Key Assessment information for SCI

Database
a.
b.
c.
d.
e.

Spinal fractures
Spinal level lesion
Spinal stability
Assosiated injury
Spinal shock- transient suppression and gradual return of reflex activity
caudal to the SCI(Dinno et al 2004)
Subjective
a. Pre-morbid moskuloskeletal problem
b. PMH : relevant respiratory factors
Objective
a. Respiratory status (including FCV and cough)
b. Passive range of movement of all joint
c. Active movement
d. Muscle strengh
e. Tone : Modified Ashworth Scale(Bahannon & Smith 1987)
f. Sensory espicially pin prick sensation
g. Joint range
h. Other injury
Treatment consideration in the acute phase, key intervention are :
1. Prophylactic chest care
Espesially for T6 and above, including assisted coughing, repiratory
muscle training and positioning programme
2. Maintenance of muscle lenght and joint range of motion.
This is include of maintaining position in order to manage spasticity,
hypertone and prevent loss of range and the dvelopment of shoulder pain.
Some muscle are prone to contracture because of habitual positions
adopted , muscle imbalance and weakness.
3. Active assisted and passive movement.
Limbs are normally taken through range twice a day (No evidance base
rules for SCI are currently available ). Time orf treatment depend of the
level spacticity, active strengh available and pain.
4. Teaching subtitution movement where active movement is lost,
e.g. elbow extension using shoulder lateral rotation and gravity to assist.
Splinting the hands of the patients with C6 complete lesion, in order to
effective tendoesis grip.
5. Progressive mobilization up againt gravity
Using a tilt table is commonly used after flat bed rest. Patients will be
hypotensive due to loss of venous tone and muscle pump. An Abdominal
binder and compression stockings are worn to assist in venous return.
Pharmacological management wil assist in the control of low blood
pressure and complication of autonomic dysreflexia.
Treatment consideration in the acute phase of the paraplegia
Impairments :
- Respiratory compromise,

Weakness in affected muscle of trunk and lower limbs

Alterd tone flaccid (cauda equina) or spasticity
Altered/loss sensation sense , cutaneus hypersensitivity
Autonomic dysreflexia T6 and above
Muscle Imbalance leading to contracture

Activity Limitations
- Pain
- Distupted postural/balance system
- Loss/impairmed functional gait
- Compromised ability to caugh
- Loss of funtional bowel and bladder control
- Distrupted temperature control systems
- Pressure are consideration
Key aims & strategies
- Respiratory muscle training
- Strengthen/ maintain inervated muscle
- Passive and active assisted movement
- Teach compensatory activities
- Prevent contractures
- Gait re- education with orthotic
- Progressive standing programme: tilt table, with abdo binder and pressure
stockings
- Anasthetic skin prone to demage
- Adress psycological issues
- Education
Physioterapy management (derived from paddison and Middleton, 2004) of the
rehabilitation phase
1. Establishment of a standing programme : progressing from the tilt table to
a standing frame.
2. Balance re education : proggresion from bilateral arm support to unilateral
arm support to no arm support, e.g. reaching in the different direction
3. Basic level transfer techniques : from bed to whelchair ; progressing to
varied level transfers, e.g. chair to floor, car transfer.
4. Learning Wheelchair mobility skills
5. Postural amd wheelchair seating assesment
To facilitate an optimum pushing position and minimize upper limb joint
pain.
6. General bed mobility and mat activities
7. Orthotics and gait training. During rehabilitation, the patient may be
assesed for walking with orthoses dependign of the fracture.

Key factors for consideration in Spinal Cord Injury Management

A. Spinal stability
1. Spinal Stability account of structural and ligamentous of demage
2. Surgical or conservatif management(bed rest/traction/bracing)
B. Orthothic Bracing
1. For conservative management or as an adjunct to the surgical fixation

C.

D.

E.

F.

2. The halo brace jacket for stability to the upper and lower cervical spine;
thoraco-lumbal for vary ektensively
Spinal Shock
1. Transient suppression and gradual return of reflex activity caudal to the
SCI
Pain Management
1. May affect accuracy of assessment, respiratory effort and ability to
participate in treatment
2. Source of pain : neurodynamic, central dysaesthesia, mechanical
instability, fracture pain, muscle spasm pain, viseral pain, nerve root
entrapment and syringomyelia(cyst formation within the spinal cord)
Autonomic dysreflexia
1. A sympathetic nervous system dysfunction producing hyperekstension,
bradicardia and headaches with pilo erection and capillary dilatation
and sweating, above the level of the lesion with the lesion T6 or above.
2. Can result from any noxious stimulus such as bladder or rectal
distension.
Heterotropic ossification
1. Calcification in denervated or UMN disordered muscle may result from
loss of range in joint and impaired functional activities such as sitting.
2. May be confused in early stage with DVT, when it presents as swelling,
alterating in skin colour and increased heat, usually in relation to joint.

Question :
1. Relief the pain??