A spinal cord injury is damage to the spinal cord that causes changes in its function which may be permanent or temporary in the loss of muscle function , sensation, autonomic functions at various parts of the body below the level of lesion.

CAUSES OF SPINAL CORD INJURY

• Fractures or fractures with dislocation
• Sports injuries
• Industrial  accident
• Gunshot injuries
• Surgical  trauma
• The prevalance of sci in india is 1.85 – 2.19%.
• It is mostly occurs in young adults between 20 to 40 years of age.
• Males are more affected then females.
• In india , fall from height is the most common causes of traumatic sci.

TYPES OF SPINAL CORD INJURY

Spinal cord injuries (SCI) are categorized based on several factors, including the location of the injury, the extent of the damage, and the resulting functional impairments. Here’s an overview of the different types:

1. By Location

• Cervical Injuries (C1-C8):

• C1-C4: Often result in tetraplegia (quadriplegia), affecting the arms, legs, and trunk. Injury to C1 or C2 can impact breathing and require a ventilator.
• C5-C8: Can cause varying degrees of paralysis in the arms, hands, and legs. Some arm and hand function might be preserved.
• Thoracic Injuries (T1-T12):
• Typically lead to paraplegia, affecting the trunk and legs. The higher the injury (closer to T1), the more of the trunk and upper body may be affected.
• Lumbar Injuries (L1-L5):
• Usually result in paraplegia, with impairment of the legs and possibly lower trunk. Some individuals retain partial trunk and upper body function.
• Sacral Injuries (S1-S5):
• Can affect the hips, pelvis, and legs. They may also impact bowel, bladder, and sexual functions. The severity depends on the specific sacral nerves affected.

2. By Completeness of Injury

• Complete Injury:
• There is a total loss of all sensory and motor function below the level of the injury. The spinal cord’s nerve pathways are fully disrupted.

• Incomplete Injury:
• Some sensory or motor function remains below the level of the injury. The degree of remaining function varies widely and can include:
  • Anterior Cord Syndrome: Loss of motor function and pain/temperature sensation, but preserved touch and proprioception.
  • Posterior Cord Syndrome: Loss of proprioception and vibration sense, but preserved motor function and pain/temperature sensation.
  • Central Cord Syndrome: Greater impairment of the upper limbs compared to the lower limbs, often with some degree of motor function preserved in the lower limbs.
  • Brown-Séquard Syndrome: Loss of motor function and proprioception on one side of the body and loss of pain and temperature sensation on the opposite side.

Zone of partial preservation:

                          The “zone of partial preservation” (ZPP) is refers to the  areas of the spinal cord where some sensory or motor function is still preserved below the level of the injury. This term is used when there is a complete SCI, meaning there is a total loss of function below the injury site, but some function is still preserved in certain regions.   

3. By Mechanism of Injury for SPINAL CORD INJURY

• Traumatic Injuries:

• Acute Trauma: Result from direct impact or sudden force (e.g., car accidents, falls, sports injuries).
• Penetrating Trauma: Result from objects like bullets or knives that directly damage the spinal cord.
• Non-Traumatic Injuries:

• Degenerative Diseases: Such as spinal stenosis or herniated discs that cause gradual compression of the spinal cord.
• Inflammatory Diseases: Such as multiple sclerosis or transverse myelitis, which involve inflammation of the spinal cord.

4. By Severity

• Mild Injury: Minimal disruption with some preservation of function and sensation.
• Moderate Injury: Significant loss of function, with varying degrees of impairment.
• Severe Injury: Extensive loss of function and sensation, potentially leading to total paralysis below the level of injury.

5.ACCORDING TO FUNCTION

• Quadriplegia: Paralysis affecting all four limbs, typically from cervical injuries
• Paraplegia: Paralysis affecting the lower body and legs, typically from thoracic, lumbar, or sacral injuries.

Each type of spinal cord injury has different implications for mobility, independence, and quality of life, making individualized assessment and treatment crucial.

CLINICAL FEATURES OF SPINAL INJURY CORD

Anterior cord syndrome:

• It describes the damage to the spinothalamic tract and corticospinal tract.
• There is a complete motor loss below the level of lesion due to the involvement of corticospinal tract.
• There is a loss of pain and temperature at and below the level of injury due to the involvement of lateral spinothelamic tract.
• 2 point discrimination sense , vibration and proprioception sense are remain preserved due  to intact posterior column.
• Bladder and bowel dysfunction may seen.

 Posterior cord syndrome:

• Loss of the sensation of the light touch, proprioception and vibration due to the damage of dorsal column of spinal cord.
• Motor function and pain and temperature sensation are preserved.

Central cord syndrome

• Patients present with upper limb weakness , urinary retention and sensory loss below the level of lesion.
• Upper limbs are more affected than the lower limbs with motor dysfunction more than the sensory loss.

Brown – Sequard syndrome

• It is a rare form of incomplete spinal cord injury which results due to the damage to one side of the spinal cord.
• There is a loss of vibration sensation , deep touch, deep touch or pressure, joint position sensense and mitor paralysis below the level of spinal cord injury on the same side.
• Also there is a loss of light touch, pain and temperature on the opposite side of the body

Conus medullaris syndrome

• It is caused by the injury to the conus medullaris and lumbar nearve roots at the level of T12 to L2 vertebra.
• Patients present  with a combination of UMN and LMN palsies like saddle anesthesia, urinary retention, loss of bowel reflex , lower limb motor weakness , paresthesia and numbness and chronic lower back pain.

Cauda equine syndrome

• It is caused by the injury to the caudaequina portion of the spinal cord.
• Patient present with muscles weakness or flaccidity in the lower limbs , wasting of the muscles and loss of reflexes.
• Due to the extramedullary lesion there will be sensory loss and motor dysfunction more in the distal lower limb than the proximal area.

Physiotherapy Management

 Goals

• To maintain normal muscle properties in the muscle affected.
• To prevent abnormal  movement spine.
• To prevent  respiratory complication.
• To aid in mobility and ambulation for functional independence.
• To provide psychological support to the patient.

Treatment

•  Mobility Training:

• Transfers: Training in safe transfer techniques (e.g., from bed to wheelchair).
• Wheelchair Skills: Skills for maneuvering and managing a wheelchair.
• Ambulation Training: For individuals with potential for walking, using parallel bars or gait trainers.
• Strengthening Exercises:

• Targeting major muscle groups, especially in the upper body for those with lower limb paralysis.
• Resistance training, including bodyweight exercises and resistance bands.
• Range of Motion and Stretching:

• Passive and active stretching exercises to prevent contractures and maintain joint mobility.
• Focus on both upper and lower limbs.
• Postural Training:

Neuromuscular electrical stimulation (NMES) to activate muscles and reduce atrophy in paralyzed areas.

Techniques to improve sitting posture and alignment in a wheelchair or during standing.

Education on pressure relief strategies to prevent pressure sores.

Balance and Coordination:

Exercises to enhance stability and proprioception, using tools like balance boards or stability balls.

Breathing Exercises:

Techniques to improve lung capacity and respiratory function, particularly for high-level injuries.

Aquatic Therapy:

Exercises in water to reduce joint stress and facilitate movement, often beneficial for strengthening and relaxation.

Electrical Stimulation:

Neuromuscular electrical stimulation (NMES) to activate muscles and reduce atrophy in paralyzed areas.