Spinal Cord Injury
By Alyssa Flake and Kari
Durrant
Winter 2013
RECM 470
Table of Contents
1. Spinal
Cord and Column
2. Facts
and Statistics
3. Levels
and Classification of Injury
4. Functional
Goals
5. TR
Implications
6. Adaptive
Technologies
7. Resources
8. Associations
and Organizations
9. Glossary
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.
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.
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.
http://www.sci-info-pages.com/facts.html
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
Support and
Financial Assistance
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.
- Childhood Brain & Spinal
Cord Tumors: A Guide for Families, Friends & Caregivers
- Diagnosis and Management of
Disorders of the Spinal Cord
Review of current clinical literature for neurologists of spinal cord
disorders.
- Early Management of Acute
Spinal Cord Injury
- 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.
- Pharmacological Approaches to
the Treatment of Brain and Spinal Cord Injury
- Spinal Cord Injuries in
Children
- 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: Concepts
and Management Approaches
- 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.
- Spinal Cord Medicine:
Principles and Practice
- 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 Management of Persons With
Spinal Cord Injuries
- 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)
American Spinal Injury Association (ASIA)
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.
Canadian & American Spinal
Research Organization
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.
Center for Paralysis Research
The Center for Paralysis Research at Purdue University was founded to both
develop and test promising methods of treatment for spinal cord injuries.
Christopher & Dana Reeve Foundation
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.
Darrell Gwynn Foundation
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.
Facing Disability
A web resource with more than 1,000 videos drawn from interviews of people with
spinal cord injuries, their families, caregivers and experts.
International Campaign for Cure of
Spinal Injury
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.
Life Rolls On
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.
Miami Project to Cure 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.
Mike
Utley Foundation
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.
Morton Cure Paralysis Fund
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.
National Spinal Cord Injury Association
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.
Paralyzed Veterans of America (PVA)
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.
Roman Reed Foundation
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.
Sam Schmidt Paralysis Foundation
Helps individuals overcome spinal cord injuries and other neurological
disorders by funding scientific research, medical treatment, rehabilitation and
technological advances.
Spinal Cord and Brain Injury Research Center
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.
Spinal Cord Injury Network International (SCINI)
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.
Spinal
Cord Society (SCS)
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!
United Spinal Association
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.
W. M. Keck Center for Collaborative
Neuroscience
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.
