
        
        Excessive glutamate
        
        Apoptosis
      - Ischemia
        
        Excessive Ca and ROS
        
        Apoptosis
        
        Activation of the ischemic cascade
      - Inflammation
        
        Astrogliosis
        
        Lymphocyte infiltration of lesion
        
        Activated and phagocytic monocytes
  - - - • Afferent (sensory) and efferent (motor) pathways transmission is interrupted.
      - • Voluntary movement and sensory perception are absent below the lesion.
- - - - Flaccidity
      - Hypotension
      - Hperreflexia
      - Pulmonary dysfunction
      - Sensory loss
      - Neurogenic bladder
      - Motor paralysis
      - Neurogenic bowel
    - - Flaccid paralysis with absent deep tendon reflexes
      - Dizziness or loss of consciousness
      - Brisk DTRs, spasticity, spasms, clonus
      - Accessory muscles of respiration required
      - Impaired or absent sensation
      - Urinary incontinence, urinary tract infection
      - Impaired or absent voluntary motor function
      - Fecal incontinence, constipation
  - - - Circulatory hypokines (hypotensive)
      - Obesity
      - Peripheral arterial disease
      - Type 2 diabetes mellitus
      - Coronary artery disease
      - Pressure injuries
      - Respiratory complications
      - Joint contractures
      - Osteoporosis
    - - Preinjury history of high- risk behaviours, including alcohol
        abuse, is common.
    - - Second leading cause of death in patients (22% of all death
      - Silent myocardial ischemia caused by disrupted visceral afferent fibres in higher levels of SCI may prevent an individual from recognizing angina.
    - - • Greater risk of peripheral arterial disease.
      - • Complications related to reduced circulation.
      - • Sometimes results into amputations.
    - - • Result of shear, friction, and unrelieved pressure over bony prominence.
      - • SCI unable to feel sentsation of tingling, discomfort and pain
      - • Wheelchair seating systems essential
    - - Burning, tingling and picking sensations
      - May occur from a region below the SCI and can adversely affect exercise ability
    - - Diabetes type 2
      - Insulin resistant
      - Glucose intolerance
      - Skeletal muscle wasting below injury
      - ↓ed RMR (12%)
      - ↑ed fat mass
    - - • Wheelchair use – shoulder and wrist pain
      - • Hip, knee, and plantar flexion contractures due to unbalanced muscle forces in wheelchair-reliant individuals
    - - Formation of lamellar bone-like structures inside soft tissue where bones do not normally exist
      - Limit range of motion
        Lose ability to transfer A
        ffects certain ADL
      - Treatment
        Biphosphonates
        Radiotherapy
        Surgical resection
      - Prevention.
        Nonsteriodal anti-inflammatory agents & warfarin
        Pulse low-intensity electromagnetic field therapy
    - - Causes significant functional impairments
      - Inhibition of functional ambulation
      - Affect exercise ability
      - Pain & Fatigue
      - 53-78% of SCI patient
      - Treatment
        
        Removal of any stimuli- inducing increased tone
        
        Daily prolonged stretching of affected muscle group
        
        Pharmacological management
        
        Surgical management
        
        Physical therapy
      - Increased risk of developing contractures and pressure ulcers
      - Difficulties with self-hygiene
    - - Women >= 50
      - Men >= 40
- - - - ecent deep vein thrombosis
      - Pulmonary embolism
      - Othostatic hypotension (with syncope)
      - Pressure ulcers (↑ risk of autonomic dysreflexia during exercise)
      - Autonomic dysreflexia resulting from recent fracture (precipitate spasms or ↑ed risk of fatty emboli, hypertensive crisis, or cerebrovascular events)
    - - Peripheral neuropoathy
      - Pressure ulcers of grade 2 or less
      - Chronic heterotopic ossification
      - Spasticity
      - Active tendinitis (rotator cuff, eblow flexors, wrist flexors and extensors)
- - - - Muscles to exercise
        
        Rotator cuff
        
        Infraspinatus
        
        Subscapularis
        
        Supraspinatus
        
        Teres minor
        
        Latissiums Dorsi
        
        Scapular Stabilizers
        
        Trapezius
        
        Rhomboids
        
        Pectoralis Major
      - Balance of weights
        
        Paralyzed lower extremities and truncal musculature significantly reduce a person’s ability to balance even small objects when lying supine or when seated without significant truncal support..
      - Free weights, isotonic or isokinetic machines
        
        Wheelchair brakes should be set before lifting and care should be taken not to exceed the weight and stress limitations of the
        wheelchair.
    - - Maintain shoulder range of motion, especially external rotation and retraction and upward rotation of the scapula.
      - Active and passive stretching
        
        • Incorporate both active and passive stretching.
        
        • Be carful during passive stretching in joints lacking sensation (individual cannot determine when maximal range of joint has been reached).
      - Standing Frame - Should be medically cleared for full weight bearing
    - - Increase VO2peak
        
        Increase active muscles
        
        Increase peripheral O2 extraction
        
        Increase Venous Return
      - Circulatory Hypokinesis
        
        High heart rate
        
        Limited increase in cardiac contractility, stroke volume and arterial blood pressure
        
        Characterised by lower increase in cardiac output per unit increase in VO2
        
        Decrease in peripheral vascular resistance
      - Therapeutic recreaction
        
        Effective physical activity program for people with SCI
      - Heart Rate Responses
        
        • Controversial in people with tetraplegia and high-level paraplegia
        
        • ↓ Heart rate
        
        • ↓ Active muscle mass
        
        • ↓ Sympathetic response
        
        • Rather use RPE (11 – 14)
      - Caloric expenditure: Decreases CVD risk and weight management
        Upper extremity overuse syndrome: Rather perform exercise session in bouts to avoid. Strain from too high volume of exercise
  - - - Patients with longstanding (> 20 yr) SCI require greater physical assistance as they age.
    - - % of maximal heart rate during performance of Activities of Daily Living and community mobility tasks is higher in people with tetraplegia than in those
        paraplegia
    - - ↑ed VO2peak
      - ↑ed peak work rate
      - Improved body composition
      - ↑ed functional capacity
      - ↑ed stroke volume
      - Improved insulin resistance
    - - Due to the large number of shoulder and upper extremity musculoskeletal problems encountered by persons with SCI, a prophylactic, structured, and progressively resistive strengthening program that focuses on scapular, rotator cuff, and pectoral muscles is likely to increase strength and reduce the risk of overuse injury.
    - - ↑ed Endurance
      - ↑ed Anaerobic power
      - ↓ed Shoulder pain
      - ↑ed Dynamic strength
      - ↑ed Activities of Daily Living
      - Improved body composition (↓ed fat mass
    - - ↑ skeletal muscle endurance
      - ↑ total body peak power
      - ↑ HDL
      - Improved body composition
      - ↑ Lower extremity bone mineral density
      - ↑ stroke volume
      - ↑ Myocardial disuse atrophy
      - ↑ skeletal muscle strength
      - ↑ Myocardial disuse atrophy
      - ↑ Self-perception
  - - - Partial Body-weight-supported treadmill
      - Robotic assisted
      - Overground
    - - Task-specific motor learning occurs and gait control and mechanics improve.
        Chronic incomplete SCI: Approximately 80% of wheelchair-reliant individuals became independent walkers after locomotor training.