Spinal Cord Injury Report

Spinal Cord Injury Report: Complete Paraplegia of Frances F.
Introduction:
The spinal cord is an important structure for the communication between the body and the brain since it containing the spinal nerves that are in charge of the motor and sensory pathways. Therefore, a spinal cord injury (SCI) can affect the pathways of these motor and sensory signals depending on the location of the lesion (Kirshblum, Burns, Biering-Sorensen, Donovan, Graves, Jha, & Waring, 2011). A 38-year-old female patient named Frances F. suffered a SCI and became paraplegic after accidentally being shot with a rifle, leaving a gunshot wound by a bullet entering through the dorsal region of her back close to the tenth rib and leaving no exit wound. After the occurrence, the lower limbs of the patient showed no muscle contractions and she was unable to control defecation or urination.

Analysis First, the sensory neurological levels of the patient were determined by identifying the most caudal and intact dermatome using two key sensory points, light touch and pin prick (Kirshblum et
al., 2011). These two sensory key points were tested separately on each side of the body. A score of 0 is given if there is an absence of sensory feeling, a score of 1 is given if there is an altered feeling, and a score of 2 is given if the sensory levels of the patient are normal (Kirshblum et al., 2011). The sensory levels of the patient Frances F. were found to be normal from C2-T8 dermatomes with T8 being the most caudal and intact, and some altered sensory functions in her T9 and T10 on both right and left sides of her body. However, the patient showed no sensory functions from her T11-S4/5 dermatomes on both sides of her body. The motor neurological levels of Frances F. were determined by testing the 10 pairs of myotomes of her upper and lower extremities which consist from C5-T1 and L1-S1 (Kirshblum et al., 2011). The scores of the neurological levels of the patient can arrange from form 0 which means total paralysis, all the way to 5 for a normal movement activity (Kirshblum et al., 2011). The motor functioning of both right and left upper extremities of Frances F. were normal with a score of 5, while her right and left lower extremities presented a motor loss in L2 and below.
The neurological level of injury (NLI) of the Frances F.
was reported at the T8 level since it was the most caudal segment of her spinal cord with normal and intact sensory and motor functioning on both sides of her body (Kirshblum et al., 2011). The American Spinal Injury Association (ASIA) Impairment Scale (AIS) helped to decide whether the injury was complete of incomplete. Frances F. was reported with a complete SCI and an AIS of A, which means that the patient presents no sensory or motor functions in the sacral segments S4/5 (Kirshblum et al., 2011). The nerve that were most affected by the occurrence where the femoral nerve which innervates with the muscles of the anterior part of the thigh, and the sciatic nerve which innervates with the muscles of the posterior part of the thigh and all the muscles of the leg and foot, leaving Frances F. unable to feel or move the lower extremities of her
body.

Discussion Due to the loss of motor functioning of the lower part of her body, Frances F. will be unable to use her legs for normal activities as she used to do before the accident. However, physical rehabilitation and medical devices would allow her to perform activities and lead her to a more independent live. Frances F. will be able to perform some daily activities for self-care such as brushing her hair, teeth and wash her face. She also is independent to feed herself and she will be able to go about anywhere a person would do by walking with the use a manual wheelchair, and she will also be able to transfer herself to bed. Mulroy, Hatchett, Eberly, Haubert, Conners, and Requejo (2015) conducted research to help to design a program to prevent shoulder pain for people with paraplegia due to the high shoulder force and activity required by transfers, and wheelchairs propulsion. Mulroy et al. (2015) suggest a prevention program of shoulder muscle strengthening to improve the capacity for the function of the shoulders of individuals with paraplegia, although this may not reduce the risk for the development of shoulder pain. Besides the limitations of movement caused by the loss of sensory and motor functioning of her lower limbs, the SCI may cause other problems related to bladder, bowel, and sexual dysfunctions due to nervous control. Benevento and Sipski (2002) suggested that the most convenient method for bladder drainage in a person with paraplegia is the intermittent catheterization, and the use of medications such as oxybutynin and propantheline that can help to increase the bladder capacity and suppress uninhibited bladder contractions. In addition to the bladder dysfunctions, Frances F. will not be able to control defecation. Benevento and Sipski (2002) state that bowel dysfunctions can be one of the most devastating sequelae of a SCI since it can affect a person’s quality of life due to the numerous complications that it can present, including ileus, gastric ulcers, gastro-esophageal reflux, autonomic dysreflexia, pain, distention, diverticulosis, hemorrhoids, nausea, loss of appetite, impaction, constipation, diarrhea, and delayed or unplanned evacuation. However, these complications can be reduced with proper care. There are also several medications used to emptying the bowel. Patient Frances F. can follow a bowel program which consists of the intake of a stool softener 3 times per day to achieve fecal evacuation (Benevento & Sipski, 2002).
Frances F will be also be affected in the sexual aspect of her life. Research have shown that similar to men, women’s desire for sexual activity decrease after an injury (Benevento & Sipski, 2002). In addition, Frances F. will have a lower likelihood to achieve lubrication because of the loss of sensory function in the T11-L2 dermatomes (Benevento & Sipski, 2002).