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Tetraplegia, also known as quadriplegia, is defined as the dysfunction or loss of motor and/or sensory function in the cervical area of the spinal cord. A loss of motor function can present as either weakness or paralysis leading to partial or total loss of function in the arms, legs, trunk, and pelvis. The paralysis may be flaccid or spastic. A loss of sensory function can present as an impairment or complete inability to sense light touch, pressure, heat, pinprick/pain, and proprioception. In these types of spinal cord injury, it is common to have a loss of both sensation and motor control.
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.
Paraplegia, or paraparesis, is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek (παραπληγίη) "half-stricken". It is usually caused by spinal cord injury or a congenital condition that affects the neural (brain) elements of the spinal canal. The area of the spinal canal that is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If four limbs are affected by paralysis, tetraplegia or quadriplegia is the correct term. If only one limb is affected, the correct term is monoplegia. Spastic paraplegia is a form of paraplegia defined by spasticity of the affected muscles, rather than flaccid paralysis.
Cervical spine disorders are illnesses that affect the cervical spine, which is made up of the upper first seven vertebrae, encasing and shielding the spinal cord. This fragment of the spine starts from the region above the shoulder blades and ends by supporting and connecting the skull.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions.
Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery. Neurapraxia is derived from the word apraxia, meaning “loss or impairment of the ability to execute complex coordinated movements without muscular or sensory impairment”.
Hypertonia is a term sometimes used synonymously with spasticity and rigidity in the literature surrounding damage to the central nervous system, namely upper motor neuron lesions. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles, and decreased synaptic inhibition. These consequences result in abnormally increased muscle tone of symptomatic muscles. Some authors suggest that the current definition for spasticity, the velocity-dependent over-activity of the stretch reflex, is not sufficient as it fails to take into account patients exhibiting increased muscle tone in the absence of stretch reflex over-activity. They instead suggest that "reversible hypertonia" is more appropriate and represents a treatable condition that is responsive to various therapy modalities like drug or physical therapy.
Autonomic dysreflexia (AD) is a potentially fatal medical emergency classically characterized by uncontrolled hypertension and cardiac arrhythmia. AD occurs most often in individuals with spinal cord injuries with lesions at or above the T6 spinal cord level, although it has been reported in patients with lesions as low as T10. Guillain–Barré syndrome may also cause autonomic dysreflexia.
Anterior spinal artery syndrome is syndrome caused by ischemia of the area supplied by the anterior spinal artery, resulting in loss of function of the anterior two-thirds of the spinal cord. The region affected includes the descending corticospinal tract, ascending spinothalamic tract, and autonomic fibers. It is characterized by a corresponding loss of motor function, loss of pain and temperature sensation, and hypotension.
Central cord syndrome (CCS) is the most common form of cervical spinal cord injury. It is characterized by loss of power and sensation in arms and hands. It usually results from trauma which causes damage to the neck, leading to major injury to the central corticospinal tract of the spinal cord. CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.
Brown-Séquard syndrome is caused by damage to one half of the spinal cord, i.e. hemisection of the spinal cord resulting in paralysis and loss of proprioception on the same side as the injury or lesion, and loss of pain and temperature sensation on the opposite side as the lesion. It is named after physiologist Charles-Édouard Brown-Séquard, who first described the condition in 1850.
MedStar National Rehabilitation Network is located in Washington, D.C., and specializes in treating persons with physical disabilities. The National Rehabilitation Hospital was founded in 1986 by Edward A. Eckenhoff, and is a member of the MedStar Health system, the Washington, D.C.-Baltimore region's largest non-profit healthcare organization.
Ernest Herman Joseph Bors, MD was a Czech-born American physician. He was a pioneer in the multidisciplinary care of individuals with spinal cord injury (SCI).
H3 is a para-cycling classification. The UCI recommends this be coded as MH3 or WH3.
Restorative neurology is a branch of neurology dedicated to improving functions of the impaired nervous system through selective structural or functional modification of abnormal neurocontrol according to underlying mechanisms and clinically unrecognized residual functions. When impaired, the body naturally reconstructs new neurological pathways and redirects activity. The field of restorative neurology works to accentuate these new pathways and primarily focuses on the theory of the plasticity of an impaired nervous system. Its main goal is to take a broken down and disordered nervous system and return it to a state of normal function. Certain treatment strategies are used to augment instead of fully replace any performance of surviving and also improving the potential of motor neuron functions. This rehabilitation of motor neurons allows patients a therapeutic approach to recovery opposed to physical structural reconstruction. It is applied in a wide range of disorders of the nervous system, including upper motor neuron dysfunctions like spinal cord injury, cerebral palsy, multiple sclerosis and acquired brain injury including stroke, and neuromuscular diseases as well as for control of pain and spasticity. Instead of applying a reconstructive neurobiological approach, i.e. structural modifications, restorative neurology relies on improving residual function. While subspecialties like neurosurgery and pharmacology exist and are useful in diagnosing and treating conditions of the nervous system, restorative neurology takes a pathophysiological approach. Instead of heavily relying on neurochemistry or perhaps an anatomical discipline, restorative neurology encompasses many fields and blends them together.
Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI are able to have satisfying sex lives. Physical limitations acquired from SCI affect sexual function and sexuality in broader areas, which in turn has important effects on quality of life. Damage to the spinal cord impairs its ability to transmit messages between the brain and parts of the body below the level of the lesion. This results in lost or reduced sensation and muscle motion, and affects orgasm, erection, ejaculation, and vaginal lubrication. More indirect causes of sexual dysfunction include pain, weakness, and side effects of medications. Psycho-social causes include depression and altered self-image. Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm. People with SCI may employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts. Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.
Michael Fehlings is a Canadian neurosurgeon based at Toronto Western Hospital in Toronto, Ontario, Canada. Dr. Fehlings specializes in complex spine surgery with a special interest in traumatic and non-traumatic spinal cord injury and spine oncology. He mainly focuses on preclinical and clinical translational research related to enhancing repair and regeneration of the injured central nervous system. He holds many positions, including Professor of Neurosurgery at the University of Toronto, Vice Chair Research at the University of Toronto, Robert Campeau Foundation/Dr. C.H. Tator Chair in Brain and Spinal Cord Research at UHN, Scientist at the McEwen Centre for Regenerative Medicine, McLaughlin Scholar in Molecular Medicine, and Co-Director of the University of Toronto Spine Program. He is the past inaugural Director of the University of Toronto Neuroscience Program, and was the previous Medical Director at Toronto Western Hospital. Dr. Fehlings is a Fellow of the American College of Surgeons and a Fellow of the Royal College of Surgeons of Canada.
Spinal cord injury without radiographic abnormality (SCIWORA) is symptoms of a spinal cord injury (SCI) with no evidence of injury to the spinal column on X-rays or CT scan. Symptoms may include numbness, weakness, abnormal reflexes, or loss of bladder or bowel control. Neck or back pain is also common. Symptoms may be brief or persistent. Some do not develop symptoms until a few days after the injury.
Wheelchair sport classification is a system designed to allow fair competition between people of different disabilities, and minimize the impact of a person's specific disability on the outcome of a competition. Wheelchair sports is associated with spinal cord injuries, and includes a number of different types of disabilities including paraplegia, quadriplegia, muscular dystrophy, post-polio syndrome and spina bifida. The disability must meet minimal body function impairment requirements. Wheelchair sport and sport for people with spinal cord injuries is often based on the location of lesions on the spinal cord and their association with physical disability and functionality.
Bizhan Aarabi is an Iranian-American neurosurgeon, researcher, author, and academic. He is a professor of neurosurgery at University of Maryland and the Director of Neurotrauma at the R Adams Cowley Shock Trauma Center.
References
- ↑ Harvey 2008, p. 7.
- ↑ "ASIA | History". Archived from the original on 2016-01-23. Retrieved 2016-01-05.
- 1 2 3 Kirshblum, Steven C.; Burns, Stephen P.; Biering-Sorensen, Fin; Donovan, William; Graves, Daniel E.; Jha, Amitabh; Johansen, Mark; Jones, Linda; Krassioukov, Andrei; Mulcahey, M.J.; Schmidt-Read, Mary; Waring, William (2011). "International standards for neurological classification of spinal cord injury (Revised 2011)". The Journal of Spinal Cord Medicine. 34 (6): 535–546. doi:10.1179/204577211X13207446293695. ISSN 1079-0268. PMC 3232636 . PMID 22330108.
- ↑ Marino, R.J.; Barros, T.; Biering-Sorensen, F.; Burns, S.P.; Donovan, W.H.; Graves, D.E.; Haak, M.; Hudson, L.M.; Priebe, M.M.; ASIA Neurological Standards Committee 2002 (2003). "International standards for neurological classification of spinal cord injury". The Journal of Spinal Cord Medicine. 26 Suppl 1: S50–56. doi:10.1080/10790268.2003.11754575. PMID 16296564. S2CID 12799339.
{{cite journal}}: CS1 maint: numeric names: authors list (link) - ↑ Dimitrijevic et al. 2012, p. 12.
- ↑ Affiliated Societies 13.04.2011
- 1 2 "Standard Neurological Classification of Spinal Cord Injury" (PDF). American Spinal Injury Association & ISCOS. Archived from the original (PDF) on June 18, 2011. Retrieved 5 November 2015.
- 1 2 Weiss 2010, p. 307.
- ↑ Teufack, Harrop & Ashwini 2012, p. 67.
- 1 2 Kirshblum, Steven; Botticello, Amanda; Benedetto, John; Donovan, Jayne; Marino, Ralph; Hsieh, Shelly; Wagaman, Nicole (2020-06-09). "A Comparison of Diagnostic Stability of the ASIA Impairment Scale Versus Frankel Classification Systems for Traumatic Spinal Cord Injury". Archives of Physical Medicine and Rehabilitation. 101 (9): 1556–1562. doi:10.1016/j.apmr.2020.05.016.
