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LEARNING OBJECTIVES

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 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.

INTRODUCTION

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 an 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.

DEMOGRAPHICS AND ETIOLOGY

It is estimated that approximately 17,000 new cases of SCI occur in the United States annually. Between 243,000 and 347,000 individuals with SCI are currently living in the United States. The average age at injury is 42.1 However, there is a bimodal distribution of age at injury. The first peak occurs in young adults between the ages of 15 and 29, and a second peak occurs in older adults (65 or older).2 This may be due to the aging of the U.S. population and an increase in falls as a cause of injury.1 The majority of persons with SCI are male (80% male vs. 20% female).1

Spinal cord injuries can be grossly divided into two broad etiological categories: traumatic and nontraumatic. Trauma is the most frequent cause of injury in adult rehabilitation populations. Traumatic injury results from damage caused by events such as motor vehicle accidents (38%), falls (30.5%), violence (13.5%), and sports-related injuries (9%).1 Falls are the most common cause of SCI in older adults.3 Nontraumatic damage in adult populations generally results ...

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