Practical Considerations for Fluid Replacement for Athletes with a Spinal Cord Injury
Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk in Fluid Balance, Hydration, and Athletic Performance, 2016
Whether an SCI is traumatic or non-traumatic, the resultant deficits in motor, sensory, and autonomic functions are dependent on the level and the pattern of spinal lesion, mainly in the transverse plane. Remaining sensory (dermatome) and motor (myotome) function is examined according to international guidelines for neurological classification (American Spinal Injuries Association—ASIA) to identify lesion level and completeness (Kirschblum et al. 2011), see Figure 16.1. Injury level is described as the most caudal (away from the head) spinal segment with remaining function. Tetraplegia refers to impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord and results in some impairment of the arms as well as typically the trunk, legs, and pelvic organs (Kirschblum et al. 2011). Paraplegia refers to impairment or loss of motor function in the thoracic, lumbar, or sacral segments of the spinal cord, with lesion level-dependent losses in trunk, leg, and pelvic function (Kirschblum et al. 2011). A complete SCI results in the complete loss of both sensory and motor communication between the brain and tissue innervated below the lesion level (classified as ASIA grade A). In contrast, the neurology of incomplete injuries is complex and can differ greatly from one case to another (classified as ASIA grade B–D) (Kirschblum et al. 2011). Damage to the neurons of the anterior ventral roots may lead to a loss of motor function but maintenance of sensory function, whereas the converse may apply with damage to neurons of posterior dorsal roots.
Inflammatory diseases affecting the spinal cord
Milosh Perovitch in Radiological Evaluation of the Spinal Cord, 2019
In a spinal extradural abscess, the onset of symptoms is usually rapid, being in essence the result of a present local infection, direct pressure on the spinal nerve roots and cord itself, compression of longitudinal and radicular spinal arteries leading to ischemia of the segments of the cord, and of the impairment to the venous circulation. Circulatory disturbances cause local edema, later, areas of softening, and eventually, the state known as “compression” myelitis.70 Below the site of compression, the CSF will show an increase in cells and protein. In the initial phase, the pain in the back often associated with root pains, tenderness of the bony spinal structures, fever, and leukocytosis are the main symptoms that precede the sensorimotor disturbances in the limbs and bladder paralysis. If a prompt treatment is not applied, irreversible paraplegia or tetraplegia will follow. An extradural abscess represents a neurosurgical emergency, which should be assumed if neuroradiologic evaluation is sought.69
Neurological Disease in Herpes Simplex Virus Type 2 (HSV-2) Infection
Marie Studahl, Paola Cinque, Tomas Bergström in Herpes Simplex Viruses, 2017
Although mild cases with recovery without treatment are also seen, prompt therapy is generally instituted, as a severe and potentially lethal disease may result. Antiviral therapy with intravenous acyclovir along with corticosteroids has been given in order to prevent further development of an ascending pattern of the myelitis. The duration of antiviral therapy has mostly been 2–3 weeks IV, sometimes with a switch to oral valacyclovir during the third week. With early initiation of this treatment, cessation of disease progression has been reported and even recovery in a few cases. Most reported patients are left, however, with severe sequelae like paraplegia or tetraplegia. Some few cases of recurrent myelitis have been reported to be treated successfully with valacyclovir (1 g tid) together with decreasing doses of corticosteroids followed by long-term antiviral suppressive prophylaxis (88).
Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020
Published in Temperature, 2020
Katy E. Griggs, Ben T. Stephenson, Michael J. Price, Victoria L. Goosey-Tolfrey
Out of the six impairment groups, spinal cord injury (SCI) is the most comprehensively researched in relation to athletic performance [14]. Athletes with an SCI are eligible to compete in a number of sports including wheelchair rugby, archery, triathlon, wheelchair tennis and athletics (See Table 1). An SCI may occur through either application of extreme traumatic forces or via degenerative and congenital disorders. Individuals with an SCI experience varying degrees of sensory, motor and functional loss depending on the level of their injury. Injury to the cervical region of the spinal cord is referred to as tetraplegia leading to impaired function of the arms, trunk, legs and pelvic organs. Injury to the thoracic, lumbar and sacral segments of the spinal cord, referred to as paraplegia affects the function of the trunk and pelvic organs below the lesion level and the legs. Spinal cord injuries are further classified as being neurologically complete or incomplete in relation to the motor or sensory function [15,16].
Return to work in the context of everyday life 7–11 years after spinal cord injury – a follow-up study
Published in Disability and Rehabilitation, 2018
Lisa Holmlund, Susanne Guidetti, Gunilla Eriksson, Eric Asaba
Six men and two women with traumatic SCI were invited to participate, all of whom had been interviewed in a previous study in 2008 [4]. At that time, purposive sampling [39] was used to include persons with different backgrounds, e.g., gender and injury level [40]. Eligibility criteria were 20–34 years of age, 1–5 years post injury, and not yet returned to work. Exclusion criteria were persons who had received clinical occupational therapy from the first author and persons who had a psychiatric diagnosis as defined in the Axis I and Axis II Diagnostic and Statistical Manual of Mental Disorders-IV. All participants from the previous study [4] were contacted by telephone by the first author with information about this follow-up study. They all agreed to participate and gave informed consent prior to the first interview. Four participants were diagnosed with paraplegia and four with tetraplegia. The participants represented diversity in gender, injury level [40] and ethnicity. All had a similar educational background and were born in Sweden, though two also had family connections originating in another country. Efforts were made to include participants with diverse educational backgrounds. However, this was difficult because among those who were eligible for the study, none had pursued higher education. Moreover, none had resumed their previous employment or education because it was too heavy or otherwise demanding [4].
Body composition and metabolic parameters in men with chronic traumatic paraplegia – A pilot study from India
Published in The Journal of Spinal Cord Medicine, 2022
Kalyani Sridharan, Shipra Rachna Singh, Kripa Elizabeth Cherian, Nitin Kapoor, Jane Elizabeth, Judy Ann John, Nihal Thomas, Thomas V. Paul
The immediate and profound skeletal muscle atrophy that follows SCI results in a decrease in lean mass below the level of injury.6 Studies have demonstrated lower fat-free mass and higher fat mass post SCI in comparison to able-bodied individuals in spite of similar BMIs.7 This decline in lean mass correlates inversely with age and duration of injury and depends on the level and completeness of injury.8 A more complete and a higher level of injury causes a greater decline in lean mass. Subjects with tetraplegia have a reduced lean mass in the upper limbs compared to those with paraplegia.5 The loss of metabolically active muscle mass combined with physical inactivity due to the disability decreases the basal metabolic rate and total energy expenditure resulting in obesity.9
Related Knowledge Centers
- Cervical Vertebrae
- Lumbar Vertebrae
- Thoracic Vertebrae
- Paralysis
- Spinal Cord
- Paraplegia
- Sacrum
- Motor Control
- Sense
- Weakness