For spinal cord injury patients, new insights for rehabilitation therapy

(January 21, 2003) - Bethesda, MD As this year draws to a close, some ten thousand Americans will have incurred a non-fatal spinal cord injury (SCI), joining about 200,000 others similarly disabled. The peak season for spinal cord injury is in the summer and is caused primarily by motor vehicle accidents, falls, sports injuries and violence. Paraplegia (the loss of sensation and or movement in the legs and part of the trunk) affects 47 percent of people with spinal cord injuries; quadriplegia (affecting all four limbs and the trunk) affects 52 percent. The actor Christopher Reeves, for example, is a quadriplegic.


SCIs are classified as primary or secondary. Primary SCIs are caused by mechanical disruption, transection, extradural pathology (spinal epidural hematomas or abscesses), or distraction of neural elements. This usually occurs with fracture and/or dislocation of the spine. However, primary SCI may occur in the absence of spinal fracture or dislocation. Penetrating injuries due to bullets or weapons may also cause primary SCI. More commonly, displaced bony fragments cause penetrating spinal cord or segmental spinal nerve injuries.

Vascular injury to the spinal cord can be caused by arterial disruption, arterial thrombosis, or hypoperfusion due to shock. These are the major causes of secondary SCI; anoxic or hypoxic effects compound the extent of the injury. The science behind vascular performance or blood flow is that perfusion pressure and vascular resistance govern blood flow to tissue. Because mean arterial pressure and venous pressure are normally maintained within narrow limits, blood flow control is accomplished in large part by variation in vascular resistance.

Vascular resistance is essentially under dual control, through systemic control via the autonomic nervous system and humoral factors and by local control via the conditions in the immediate vicinity of the blood vessels. The importance of sy

Contact: Donna Krupa
American Physiological Society

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