- The spinal cord injury (SCI) takes place in (third thoracic vertebra) T3 that is located little down in the spinal column near to skull. The damage is caused to any part of the spinal cord or its nerves that is located at the end of the spinal canal. T1-T4 becomes parapalegic (legs and trunk affected) with full rising of arms, chest muscles and upper back muscles having varying strength that depends on level of injury (Simpson et al., 2012). The corresponding nerves affect the upper chest, muscles, abdominal and mid-back muscles. The person is likely to use a manual wheelchair and may walk with braces or standing frames.
- There are three different causes of SCI at T3 complete: the most common are the traumatic causes like sports injuries, falls and violence. Paediatric SCI is caused by accidents due to motor vehicles and non-traumatic causes are spinal cord lesion, tumours or processes in spinal processes.
- The assessments or evaluation tools include neurological exam that helps in assessing motor and sensory function of each segmental level of the spine. The perineal and deep tendon reflexes are evaluated for the classification of lesions that is specific to spinal syndrome.
- The main problem that occurs due to SCI at T3 complete is inability to perform activities of daily living (ADL) like toileting, bathing, personal hygiene, functional mobility, grooming. SCI also affect the social participation, leisure, play, education and occupation.
- The strategies include active assisted range of motion (ROM), strengthening and fine motor control. This imparts accessibility to community, environment as well as in homes. The assistive devices like splints and braces can be incorporated into the treatment regimen facilitating and promoting ADL performance and functional independence for the patient with SCI. There is pain treatment and respiratory, physical and occupational therapists assist in treating SCI patients. There is also surgical options, although, it cannot fix or reverse the injury like stabilizing spinal fractures, spinal cord pressure release and treatment of other injuries that occurs at the time of SCI (Garbossa et al., 2012).
- Spinal injury specialists encompass rehabilitation for SCI patients that focuses on achievement and maintenance of good health, maximization of function and extensive follow-up after a severe SCI. These centres also focus on routine follow-ups that can be extended to clinical disciplinary. Rehabilitation promotes quality of life that can be helpful for the patients with SCI to have speedy recovery. Occupational therapists (OTs) also provide acute medical care for the patients who receive secondary injury along with primary SCI injury (Hammell, 2013).
- Contraindications or precautions associated with SCI include bladder management as one need to prevent the complications of lower and upper urinary tract. Prolonged resting on bed also affects bowel movement and it is advised that seated position can be helpful in reducing the anorectal angle and facilitation in defecation. The seated position is suitable for performing bowel program, although seated position is preferable. Pressure ulcers also need to be prevented along with mobility and management of skin care.
- Prognosis for SCI comprises of incomplete, complete and conus medullaris syndrome. Improvement of one nerve root level is expected in majority of patients (80%), two-nerve root level improvement occurs in only 20% of patients, and finally only 1% of patients undergo complete recovery during hospital diagnosis. The recovery level is directly proportional to sparring and there is better prognosis if the patients show rapid recovery and resumes improvement (Varma et al., 2013). Conus medullaris syndrome shows better prognosis in terms of recovery as compared to proximal lesions.
SCI has negative effect on the performance skills that comprise of motor skills related to trunk and LE. The process skills are also affected along with social interaction that has a direct impact on the self-esteem and confidence levels of the patient with SCI. The sensory functioning is also affected like touch, proprioceptive, sensitivity and pain in terms of temperature, pressure and functioning of trunk and LE that cannot use the body below arms and chest level (McDonald, Becker & Huettner, 2013). Motor movement and neuromuscular related functioning is also affected in terms of bones and joints stability as it will not function below level of injury. The muscle functioning is also affected in terms of endurance, tone and power as muscle tone is lost below the level of injury. The involuntary and voluntary movement reactions and reflexes are affected along with impairment of gait pattern, as there is loss of LE and trunk muscle functioning (Finnerup & Baastrup, 2012). Perceptual processing is also affected in patients with SCI correlated with impaired processing of information. The patients show disturbances in the inhibitory function, there are alterations in early encoding perceptual processing and executive functioning that is associated with memory or contextual updating operations (Lazzaro et al., 2013).
Finnerup, N. B., & Baastrup, C. (2012). Spinal cord injury pain: mechanisms and management. Current pain and headache reports, 16(3), 207-216.
Garbossa, D., Boido, M., Fontanella, M., Fronda, C., Ducati, A., & Vercelli, A. (2012). Recent therapeutic strategies for spinal cord injury treatment: possible role of stem cells. Neurosurgical Review, 35(3), 293-311.
Hammell, K. W. (2013). Spinal cord injury rehabilitation. Springer.
Lazzaro, I., Tran, Y., Wijesuriya, N., & Craig, A. (2013). Central correlates of impaired information processing in people with spinal cord injury. Journal of Clinical Neurophysiology, 30(1), 59-65.
McDonald, J. W., Becker, D., & Huettner, J. (2013). Spinal cord injury. In Handbook of Stem Cells (Second Edition) (pp. 723-738).
Simpson, L. A., Eng, J. J., Hsieh, J. T., & Wolfe and the Spinal Cord Injury Rehabilitation Evidence (SCIRE) Research Team, D. L. (2012). The health and life priorities of individuals with spinal cord injury: a systematic review. Journal of neurotrauma, 29(8), 1548-1555.
Varma, A. K., Das, A., Wallace, G., Barry, J., Vertegel, A. A., Ray, S. K., & Banik, N. L. (2013). Spinal cord injury: a review of current therapy, future treatments, and basic science frontiers. Neurochemical research, 38(5), 895-905.