26/06/2025
๐๐ฅ๐๐ฃ๐๐ก ๐พ๐ค๐ง๐ ๐๐ฃ๐๐ช๐ง๐ฎ (SCI)
Spinal cord injury (SCI) is damage to the spinal cord resulting in partial or complete loss of motor, sensory, and autonomic function below the level of the lesion. It can be traumatic (e.g., road traffic accidents, falls) or non-traumatic (e.g., tumors, infections).
๐ผ๐ฃ๐๐ฉ๐ค๐ข๐ฎ of the Spinal Cord:
โขExtends from the foramen magnum to the L1โL2 vertebral level.
โขDivided into segments:
-Cervical (C1โC8)
-Thoracic (T1โT12)
-Lumbar (L1โL5)
-Sacral (S1โS5)
-Coccygeal
Injury at a specific level affects all the segments below.
๐๐ฎ๐ฅ๐๐จ of Spinal Cord Injury:
1. Based on Cause:
โขTraumatic: Fracture, dislocation, penetrating injury.
โขNon-Traumatic: Tumors, infections (TB, HIV), degenerative diseases, ischemia.
2. Based on Severity:
โขComplete SCI: No sensory or motor function preserved below injury level (ASIA A).
โขIncomplete SCI: Some function remains below injury level (ASIA BโD).
๐ผ๐๐๐ผ ๐๐ข๐ฅ๐๐๐ง๐ข๐๐ฃ๐ฉ ๐๐๐๐ก๐ (AIS):
Grade -Description
'๐ผ' Complete โ No motor/sensory function below injury level
'๐ฝ' Incomplete โ Sensory preserved, no motor
'๐พ' Incomplete โ Motor preserved, muscle grade LE, bladder dysfunction
2) Anterior Cord Syndrome Loss of motor, pain, and temp; sparing of proprioception
3) Brown-Sรฉquard Syndrome Ipsilateral motor loss, contralateral pain/temp loss
4) Posterior Cord Syndrome Loss of proprioception, preserved motor
5) Conus Medullaris Syndrome Saddle anesthesia, bladder/bowel dysfunction, LE weakness
6) Cauda Equina Syndrome LMN signs, radicular pain, areflexic bladder/bowel
๐พ๐ก๐๐ฃ๐๐๐๐ก ๐๐๐๐ฉ๐ช๐ง๐๐จ
โขMotor loss: Paralysis or paresis
โขSensory loss: Pain, temperature, touch, proprioception
โขAutonomic dysfunction: Bladder, bowel, sexual dysfunction
โขSpasticity: In upper motor neuron lesions
โขPressure sores, contractures, DVT, respiratory issues (especially cervical injuries)
๐ฟ๐๐๐๐ฃ๐ค๐จ๐๐จ:
-Neurological examination: ASIA scale
-Radiological imaging: MRI (preferred), CT, X-rays
-Evoked potentials (in some cases)
๐๐๐ฃ๐๐๐๐ข๐๐ฃ๐ฉ
โขAcute Phase:
-Immobilization and stabilization (e.g., spine board, collars)
-Methylprednisolone (controversial)
-Surgical decompression if indicated
-Bladder and bowel care
-DVT prophylaxis
-Respiratory support (esp. for high cervical injuries)
-Rehabilitation Phase (Physiotherapy Focus):
๐๐ค๐๐ก๐จ
-Prevent secondary complications
-Restore function
-Promote independence in ADLs
-Psychological support
๐๐ฃ๐ฉ๐๐ง๐ซ๐๐ฃ๐ฉ๐๐ค๐ฃ๐จ:
1) Domain Intervention
2) Positioning To prevent pressure sores and contractures
3) Range of Motion (ROM) Passive and active ROM to maintain flexibility
4) Strengthening Strengthen unaffected muscles, use of therabands
5) Respiratory therapy Diaphragmatic breathing, coughing techniques
6) Gait training Parallel bars, orthoses, functional electrical stimulation
7) Functional training Wheelchair mobility, bed mobility, transfers
8) ADL training Dressing, grooming, toileting with adaptive techniques
9) Spasticity management Stretching, TENS, medications like baclofen
10) Assistive devices Wheelchair, walker, braces
11) Neuro-rehabilitation techniques PNF, NDT, task-oriented training
๐พ๐ค๐ข๐ฅ๐ก๐๐๐๐ฉ๐๐ค๐ฃ๐จ ๐ฉ๐ค ๐๐ค๐ฃ๐๐ฉ๐ค๐ง
-Pressure ulcers
-Autonomic dysreflexia (especially in injuries above T6)
-Respiratory infections
-Deep vein thrombosis
-Osteoporosis
-Bladder & bowel incontinence
๐๐ง๐ค๐๐ฃ๐ค๐จ๐๐จ
-Better in incomplete injuries
-Depends on level, severity, and early rehab
-Cervical injuries may lead to tetraplegia
-Lower thoracic/lumbar may result in paraplegia
๐๐๐๐๐ฃ๐ฉ ๐ผ๐๐ซ๐๐ฃ๐๐๐จ
-Neuroplasticity-based rehab
-Robotic exoskeletons
-Spinal cord stimulation
-Stem cell therapy (under trial)
-Brain-computer interfaces
