Muscles Are Affected by a C4 Spinal Cord Injury

In the realm of spinal cord injuries, C4 represents a critical juncture. Injuries above this level cause paralysis of the diaphragm muscle, making breathing possible only with the assistance of a mechanical ventilator. Injuries at or below C4 preserve the ability to breathe independently. Movement of the head and neck is preserved, while paralysis of the body and legs will occur in patterns reflecting the extent of injury.

Categories of Injury

The spinal cord is organized so that information flows in distinct bundles based on type and destination. A complete injury results in no function below that level. An incomplete injury will cause varying deficits. For example, anterior cord damage leaves motor function intact while central cord damage leads to paralysis of the arms and spares the legs. A condition known as Brown-Sequard syndrome results in weakness or paralysis on one side of the body, called hemiparalysis, and a loss of sensation on the other side. According to the National Spinal Cord Injury Association, since 1988, 45 percent of all injuries have been complete, 55 percent incomplete.

The diaphragm, a sheet of muscle at the bottom of the ribcage, contracts to cause a vacuum effect that sucks air into the lungs. The diaphragm might be weakened, though not paralyzed by a C4 injury. Taking deep breaths or coughing is assisted by the scalenus muscles of the neck. Impairment of these accessory breathing muscles, which receive their innervation from C4, can lead to the inability to properly clear the airways, making the individual susceptible to respiratory infections. In fact, pneumonia and pulmonary embolism are two of the leading causes of death for people with spinal cord injuries.


Nerve control of the heart muscle and the muscles that line the blood vessels can be affected in a C4 injury through a process known as autonomic hyperreflexia. In this life threatening situation, sensory messages from the body that convey commonplace messages such the impulse to urinate can lead to an incorrect nervous system response such a spike in heart rate or blood pressure, putting the individual at risk of heart attack or stroke.

Nursing Care for C5 Spinal Cord Injury

A C5 spinal cord injury can be a very serious condition that requires around-the-clock care for the patient. As a nurse, it's your job not only to make sure the patient is receiving any treatments, medications, or tests the doctor orders; it's also your job to see that the patient is comfortable, that he is taken care of mentally and emotionally as well. The complexity of a spinal cord injury requires you to pay close attention to every detail the patient tells you about or that you observe, so that you can report any problems or complications to the doctor in charge.

If you work in the emergency department of the hospital, you will, at some point, have a patient come in with a spinal cord injury. In order for the patient's prognosis to be the best that it can be, you must work very closely with the doctors and other nurses to make sure that several things don't happen. For instance, the patient's head and neck need to be stabilized to ensure that he doesn't receive even more injury; it may be necessary for you to place the patient into traction. He may need help breathing also, depending on the severity of his injury. Keep him as still as possible, administering sedatives, if ordered, to allow for less movement or irritation during tests and treatments; you must also monitor his oxygen intake as well. Other things the doctor may order are the placement of a catheter, so as to allow the patient to be rid of wastes and not have it sitting in his bladder. Vital signs will also need to be monitored very closely, as the patient could develop cardiovascular signs of distress or blood clots. The doctor may order a medication called Medrol to be given to the patient, and this needs to be done right away to possibly minimize damage done to the spinal cord. Of course, keeping the charts carefully updated is always a must, as this keeps the doctors and other nurses who come in at different shifts updated and aware of any history or potential complications.

Rehab


As the patient improves, he may be transferred to a rehabilitation facility to recover and learn how to live with his injury. As a nurse in the rehab center, you may have several jobs. Most rehab involves therapists and physical therapists, but you will be monitoring the patient's health overall, and you may assist with certain things. You will help the patient in his recovery process by encouraging him to go to every session with the physical therapist, as this will speed his recovery. While there, he will be working not only with movement and strength training, but he will be learning how to live with his injury, such as using a wheelchair. He'll be relearning even the simplest tasks because he will have to do them in a different way now. You will also need to teach the patient about certain physical aspects of his injury and things that he might expect when he gets home. He may need to be taught how to use a catheter; he may need teaching on UTI's and taking care of his skin, as well as making sure his home is ready for him when he gets there.

Drugs and Medications Treatment for Spinal Cord Injury

Spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.
Early (acute) stages of treatment

In the emergency room, doctors focus on:

Maintaining your ability to breathe

Preventing shock

Immobilizing your neck to prevent further spinal cord damage
Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty and formation of deep vein blood clots in the extremities

You may be sedated so that you don't move and sustain more damage while undergoing diagnostic tests for spinal cord injury.
If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

Medications. Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement.

It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. However, it's not a cure for a spinal cord injury.
Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.

Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.

Medications
Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

Modern wheelchairs. Improved, lighter weight wheelchairs are making people with a spinal cord injury more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.

Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They're often called functional electrical stimulation (FES) systems, and they use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand, walk, reach and grip.


Robotic gait training. This emerging technology is used for retraining walking ability after spinal cord injury.

Recovery and Rehabilitation Spinal Cord Injury

Spinal cord injury treatment and rehabilitation focuses on aggressively working with patients physically and psychologically, so that in a short period of time patients can maximize theirneurological recovery and general health. Our clinicians and physicians educate patients about all aspects of their injury and care. We want patients to return home as independent and productive as possible, prepared to resume their lives.

When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method. Furthermore, increasing activity will increase his/her chances of recovery.

The rehabilitation process following a spinal cord injury typically begins in the acute care setting. Occupational therapy plays an important role in the management of SCI. Recent studies emphasize the importance of early occupational therapy, started immediately after the client is stable. This process includes teaching of coping skills, and physical therapy. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals typically work as a team under the coordination of a physiatrist to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition. In the first step, the focus is on support and prevention. Interventions aim to give the individual a sense of control over a situation in which the patient likely feels little independence.


As the patient becomes more stable, they may move to a rehabilitation facility or remain in the acute care setting. The patient begins to take more of an active role in their rehabilitation at this stage and works with the team to develop reasonable functional goals.

Causes And Risk Factors of Spinal Cord Injury

Life with a spinal cord injury or disease is demanding enough without secondary symptoms such as spasticity, which tightens muscles and can make daily activities more challenging. That’s why Medtronic developed a treatment technology.

Definition of Spinal Cord Injury

Spinal cord injury refers to damage of the spinal cord resulting from a blunt or penetrating trauma.

Causes of Spinal Cord Injury

Spinal cord injury is usually the result of an accident (for example, motor vehicle accident, fall, sports injury) or acts of violence such as gunshot wounds. It can also be caused by surgical complications2 or by disease (for example, polio, spina bifida, Friedreich's Ataxia)

Risk Factors of Spinal Cord Injury

Spinal cord injury can happen to anyone, but some people are at higher risk, including:

Men – 80% of spinal cord injuries

Young adults 16 to 30—more than half of spinal cord injuries

People who engage in risky behavior – such as diving into shallow water or playing sports without proper safety gear or precautions


People with an underlying bone or joint disorder – for example, arthritis, osteoporosis

What are Symptoms of Spinal Cord Injury

Spinal Cord Injury (SCI) is an injury to the spinal cord resulting in a change, either temporary or permanent, in the cord's normal motor, sensory, or autonomic function Common causes of damage are trauma . The spinal cord does not have to be severed in order for a loss of function to occur. Depending on where the spinal cord andnerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence.

Signs recorded by a clinician and symptoms experienced by a patient will vary depending on where the spine is injured and the extent of the injury. These are all determined by the area of the body that the injured area of the spine innervates. A section of skin innervatedthrough a specific part of the spine is called a dermatome, and spinal injury can cause pain, numbness, or a loss of sensation in the relevant areas. A group of muscles innervated through a specific part of the spine is called a myotome, and injury to the spine can cause problems with voluntary motor control. The muscles may contract uncontrollably, become weak, or be completely paralysed. The loss of muscle function can have additional effects if the muscle is not used, including atrophy of the muscle and bone degeneration.

A severe injury may also cause problems in parts of the spine below the injured area. In a "complete" spinal injury, all functions below the injured area are lost. An "incomplete" spinal cord injury involves preservation of motor or sensory function below the level of injury in the spinal cord. If the patient has the ability to contract the anal sphincter voluntarily or to feel a pinprick or touch around the anus, the injury is considered to be incomplete. The nerves in this area are connected to the very lowest region of the spine, the sacralregion, and retaining sensation and function in these parts of the body indicates that the spinal cord is only partially damaged. This includes a phenomenon known as sacral sparing which involves the preservation of cutaneous sensation in the sacral dermatomes, even though sensation is impaired in the thoracic and lumbar dermatomes below the level of the lesion. Sacral sparing may also include the preservation of motor function (voluntary external anal sphincter contraction) in the lowest sacral segments. Sacral sparing has been attributed to the fact that the sacral spinal pathways are not as likely as the other spinal pathways to become compressed after injury. The sparing of the sacral spinal pathways can be attributed to the lamination of fibers within the spinal cord.

A complete injury frequently means that the patient has little hope of functional recovery. The relative incidence of incomplete injuries compared to complete spinal cord injury has improved over the past half century, due mainly to the emphasis on faster and better initial care and stabilization of spinal cord injury patients. Most patients with incomplete injuries recover at least some function.


Determining the exact "level" of injury is critical in making accurate predictions about the specific parts of the body that may be affected by paralysis and loss of function. The level is assigned according to the location of the injury by the vertebra of the spinal column closest to the injury on the spinal cord.