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INTRODUCTION

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LEARNING OBJECTIVES

  1. Identify the major etiological factors associated with traumatic spinal cord injury.

  2. Describe the clinical presentation following damage to the spinal cord.

  3. Given a patient with a spinal cord injury, identify the motor and sensory level of injury and the American Spinal Injury Association impairment scale classification.

  4. Analyze the impact of complications associated with spinal cord injury on the physical therapy plan of care and outcomes.

  5. Identify the expected functional outcomes for patients with spinal cord injury at various lesion levels.

  6. Explain how common precautions will affect physical therapy interventions.

  7. Evaluate different outcome measures commonly used in people with spinal cord injury.

  8. Analyze and interpret patient data, formulate anticipated goals and expected outcomes, and develop a plan of care when presented with a clinical case study.

  9. Justify the selection of different interventions for the acute and active rehabilitation stages of recovery.

  10. Discuss the use of neurotechnologies for people with spinal cord injury.

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Spinal cord injury (SCI) is a relatively low-incidence, high-cost injury that results in tremendous change in an individual's life. Paralysis of the muscles below the level of the injury can lead to limited and altered mobility, self-care, and ability to participate in valued social activities. In addition to the musculoskeletal system, many other body systems are impaired after a SCI, including the cardiopulmonary, integumentary, gastrointestinal, genitourinary, and sensory systems. The psychosocial impact of SCI can be just as great as the physical impact. Changes in body image and sexual function, incontinence, and having to rely on others to complete everyday tasks that were previously done without thought or effort can profoundly influence a person's identity. Rehabilitation is an important element toward achieving a fulfilling and active life after SCI. Physical therapists play a key role in the rehabilitation process.

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DEMOGRAPHICS AND ETIOLOGY

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It is estimated that approximately 11,000 new cases of SCI occur in the United States annually. Between 225,000 and 288,000 individuals with SCI are currently living in the United States.1 Spinal cord injury is generally thought to primarily affect young adults. However, the age at injury has steadily increased. During the 1970s the average age at the time of injury was 28.7 years old. Between 2005 and 2008 this increased to 37.1 years old.1 This may be due to the aging of the U.S. population and an increase in falls as a cause of injury. The majority of persons with SCI are male (78.3% male vs. 21.7% female). Ethnic distributions indicate that whites represent 66.5% of those with SCI, followed by African Americans (26.8%), Hispanics (8.3%), and Asians (2.0%).2

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Spinal cord injuries can be grossly divided into two broad etiological categories: traumatic injuries and nontraumatic damage. Trauma is the most frequent cause of injury in adult rehabilitation populations. Injury results from damage caused by traumatic events such as motor vehicle accidents (40.4%), falls (27.9%), violence (15.0%), and sports (8.0%).2 Nontraumatic ...

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