Question

G. H. is a 26-year-old male who was involved in a serious motorcycle accident that fractured his vertebrae and compressed his spinal cord at the level of T8. Answer the following questions:

1. What is spinal shock? How long can it last? Why is it difficult to determine the degree of injury and impairment during this time frame?
2. Immediately after this injury, what should you expect to occur for each of the following:
   1. Range of movement for his arms? For his legs? Why?
   2. Spastic or flaccid paralysis? Why?
   3. Bowel and/or bladder dysfunction? Why or why not?
   4. Breathing difficulties? Why or why not?
3. After the period of spinal shock, what changes should you expect to see (if any) in the manifestations listed in #2 above?
4. What type of rehabilitative treatments might G. H. need to promote his recovery and return to function?
5. If G. H. has mild-to-moderate chronic back pain one year after his accident, explain the pain management medications you would suggest to improve his quality of life and why you selected those particular medications.

Answer 1

Spinal shock

Spinal cord injury has a profound effect on the autonomic nervous system. Immediately following injury, cord below injury stops functioning completely. This causes a disruption of sympathetic nervous system function, resisting in vasodilation, hypotension, and bradycardia. Dilation of blood vessels allows more blood flow just beneath the skin.

Spinal shock can last from a week to many weeks in some patients.

The patient is unable to maintain control of body temparature. In addition to that patient may looses all reflexes below the level of injury.

Most of the spinal cord injury patient no longer have muscular function in their legs to premote venous return to the heart. They also have impaired vasoconstriction. This leads to fainting and dizzines when he suddenly sit up.

Spastic or flaccid paralysis

It means the weakness of musles in which condition muscle become flabby nodue to the injury of nervous system. No proper function do not happen in this stage.

Bowel and bladder impaction

The spinal cord injury impairs normal equilibrium between the sympathetic and parasympathetic divisions of the autonomic nervous system. Some type of noxious stimuli below the spinal cord injury causes activation of sympathetic system. This conditions lead to autonomic Dysreflexia. Stimulation of sympathetic system results in vasocontricion which causes bladder distention and bowel impaction.

The patient with spinal cord injury has a respiratory problem, beacuase of pulmonary edema and spinal cord edema compress the lesion of this part involved.The parasympathetic responses also results in vasodilation causing breathing difficulty.

A spinal cord injury patient need ingoing evaluation of all body system. Frequent neurological and respiratory assessment are essential. Give respiratory management, Gastrointestinal management, Genitoueinary management is also needed in the treatment process.