What is spinal cord injury?

What is spinal cord injury?

Safe Ways To Treat Chronic Pain

According to the National Spinal Cord Injury Association, as many as 450,000 people in the United States are living with a spinal cord injury (SCI)

Spinal cord injuries are commonly seen in traumatic incidents such as gunshot, motor vehicle accidents, falls, etc. These injuries can result in various symptoms ranging from sensory symptoms such as pain, numbness, tingling, etc., to motor control deficits such as paralysis. To understand spinal cord injury and its management, you should first know the structure and function of the spinal cord.

Spinal Cord – What Is It?

The spinal cord is a structure made up of neurons (cells) that connects your brain to the rest of your body. It lies within the center of your body and is present inside your spine (vertebral column). It is the continuation of your brain and starts from the point where the brain ends (beneath the skull). It then runs down in your spine and transmits signals from the brain to the rest of your body.

So if you want to move your hand to pick up a glass, your brain will generate a motor signal. This signal will travel down the spinal cord and ultimately reach your muscles via nerves originating from your spinal cord. Not only this, but the spinal cord also serves the function of carrying sensory signals to your brain. You can feel pain only when this sensation is conveyed to the brain via sensory nerves to the spinal cord to your brain.

This helps to understand that signal transmission is affected if the spinal cord is damaged, resulting in several sensory and motor symptoms.

What is Spinal Cord Injury?

Any damage to the spinal cord either because of trauma (gunshot, fall, assault, motor vehicle accident) or an infection (meningitis, transverse myelitis) is called Spinal Cord Injury (SCI).

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Here we will focus mainly on traumatic spinal cord injury.

Trauma to the spinal cord can result in a variety of injuries. Spinal cord injuries are divided into several types based on the etiology and location of spinal cord injury.

Brown-Sequard Syndrome

Spinal cord injury (SCI), in which there is an injury to only one-half of the spinal cord, is called Brown Sequard Syndrome.

This injury commonly occurs because of penetration wounds such as gunshot or stab wounds.

Anterior Cord Syndrome

In this type of spinal cord injury, the anterior part of the spinal cord is damaged. This commonly occurs because of hyper-flexion of the spine at the neck that disrupts the blood supply of the anterior region coming from the anterior spinal artery.

Central Cord Syndrome

This is the most common syndrome associated with spinal cord injuries. In this type of spinal cord injury, the central part of the spinal cord is damaged due to hyper-extension of the spine at the neck. It is also associated with congenital narrowing of the spinal canal.

Cauda Equina Syndrome

This injury affects the terminal part of the spinal cord, i.e., Cauda Equina. It results from herniation of lumbar discs (outward movement of discs present between lumbar vertebrae). It can also occur due to traumatic injury in the lower back.

Signs and Symptoms of Spinal Cord Injury

The signs and symptoms of spinal cord injury depend upon the type of injury. Some common symptoms of spinal cord injuries are as follows.

  • Decreased muscles strength (paresis)
  • Paralysis of muscles
  • Sensory disturbances

  • Inability to feel touch and pressure below the site of lesion
  • Inability to feel pain or temperature below the site of lesion

  • Inability to sense the position of the body part in space (proprioception)
  • Problems with urination and defecation
  • Sexual problems
  • Problems with balance and coordination

Management of Spinal Cord Injury

The management of spinal cord injury is divided into the following sections.

  • Immobilization
  • Surgical Management
  • Pharmacological management
  • Physiotherapy Management
  • Orthotics Management

Let’s have a look at each section one by one.

Immobilization

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It is necessary to immobilize the spine if you suspect spinal cord injury due to trauma to your vertebrae/spine. This is important because the injury can get worse if the patient is handled carelessly. Immobilization is achieved by using several braces such as soft and hard collars, Sterno-Occipital Mandibular Immobilization (SOMI) device, Halo vest, etc.

Surgical Management

Surgery is indicated following spinal cord injury to remove any foreign objects or ruptured discs, reduce fractured vertebrae, and decompress the spinal cord. Not all spinal cord injuries require surgical management, and some injuries can be managed non-operatively.

Pharmacological Management

Steroids play an essential role in suppressing secondary events following spinal cord injury and are widely used in SCI management. Several other drugs such as NSAIDs, Gabapentin, antidepressants are also used in SCI management.

Physical Therapy Management

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Physiotherapy management plays a crucial role during sub-acute and chronic phases of spinal cord injuries. It involves respiratory muscles training (injury at cervical level), muscles strengthening and stretching exercises, balance and coordination exercises, gait training, etc.

It consists of the maximum protection phase, intermediate protection phase, and minimum protection phase. Outcomes of physiotherapy management depend upon the level of spinal cord injury—the higher the level of injury, the poorer the outcomes. Nearly 25% of spinal cord injury patients cannot ambulate independently if the cervical spine is involved.

Orthotics Management

Like the treatments mentioned above, orthotics management plays a vital role in managing spinal cord injury in acute, sub-acute, and chronic phases of recovery.

Orthoses help stabilize the spine so that the healing is not affected by unnecessary spine movements. They also provide support to the body that helps in functional rehabilitation.

Individuals with spinal cord injury at the cervical (neck) level are instructed to wear a halo brace that immobilizes the neck region. For managing the injuries involving the neck and upper back, cervical-thoracic orthosis (CTO) is recommended. Similarly, Thoraco-Lumbar-Sacral Orthosis (TLSO) covers your whole back.

Lower limb orthoses such as Knee-Ankle-Foot Orthosis (KAFO) or Hip-Knee-Ankle-Foot Orthosis (HKAFO) are also used for assisting in ambulation following spinal cord injuries.

No matter which level is involved, spinal cord injury management is always multi-disciplinary and involves several healthcare professionals. Early detection of an injury is always a key to achieving better outcomes.

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Kim Spranger tells us her story of discovering the NewGait

Kim Spranger tells us her story of discovering the NewGait

Kim Spranger using the newgait

Kim Spranger Discovers the NewGait

Watch the video version here. Kim Spranger tells us her story as the first therapist to ever use the NewGait.

BENGA: Thank you everyone for joining. Today we had the opportunity to speak with Kim Spranger, one of our founding NewGait clinicians, and discoverer of the NewGait as a rehab device. Kim is a physical therapist in the UP of Michigan and today she is going to tell us her story as the first person to use the NewGait.

Kim Spranger was the first therapist to ever use the NewGait. Today, she is the Director of Culture at NewGait. Listen to her story about discovering the device and her experience using it for Spinal Cord Injury Rehab.

KIM: My name is Kim Spranger, and I’m a physical therapist. I’m a lymphedema specialist, so I have treated lymphedema patients for years, but otherwise, I have been working in outpatient orthopedics for about 14 years now.

KIM: It actually wasn’t a NewGait, when I saw the device, and I saw it, on Facebook, actually. My son pointed it out to me, as a unique training device for runners. Immediately I saw the potential application to physical therapy, so I obtained one and started to use it.

KIM: Well, if I think about the day I just had it in the clinic, I probably used it on 60-70% of the patients that I saw today. I use it for diagnosing, like, what really is problem with their gait? If I try it on them in a certain way does that change their gait? Which helps me know what muscles to train with them. So I use it in a diagnostic sort of way. I use it for biofeedback when I’m trying to teach them something about how they’re moving, but they’re not really hearing me, or they can’t take what I’m saying and then change what they’re doing. It’s great for manual cueing to make that happen. Sometimes people just need some postural stability or feedback, I’ve used it that way as well. Sometimes people are coming in with a neurological condition and they just have so much fatigue or heaviness to their limbs that the NewGait is just a fabulous way to kind of de-weight them. One of the fellows said today, “Wow, it’s just picking up my leg for me.” So I’m using it in all of those different ways throughout my day.

“I probably used it on 60-70% of the patients that I saw today… It’s great for manual cueing… Sometimes people just need some postural stability or feedback.”

KIM: Well, once someone said to me that, as therapists, we are like carpenters, and we have tools in our tool belt. The more tools we have, then the more effectively we can do our job. So the NewGait has become, a special tool in my tool belt. Throughout my day, it’s not like, “oh, this is a certain diagnosis, so I should use the NewGait.” That is not how it works, it’s more like, this is what I see, or don’t see, in how they’re moving, that I now have a whole new set of tools to give them the feedback, and help them reach their goals.

I feel like the staff that works here are always looking for new and different approaches to what we do. And we talk about it frequently. The thing about this device is, it’s not like, you know, “here’s the directions, and you put it on this way and you always use it the same way.” It’s not like that at all. We’ll be playing around with it, and be like, “Hey, you know, look at this new thing I just did. Oh my gosh, that is so cool.” I heard Megan saying that today about someone, and I will think, “Wow, I should try that on patient X tomorrow, because I see the same thing with him that you’re seeing with this patient.” So it gives us reasons to collaborate and try new things together. Patients will pick up on that energy too. They want to be looked at as individuals and not just doing the same exercises everyday, but instead really modifying things to make their therapy the most effective, and the NewGait has done that for us.

“It gives us reasons to collaborate and try new things. Patients pick up on that energy too. They want to be looked at as individuals and not just doing the same exercises everyday, but instead modifying things to make their therapy the most effective, the NewGait has done that for us.”

KIM: Well, I believe that this group of people has been, literally hand picked for this moment and for this product. We did not go searching for them. They just came into our lives. And yet, we are all very much equally have the same kind of passion for life. We are the kind of people who just really want to make a difference. We’re a team who cares in a way that is unique for this day that we live in. As we’ve all worked together over the last three years or so, it’s been truly an experience for all of us. We don’t do this because we have to, we do this because we want to. There is something within me that is really fulfilled by working on this project and watching what it can do.

“We’re a team who cares in a way that is unique for this day that we live in.”

KIM: Well, that’s easy for me because when I first got it, I had never seen it before so it was like, you know, trying a new bike for the first time. No one had ever used it for therapy before. I had this patient that I really loved and really was rooting for, I had a special connection with her. And to be able to take this thing that was unheard of, put it on her, and go from walking with two canes, to walking without a cane and looking so much more confident, almost immediately, that’s kind of a highlight day for therapists. I would say the second one is when we took it down to a spinal cord Institute in Detroit to see these young men who are so hopeful of regaining function and mobility. We were able to put the NewGait on them and have them be wowed, over and over agin. I love it when people say, “Wow!” I walked out of that building and said, “This has been a very good day.”

“to be able to take this thing that was unheard of, put it on her, and go from walking with two canes, to walking without a cane and looking so much more confident, almost immediately.”

KIM: This device will become like several other devices that I’ve seen over my years in therapy where, initially, it looks novel, and people go, “Hmm, I wonder what that does.” I see that people are going to start to understand what it can do for their clinic and how cost effective it is. I think it will become as common as any other popular rehab tool.