Spinal cord injury

Purpose : This article is an overview of the newer therapeutic interventions employed in the care of the spinal cord injured individual and the theoretical rationale supporting them.

Issue : Spinal Cord Injury (SCI) care was, until recently, a maintenance type treatment, addressing systems mostly affected by complications of the original injury (e.g. bladder, skin, spasiticity).

Conclusion : With the recent advances in the neuroscience field, more aggressive interventions geared at secondary injury prevention, neuronal regeneration and functional restoration are emerging.     

Spinal cord injury

The successful outcome of providing care to the individual with a spinal cord injury is to enable the patient to live as satisfactory and fulfilling a life as possible. How this is achieved will be different with each individual and family depending on the degree of disability, the family and social environment, and preferred life-styles. The nurse, who deals with the human response to the injury, is in an ideal position to help the patient and family realize their life potential.     

Spinal cord injury

Purpose : This article is an overview of the newer therapeutic interventions employed in the care of the spinal cord injured individual and the theoretical rationale supporting them. Issue : Spinal Cord Injury (SCI) care was, until recently, a maintenance type treatment, addressing systems mostly affected by complications of the original injury (e.g. bladder, skin, spasiticity). Conclusion : With the recent advances in the neuroscience field, more aggressive interventions geared at secondary injury prevention, neuronal regeneration and functional restoration are emerging.     

Spinal cord injury: preventing secondary injury.

Spinal cord injury is devastating to the victim, as well as being costly in terms of medical expenses, lost wages, and lost independence. The initial damage to the spinal cord results from several mechanisms of injury--flexion, extension, compression, penetration, rotation, and the disease process. When the spinal cord is injured and there is necrosis of the nervous tissue, no regeneration of that tissue occurs. Unlike in the peripheral nervous system, where regeneration is possible, the spinal cord is part of the central nervous system, as is the brain. The spinal cord extends from the base of the skull to the L1 vertebrae: the cervical levels innervate the diaphragm and muscles of the arms; the thoracic levels innervate the muscles of the chest and abdomen; and the lumbar and sacral levels innervate the muscles of the legs. In addition, the sacral levels are responsible for bowel, bladder, and sexual function. The higher the level of injury, the more severe the loss of function because, not only is the level of injury affected, but also the levels below. Injury occurs by initial trauma to the surrounding ligaments, bones, and muscles, which then affect the spinal cord. There may be total loss of function with damage completely across the cord or partial loss of function with damage affecting only part of the cord. No current treatment can reverse this initial injury, which causes irreversible damage within minutes of injury. Secondary damage occurs as the injury spreads over several hours. Treatment can help prevent this secondary damage.     

Spinal cord injury pathophysiology

This article reviews the mechanisms and pathophysiology of spinal cord injury (SCI). It is clear that there are two entwined phases of injury: one that occurs concurrently with the insult and the other that is initiated immediately after trauma and lasts for several days to weeks. The mechanisms of primary injury are described in terms of hyperflexion, hyperextension, axial loading, and rotation. Secondary injury processes are addressed at systemic and cellular levels. Diagnosis of SCI is discussed with respect to plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Clinical motor and sensory patterns of complete and incomplete SCI are described.     

Spinal cord injury: a comprehensive review

Spinal cord injury (SCI) results in multiorgan system dysfunction. Previously, SCI portended reduced survival and diminished quality of life. However, with increasing awareness and advances in the management of complications from SCI, individuals are living longer and more satisfying lives. This article summarizes major interventions and advances in the management of patients who have SCI. Fundamental principles of SCI are reviewed by organ system and key points are highlighted.     

Spinal cord injury pain: the influence of psychologic factors and impact on quality of life

OBJECTIVES: To examine chronic pain prevalence in a spinal cord injury (SCI) population, and to determine the influence of psychologic factors on SCI pain and impact of SCI pain on quality of life. METHODS: Five hundred seventy-five persons with SCI were asked to participate in the study. Demographic, SCI, and pain characteristics were obtained. The Chronic Pain Grade, anger items of the Profile of Mood States, Illness Cognition Questionnaire, Pain Coping and Cognition List, and Patient Health Questionnaire were used. General health and well-being were assessed with 0-10 scales. The influence of psychologic factors was assessed with regression analyses controlling for person and injury characteristics and pain intensity. RESULTS: Response rate was 49%. SCI pain prevalence was high (77.1%). More internal pain control and coping, less catastrophizing, higher level of lesion, and nontraumatic SCI cause were associated with less pain intensity. More pain was associated with higher pain-related disability. Lower catastrophizing was related to better health. Less SCI helplessness and catastrophizing, greater SCI acceptance and lower anger levels were related to higher well-being. Higher levels of SCI helplessness, catastrophizing, and anger were related to higher depression levels. Pain intensity showed no independent relationships with health, well-being, and depression in the regression analyses. DISCUSSION: Chronic SCI pain and quality of life were both largely associated with several psychologic factors of which pain catastrophizing and SCI helplessness were most important. Psychologic intervention programs may be useful for persons suffering from chronic SCI pain to improve their quality of life.     

Spinal cord injury pain.

Awareness that SCI pain is common emerged during the past decade. However, there are a number of unresolved issues. There is a need for variety of experimental models to reflect diversity of SCI pains. Current classification is not as user-friendly as it should be. More attention should be given to a condition of the spinal cord below and above the SCI lesion. A consensus for what is an optimal SCI functional assessment for patients with sensory complaints and pain should be developed. Further extensive SCI pain research is needed prior to spinal cord regeneration trials in order to be able to cope with a potential for newly developed pains that may appear during incomplete spinal cord regenerative attempts.     

个体化截瘫行走支具对脊髓损伤患者功能的影响

摘要 目的: 观察个体化截瘫行走支具对脊髓损伤患者运动功能、日常生活活动能力及步行能力的影响。 方法: 将44例脊髓损伤患者随机分为支具组22例和对照组22例。对照组进行综合性的系统康复治疗, 支具组在综合性的系统康复治疗基础上根据康复治疗效果评估后装配不同的截瘫行走支具并进行功能训练。 结果: 经过3个月的康复训练后两组患者的运动功能、感觉功能和日常生活活动能力的评分均得到有效提高, 且支具组日常生活活动能力的评分明显优于对照组(P<0.05)。支具组22例患者装配截瘫行走支具训练后平均行走距离达470m（四分位数间距为：162.50m—900m）,其中达到治疗性步行6例,家庭性步行10例,社区性步行6例。而对照组无一例有步行能力。 结论: 早期规范康复介入可明显提高脊髓损伤患者的运动功能、感觉功能及日常生活活动能力,针对患者的具体状况装配个体化截瘫支具对患者的日常生活活动能力及步行能力的改善有重要意义。