Transcript Treatment`s methods of brain and spinal cord injury

Treatment's methods of
brain and spinal cord
injury
Ilona Balajti
Department of Physiotherapy, Faculty of Health Care
University of Debrecen
Hungary
Brain Injury /head trauma/
A head injury is any trauma that leads to injury of
the scalp, skull, or brain. The injuries can range
from a minor bump on the skull to serious brain
injury.
Frequently there is no visible head injury yet
there can be serious brain damage to the person
involved in the accident.
Head injury is classified
1. closed head injury: you received a hard blow
to the head from striking an object
2. open (penetrating) head injury: you were
hit with an object that broke the skull and
entered the brain.
← you move at high speed
← going through the windshield during a car
accident
← from a shot to the head
Main types of brain injuries
Minor head injuries
1. Concussion (most common type of traumatic brain injury)
2. Contusion (it is a bruise on the brain )
millions of people in a year
usually go away on their own
Serious head injuries
1. Subarachnoid hemorrhage
2. Subdural hematoma
special to recognize and rehabilitation
Companied head injuries (by a spinal injury)
Causes
•
•
•
•
•
•
•
traffic accidents,
falls,
physical assault,
accidents at home,
work outdoors,
playing sports,
etc.
Symptoms
The signs of a head injury can occur immediately or develop slowly over several
hours
• Loss of consciousness, confusion or drowsiness
• Low breathing rate or drop in blood pressure
• Convulsion
• Fracture in the skull or face, facial bruising, swelling at the site of the injury,
or scalp wound
• Fluid drainage from nose, mouth, or ears (may be clear or bloody)
• Severe headache
• Initial improvement followed by worsening symptoms
• Irritability, personality changes, or unusual behavior
• Restlessness, clumsiness, lack of coordination
• Slurred speech or blurred vision
• Inability to move one or more limbs
• Stiff neck or vomiting
• Pupil changes
• Inability to hear, see, taste, or smell
Lasting symptoms
Some head injuries result in prolonged or nonreversible brain damages:
•Changes in personality, emotions, or mental abilities
•Speech and language problems
•Loss of sensation, hearing, vision, taste, or smell
•Seizures
•Hemi paresis
•Paralysis
•Coma
Spinal Cord Injuries
Usually begin with a blow that fractures or
dislocates the vertebrae
Spinal cord injury is classified
1. incomplete spinal cord injury: you have
some movement and sensation below the
injury
2. complete spinal cord injury: the cord can't
relay messages below the level of the injury
•
As a result, the patient is paralyzed below the level
of injury
Modified classification by American
Spinal Injury Association
• A - Complete: No sensory or motor function is preserved
in sacral segments S4-S5.
• B - Incomplete: Sensory, but not motor, function is
preserved below the neurologic level and extends through
sacral segments S4-S5.
• C - Incomplete: Motor function is preserved below the
neurologic level, and most key muscles below the
neurologic level have muscle grade less than 3.
• D - Incomplete: Motor function is preserved below the
neurologic level, and most key muscles below the
neurologic level have muscle grade greater than or
equal to 3.
• E - Normal: Sensory and motor functions are normal.
Muscle strengths are graded by the
Medical Research Council scale of 0-5
•
•
•
•
•
•
•
•
5 - Normal power
4+ - Sub maximal movement against resistance
4 - Moderate movement against resistance
4- - Slight movement against resistance
3 - Movement against gravity but not against resistance
2 - Movement with gravity eliminated
1 - Flicker of movement
0 - No movement
Classification of based on a
systematic motor and sensory
examination of neurologic function
• Tetraplegia (quadriplegia) - Injury to the spinal
cord in the cervical region with associated loss
of muscle strength in all 4 extremities
• Paraplegia - Injury in the spinal cord in the
thoracic, lumbar, or sacral segments, including
the cauda equina and conus medullaris
Damage: three different mechanisms
1. Destruction from direct trauma
2. Compression by bone fragments, hematoma,
or disk material
3. Ischemia from damage or impingement on the
spinal arteries
The most causes of spinal cord
injury
• Motor vehicle accidents. Accounting for almost 50 percent of
new spinal cord injuries each year.
• Acts of violence. About 15 percent of spinal cord injuries
result from violent encounters, often involving gunshot and
knife wounds.
• Falls. Spinal cord injury after age 65 is most often caused by a
fall. Overall, falls make up approximately 22 percent of spinal
cord injuries.
• Sports and recreation injuries. Athletic activities such as
impact sports and diving in shallow water cause about 8 percent
of spinal cord injuries.
• Diseases. Cancer, infections, arthritis and inflammation of the
spinal cord also cause spinal cord injuries each year.
Signs and symptoms:
• Pain or an intense stinging sensation caused by damage
to the nerve fibers in your spinal cord
• Loss of movement
• Loss of sensation, including the ability to feel heat,
cold and touch
• Loss of bowel or bladder control
• Exaggerated reflex activities or spasms
• Changes in sexual function, sexual sensitivity and
fertility
• Difficulty breathing, coughing or clearing secretions
from your lungs
Segmental spinal Cord level and
Function
Level
Function
Cl-C6
Neck flexors
Cl-T1
Neck extensors
C3, C4, C5
Supply diaphragm
C5, C6
Shoulder movement, raise arm (deltoid); flexion of elbow
(biceps); C6 externally rotates the arm (supinates)
C6, C7, C8
Extends elbow and wrist (triceps and wrist extensors);
pronates wrist
C7, C8, Tl
Flexes wrist
C8, Tl
Supply small muscles of the hand
Tl -T6
lntercostals and trunk above the waist
T7-Ll
Abdominal muscles
Ll, L2, L3, L4
Thigh flexion
L2, L3, L4
Thigh adduction
L4, L5, S1
Thigh abduction
L5, S1 S2
Extension of leg at the hip (gluteus maximus)
L2, L3, L4
Extension of leg at the knee (quadriceps femoris)
L4, L5, S1, S2
Flexion of leg at the knee (hamstrings)
L4, L5, S1
Dorsiflexion of foot (tibialis anterior)
L4, L5, S1
Extension of toes
L5, S1, S2
Plantar flexion of foot
L5, S1, S2
Fexion of toes
Treatment of Spinal Cord Injury - story
The association of paralysis with vertebral fractures or
dislocations was recognized as early as 5000 BC
• The diagnosis was not difficult— varying degrees of
weakness and incontinence associated with local pain
and an area of deformity or lateral mobility of the bone
on the back or neck.
• The prognosis in forward dislocations was hopeless
Treatment – story
Posterior displacements could be treated with
extension and pressure, principles of closed
reduction that were followed for centuries
Treatment – story
• Fifty years ago, a spinal cord injury was usually
fatal.
• Today, there's still no way to reverse damage to
the spinal cord.
• But researchers are working on new treatments,
that may promote nerve cell regeneration or
improve the function of the nerves
Early stages of treatment
1. First the doctor will treat:
•
Medications (Methylprednisolone works by reducing
damage to nerve cells and decreasing inflammation near the
site of injury )
•
•
Immobilization (It’s may need traction to stabilize the spine.)
Surgery (Often, emergency surgery is necessary to remove fragments
of bones, foreign objects, herniated disks or fractured vertebrae that
appear to be compressing the spine.)
Ongoing care –
problems that may arise from immobilization
•
•
•
•
•
•
deconditioning,
muscle contractures,
bedsores,
urinary infection
blood clots
hospitalization
During the hospital stay, a rehabilitation team will work :
physical therapist, occupational therapist,
rehabilitation nurse, rehabilitation psychologist, social
worker, dietitian recreation therapist
and a special doctor
Aims in the treatment
•
•
•
•
•
•
improve the remaining muscle strength
to give the greatest possible mobility
independence
emphasize regaining leg and arm strength
redeveloping fine-motor skills
learning adaptive techniques to accomplish day-to-day
tasks
The program typically includes exercise, as well as training
on the medical devices, such as a wheelchair or
equipment that can make it easier to fasten buttons or
dial a telephone.
New technologies in the treatment
It’s can help people with a spinal cord injury
become more independent and more mobile.
Some apparatuses may also restore any
function.
1. Modern wheelchairs
2. Computer devices
3. Electrical stimulation devices and neural
prostheses