CASE STUDY 2: A CASE OF SPINAL CORD INJURY

CASE STUDY 2: A CASE OF SPINAL CORD INJURY

1. Describe the functional anatomy of the spinal cord using the following terms: white matter, gray matter, tracts, roots, and spinal nerves.

The spinal cord is made up of spinal nerves, gray matter, roots, gray matter, and white matter (Daniels, R. & Nicoll, L. 2011). The white matter comprises of myelinated axons which form nerve tracts. The white matter is found throughout the length of the spinal cord, thereby facilitating various levels of the central nervous system (CNS) to communicate with each other and with the goal of influencing an appropriate response to stimuli. The bundles of nerve fibers that make up the white matter are connected to the CNS to form tracts (Daniels, R. & Nicoll, L. 2011). On the other hand, the grey matter consists of neural cell bodies and myelinated axon tracts that link to the CNS. The roots in the spinal cord are designed to receive the information that is relayed by the neurons. It is worth highlighting the sensory and motor neurons play a critical role in facilitating the spinal cord send information to other parts of the body.

2. Define the terms reflex and spinal reflex, and identify the components of a reflex arc.

A reflex is described as automatic, untrained, quick, involuntary and foreseeable response (Rooney, A. 2016). Notably, this is a fundamental unit of the nervous system and the simplest part that is capable of producing a reaction and receiving stimulus. A reflex often occurs in the absence of conscious thought (Allen, A., Wilkins, K., Gazzaley, A. & Morsella, E. 2013). In other words, the body reacts to stimuli instantaneously and without one thinking about it. A classic example of a reflex is the blinking of the eye because it happens unconsciously. A spinal reflex, on the other hand, refers to any reflex action that is mediated via the center of the spinal cord (Carlstedt, T., Misra, V., Papadaki, A., McRobbie, D. & Anand, P. 2012). Incidentally, a reflex arc is defined as a neural pathway that is involved in a reflex action. In particular, it comprises of the following components: receptor, sensory neuron, integration center, motor neuron, and the effector.

3. Define the term spinal cord injury (SCI) and state its prevalence.

A spinal cord injury (SCI) refers to any injury or harm on the spinal cord that is a result of a trauma as opposed to illness (Sears, A. & Jacko, J. 2009). The trauma interrupts the effective functioning of the normal sensory. It is worth pointing out that the symptoms can vary depending on the extent of damage of the spinal cord. For example, a person can experience pain or become paralyzed. Another valuable aspect that is essential to note that is that spinal cord injuries can be classified as complete or incomplete (Sears, A. & Jacko, J. 2009. In the complete SCI, the signals cannot be sent below the part that is injured, and this leads to paralysis. In respect to incomplete SCI, an individual has some sensation below the injury and can make some movements. The available research evidence shows that in the United States, acute SCI affects about 220,000 people each year (Fleisher, L. 2012). Undoubtedly, this is a significant number of individuals and this call for the relevant stakeholders to take appropriate measures to reduce the incidence.

4. Define the terms neurological level, tetraplegia, and paraplegia

Neurological level is defined as the caudal degree at which the motor and sensory functions are intact (Sabharwal, S. 2013). On the other hand, tetraplegia refers to the injury of the spinal cord that is between the cervical sections of C1-C8 or above the first thoracic vertebra. Notably, this type of injury causes some level of paralysis in the legs and arms. Parenthetically, paraplegia is described as a spinal cord injury that is below the initial spinal levels of T1-L5 and affects the legs and the trunk, but no influence on the hands and arms.

5. Define the terms dermatome and myotome and explain how each relates to SCI.

The spinal nerves are made up of sensory and motor fibers. Sensory fibers are found on certain areas of the skin while spinal fibers are located on certain muscles. Dermatomes refer to nerve fibers that permit the sensation of touch or pain to a matching sensory area of the skin. Dermatomes originate from the spine and hence can be used to assess the level of deficit in spinal injuries. These nerves can be useful to raise the deficit spinal nerve fibers and the matching muscles that comprise the myotome. The myotome is a collection of muscles that one spinal nerve supplies. Myotomes enable proper motor functioning making it possible to bend knees, flex fingers and perform other activities from muscle groups.

6. Define the term stretch reflex and describe how such reflexes are used to anatomically localize SCI.

The muscles in a stretch reflex contract to the degree of the stretching force that is applied on them. Remarkably, these reflexes are often used to determine the responses or lack of response of the central nervous system. If one cannot detect a response from a particular area, it implies that the nerves are not responsive or the brain cannot receive signal from that region.

7. Based upon the results of Jason’s neurological exam, what is the neurological level of his SCI?

The findings of the neurological examination reveal that Jason has sensation or movement abilities below his inguinal area. Notably, his neurological level shows a complete spinal code injury below the initial thoracic spinal levels (T1-L5).

8. Discuss the management of SCI and the factors that determined the prognosis for this condition.

The outcomes linked to spinal cord injuries differ significantly depending on the position of the injury along the spinal column of the spinal cord. After a spinal cord injury, the first line of action is to assist patients to gather as much strength as possible in the limbs as the arms and legs are important for communication and movement. In some instances, patients may be required to learn to use gadgets such as wheelchairs, leg braces, walkers, and also devices that enable them to talk on mobile phones, write, and type. Occupational therapists are particularly useful in aiding patients to develop skills needed for daily activities such as eating, visiting the toilet, and dressing. On the other hand, physical therapists assist patients to build muscle strength needed to perform these tasks. Notably, patients are expects to learn how to handle issues such as pain and spasticity. Working with vocational rehabilitation specialists can assist patients in assessing potential employment opportunities. Recreational therapy and keeping the patient engaged is one strategy that is crucial in building their self-esteem and enabling the patient to lead a normal life.

References

Allen, A.K., Wilkins, K., Gazzaley, A. & Morsella, E., 2013. Conscious thoughts from reflex-like processes: A new experimental paradigm for consciousness research. Consciousness and Cognition, 22(4), pp.1318-1331.

Carlstedt, T., Misra, V.P., Papadaki, A., McRobbie, D. & Anand, P., 2012. Return of spinal reflex after spinal cord surgery for brachial plexus avulsion injury: Case report. Journal of neurosurgery, 116(2), pp.414-417.

Daniels, R. & Nicoll, L.H., 2011. Contemporary medical-surgical nursing. Cengage Learning.

Fleisher, L.A., 2012. Anesthesia and Uncommon Diseases E-Book: Expert Consult–Online and Print. London, UK: Elsevier Health Sciences.

Rooney, A. 2016. The history of psychology. New York, NY: The Rosen Publishing Group.

Sabharwal, S., 2013. Essentials of spinal cord medicine. New York, NY: Demos Medical Publishing.

Sears, A. & Jacko, J.A. eds., 2009. Human-computer interaction: Designing for diverse users and domains. Boca Raton, FL: CRC Press.