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Objectives

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OBJECTIVES

After reading this chapter, you will be able to:

  • Differentiate between traumatic and nontraumatic causes of spinal cord injury (SCI) and describe the most common of these

  • Discuss how level of injury and severity of injury contribute differently to the disability associated with SCI

  • Compare and contrast the different syndromes that may be associated with incomplete SCI

  • Describe the indicators that may assist in predicting functional outcomes in individuals with SCI

  • Describe the secondary conditions that may occur after SCI and identify those that are preventable

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Introduction

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We live in a time when there are tremendous resources available to assist individuals with spinal cord injury (SCI) in living long and productive lives. While injury to the spinal cord frequently results in impairments of function that have a significant impact on the life of the individual, progress in the care of individuals with SCI has resulted in near-normal life expectancy. This outlook represents a radical reversal from the view expressed in the earliest known records describing SCI, dating back almost 4 millennia, which indicate that the ancient Egyptians characterized vertebral fracture as "an ailment not to be treated." From that time and even through World War II, individuals typically died from the initial trauma that injured the spinal cord or suffered severe morbidity from secondary conditions such as respiratory problems1 or circulatory problems.2 Since then, there have been dramatic steps forward, particularly in the 1970s. At that time, the routine use of intermittent bladder catheterization3,4,5 resulted in a dramatic decrease in the mortality due to renal failure. Improvements in emergency medical care6 meant that precautions were taken to prevent further damage to the spinal cord during transport to emergency medical facilities, resulting in a decrease in the proportion of complete injuries.

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Most of the time we give little thought to the spinal cord, but it is truly an amazing structure. Descending and ascending communications between our brain and spinal cord allow our wish to move to become a reality, and allow us to experience the world through touch and other tactile sensations. Far from being a simple conduit for information going to and coming from the brain, the spinal cord is critical for modulating descending motor commands and ascending sensory signals. Interestingly, the spinal cord can generate complex, elegant motor output via spinal central pattern generators (this concept is discussed further in chapter 13, "Locomotor Training"). When the spinal cord is damaged due to trauma or disease, the loss of these important mechanisms results in disruption of motor, sensory, and autonomic functions. Because sensory organs, muscles, and visceral organs are innervated by distinct segments of the spinal cord, there is an associated relationship between the level and severity of injury and the residual sensory, motor, and autonomic function.

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Today excellent emergency care and progressive rehabilitation strategies mean that individuals with ...

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