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85-775: Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title National Rehabilitation Hospital . If an internal link led you here, you may wish to change the link to point directly to the intended article. MedStar National Rehabilitation Hospital in Washington D.C. National Rehabilitation Hospital (Dublin) in Ireland Retrieved from " https://en.wikipedia.org/w/index.php?title=National_Rehabilitation_Hospital&oldid=780378697 " Category : Disambiguation pages Hidden categories: Short description

170-563: A pulmonary embolism , lodging in the lung and cutting off blood supply to it. DVT is an especially high risk in SCI, particularly within 10 days of injury, occurring in over 13% in the acute care setting. Preventative measures include anticoagulants , pressure hose, and moving the patient's limbs. The usual signs and symptoms of DVT and pulmonary embolism may be masked in SCI cases due to effects such as alterations in pain perception and nervous system functioning. Urinary tract infection (UTI)

255-420: A day. Priapism , an erection of the penis may be a sign of acute spinal cord injury. The specific parts of the body affected by loss of function are determined by the level of injury. Some signs, such as bowel and bladder dysfunction can occur at any level. Neurogenic bladder involves a compromised ability to empty the bladder and is a common symptom of spinal cord injury. This can lead to high pressures in

340-524: A full range of other orthopedic injuries and conditions. Throughout patients’ rehabilitative experience, MedStar NRH relies upon a number of assistive technology devices that have been developed by MedStar NRH's research team, and which have been used fortheir recovery. The National Center for Children's Rehabilitation (NCCR) at MedStar NRH addresses an unmet regional need and raises the bar for care of pediatric patients with neurological, orthopedic injuries, and other illnesses. The only center of its kind in

425-412: A high SCI risk. Since head and spinal trauma frequently coexist, anyone who is unconscious or has a lowered level of consciousness as a result of a head injury is spinal motion restricted. A rigid cervical collar is applied to the neck, and the head is held with blocks on either side and the person is strapped to a backboard . Extrication devices are used to move people without excessively moving

510-536: A lesion below the level at which the spinal cord ends. Descending nerve roots continue as the cauda equina at levels L2–S5 below the conus medullaris before exiting through intervertebral foraminae. Thus it is not a true spinal cord syndrome since it is nerve roots that are damaged and not the cord itself; however, it is common for several of these nerves to be damaged at the same time due to their proximity. CES can occur by itself or alongside conus medullaris syndrome. It can cause low back pain, weakness or paralysis in

595-1002: A list of outpatient locations.) In addition, for those needing more intense therapy following hospitalization, MedStar NRH offers unique Day Treatment programs for stroke, brain and spinal cord injury, which provide continued comprehensive care to maximize potential for recovery. Meant for patients who have occurred a brain injury, spinal cord injury, stroke, amputation, and burns. This program has also been accredited for treating motion disorders, arthritis , chronic pain syndromes, cardiac disorders , and other neurologic conditions. There are both inpatient and outpatient services available with each staff member certified in rehabilitation counseling (CRC). More than 200 spinal cord injured patients come to MedStar NRH each year for treatment. Some injuries MedStar NRH encounters are spinal cord disease , spinal stenosis , multiple sclerosis , postoperative spinal surgery , and Guillain Barre syndrome . Emphasis

680-400: A non-profit organization, the team at MedStar NRH uses the approach of care that puts the patient first. MedStar NRH's Spinal Cord Program is the area's only CARF Accredited Specialty Program for Spinal Cord Injury and Disease . The Rehabilitation Research and Training Center (RRTC) on Spinal Cord Injury (SCI): Promoting Health and Preventing Complications through Exercise is also funded by

765-553: A number of other leading acute care facilities throughout the region. Acute rehab begins at onset of injury and illness, and continues after hospitalization through the NRH Rehabilitation Network – with over 50 outpatient sites located throughout the Washington, D.C., Northern Virginia, and Maryland region. (See https://web.archive.org/web/20121205130915/http://www.medstarnrh.org/Locations/default.aspx for

850-969: A project to test the value of patient navigation to improve long-term outcomes for stroke and spinal cord patients, and a program to reduce secondary incidents among the capital region's stroke patients. Uncover new technology that increases the effectiveness of recovery. Also increases a patient's ability to live independently with a disability. Aims to offer guidance on the quality and financing of post-acute rehab. Congress approves 6 million dollars for new neuroscience research center in 2000. This area deals with research related to clinical psychology, speech language therapy, health services, and rehabilitation engineering. Research involving impairments, limitations, and recovery. The center focuses primarily on neurological and musculoskeletal factors. 38°55′49.9″N 77°0′47.9″W  /  38.930528°N 77.013306°W  / 38.930528; -77.013306 Spinal Cord Injury A spinal cord injury ( SCI )

935-448: A result of injury, 26.82% In some countries falls are more common, even surpassing vehicle crashes as the leading cause of SCI. The rates of violence-related SCI depend heavily on place and time. Of all sports-related SCIs, shallow water dives are the most common cause; winter sports and water sports have been increasing as causes while association football and trampoline injuries have been declining. Hanging can cause injury to

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1020-492: A scale of 0–2: 0 is no sensation, 1 is altered or decreased sensation, and 2 is full sensation. Each side of the body is graded independently. In a "complete" spinal injury, all functions below the injured area are lost, whether or not the spinal cord is severed. An "incomplete" spinal cord injury involves preservation of motor or sensory function below the level of injury in the spinal cord. To be classed as incomplete, there must be some preservation of sensation or motion in

1105-405: A specific part of the spine is called a myotome , and injury to that part of the spinal cord can cause problems with movements that involve those muscles. The muscles may contract uncontrollably ( spasticity ), become weak , or be completely paralysed . Spinal shock , loss of neural activity including reflexes below the level of injury, occurs shortly after the injury and usually goes away within

1190-438: A spinal cord injury. The features are namely paralysis, sensory loss, or both at any level. Other symptoms may include incontinence. A radiographic evaluation using an X-ray , CT scan, or MRI can determine if there is damage to the spinal column and where it is located. X-rays are commonly available and can detect instability or misalignment of the spinal column, but do not give very detailed images and can miss injuries to

1275-578: Is neurogenic shock , which results from an interruption in output from the sympathetic nervous system responsible for maintaining muscle tone in the blood vessels. Without the sympathetic input, the vessels relax and dilate. Neurogenic shock presents with dangerously low blood pressure, low heart rate , and blood pooling in the limbs—which results in insufficient blood flow to the spinal cord and potentially further damage to it. Complications of spinal cord injuries include pulmonary edema , respiratory failure , neurogenic shock , and paralysis below

1360-800: Is an injury to the end of the spinal cord the conus medullaris , located at about the T12–L2 vertebrae in adults. This region contains the S4–S5 spinal segments, responsible for bowel, bladder, and some sexual functions , so these can be disrupted in this type of injury. In addition, sensation and the Achilles reflex can be disrupted. Causes include tumors , physical trauma, and ischemia . Cauda equina syndrome may also be caused by central disc prolapse or slipped disc, infections such as epidural abscess, spinal haemorrhages, secondary to medical procedures and birth abnormalities. Cauda equina syndrome (CES) results from

1445-438: Is another risk that may not display the usual symptoms (pain, urgency, and frequency); it may instead be associated with worsened spasticity. The risk of UTI, likely the most common complication in the long term, is heightened by use of indwelling urinary catheters . Catheterization may be necessary because SCI interferes with the bladder's ability to empty when it gets too full, which could trigger autonomic dysreflexia or damage

1530-404: Is called a dermatome , and injury to that part of the spine can cause pain, numbness, or a loss of sensation in the related areas. Paraesthesia , a tingling or burning sensation in affected areas of the skin, is another symptom. A person with a lowered level of consciousness may show a response to a painful stimulus above a certain point but not below it. A group of muscles innervated through

1615-430: Is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Symptoms of spinal cord injury may include loss of muscle function, sensation , or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of

1700-652: Is dedicated to implementing initiatives that probe new rehabilitative interventions to address the health and rehabilitative needs of person with disabilities, and to develop better ways to deliver and pay for these services. There are four unique centers conducting both laboratory and clinical research: the Assistive Technology Research Center, the Center for Post-Acute Studies, the Neuroscience Research Center, and

1785-416: Is defined as the lowest level of full sensation and function. Paraplegia occurs when the legs are affected by the spinal cord damage (in thoracic, lumbar, or sacral injuries), and tetraplegia occurs when all four limbs are affected (cervical damage). SCI is also classified by the degree of impairment. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), published by

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1870-424: Is different from Wikidata All article disambiguation pages All disambiguation pages MedStar National Rehabilitation Hospital MedStar National Rehabilitation Hospital has grown from a single hospital into MedStar National Rehabilitation Network, which provides inpatient , outpatient , and day treatment programs. The network provides more than 350,000 ambulatory visits annually in addition to

1955-420: Is ipsilateral hemiplegia. Spinothalamic tracts are in charge for pain and temperature sensation and because these tracts cross to the opposite side and above the spinal cord there is loss on the contralateral side. Posterior spinal artery syndrome (PSAS), in which just the dorsal columns of the spinal cord are affected, is usually seen in cases of chronic myelopathy but can also occur with infarction of

2040-639: Is on the prevention of primary and secondary conditions and on the patients’ participation. The Seating and Mobility Clinic offers evaluations for patients wheeled mobility needs based on functional strength, range of motion, postural alignment, and skin integrity. MedStar NRH was also one of the first hospitals in the country to use the Lokomat . This provides body weight support for gait training. Faculty provides care for thousands suffering from mild to traumatic brain injuries. The concussion clinic at Medstar NRH focuses primarily on this form of brain injury and

2125-492: Is pain, including nociceptive pain (indication of potential or actual tissue damage) and neuropathic pain , when nerves affected by damage convey erroneous pain signals in the absence of noxious stimuli. Spasticity , the uncontrollable tensing of muscles below the level of injury, occurs in 65–78% of chronic SCI. It results from lack of input from the brain that quells muscle responses to stretch reflexes. It can be treated with drugs and physical therapy. Spasticity increases

2210-402: Is present but there is no evidence of spinal column injury on radiographs . Spinal column injury is trauma that causes fracture of the bone or instability of the ligaments in the spine ; this can coexist with or cause injury to the spinal cord, but each injury can occur without the other. Abnormalities might show up on magnetic resonance imaging (MRI), but the term was coined before MRI

2295-445: Is preserved in the sacral dermatomes, even though sensation may be more impaired in other, higher dermatomes below the level of the lesion. 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 due to the lamination of fibers within the spinal cord. Spinal cord injury without radiographic abnormality exists when spinal cord injury

2380-402: Is prevented with measures including societal and individual efforts to reduce driving under the influence of drugs or alcohol, distracted driving , and drowsy driving . Other efforts include increasing road safety (such as marking hazards and adding lighting) and vehicle safety, both to prevent accidents, such as routine maintenance and antilock brakes . There are also approaches mitigate

2465-600: Is regarded as one of the best in the country, according to U.S. News & World Report . 75 percent of all traumatic brain injuries that occur are concussions. Traumatic brain injuries contribute to a third of all deaths in the United States with over 1.5 million brain injuries occurring each year. During their stay, patients are also educated on precautions they can take to prevent a future incidence. Treat inpatient and outpatient stroke victims. With over 800,000 stroke victims each year, MedStar NRH has developed one of

2550-437: Is typically based on symptoms and medical imaging . Efforts to prevent SCI include individual measures such as using safety equipment, societal measures such as safety regulations in sports and traffic, and improvements to equipment. Treatment starts with restricting further motion of the spine and maintaining adequate blood pressure . Corticosteroids have not been found to be useful. Other interventions vary depending on

2635-431: Is used to determine the level and severity of injury. The first stage in the management of a suspected spinal cord injury is geared toward basic life support and preventing further injury: maintaining airway, breathing, circulation, and restricting further motion of the spine. In the emergency setting, most people who has been subjected to forces strong enough to cause SCI are treated as though they have instability in

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2720-496: The American Spinal Injury Association (ASIA), is widely used to document sensory and motor impairments following SCI. It is based on neurological responses, touch and pinprick sensations tested in each dermatome, and strength of the muscles that control key motions on both sides of the body. Muscle strength is scored on a scale of 0–5 according to the table on the right, and sensation is graded on

2805-604: The Americans with Disabilities Act of 1990 with his visits to Capitol Hill and work around the community. MedStar NRH strongly supported Eckenhoff's venture and was a vital part in improving the lives of the disabled. The current president is John Rockwood who adopted the role in October 2010. Physicians nationwide consistently rank MedStar NRH among “America’s Best Hospitals,” as reported by U.S. News & World Report . Since 1990, MedStar NRH has been consistently listed in

2890-506: The posterior spinal artery . This rare syndrome causes the loss of proprioception and sense of vibration below the level of injury while motor function and sensation of pain, temperature, and touch remain intact. Usually posterior cord injuries result from insults like disease or vitamin deficiency rather than trauma. Tabes dorsalis , due to injury to the posterior part of the spinal cord caused by syphilis, results in loss of touch and proprioceptive sensation. Conus medullaris syndrome

2975-486: The sacral region. It is common to experience sexual dysfunction after injury , as well as dysfunction of the bowel and bladder, including fecal and urinary incontinence . In addition to the problems found in lower-level injuries, thorax (chest height) spinal lesions can affect the muscles in the trunk. Injuries at the level of T1 to T8 result in inability to control the abdominal muscles. Trunk stability may be affected; even more so in higher level injuries. The lower

3060-737: The 2007 accreditation survey. CARF is a private, not-for-profit organization that promotes quality rehabilitation services. Their standards are reviewed annually and new ones are developed to keep pace with changing conditions and current consumer needs. NRH has received a three-year accreditation from CARF, and its Spinal Cord Injury , Stroke and Brain Injury programs are the regions only CARF accredited specialty programs. MedStar NRH's board-certified physicians , neuropsychologists , physical therapists , occupational therapists , speech-language pathologists , psychologists , vocational rehabilitation counselors , and other clinicians work in teams to meet

3145-441: The Center for Applied Biomechanics and Rehabilitation Research. Dozens of studies are underway in the development of improved rehabilitative diagnosis and treatment methods, and technology aimed at improving long-term independence for persons with a variety of disabling conditions. Among these are a unique study to evaluate the value of activity-based rehab and FES, functional electrical stimulation , for spinal cord injury patients,

3230-516: The NIDRR. The $ 4 million, 5-year grant allows MedStar NRH to further extend its research and training efforts on secondary conditions in people with SCI. The RRTC is a unique collaborative effort of national leaders in SCI-related research, clinical expertise, support and education organizations, independent living centers, and consumers with SCI. The MedStar NRH Stroke Recovery Program is among

3315-475: The U.S., motor vehicle accidents are the most common cause of SCIs; second are falls , then violence such as gunshot wounds, then sports injuries . Another study from Asia, found that the most common cause of the SCI is fall (31.70%) from various sites such as fall from roof-tops (9.75%), electric pole (7.31%), fall from tree (7.31%) etc. Whereas road traffic accidents count for 19.51%, firearm injuries (12.19%), slipped foot (7.31%) and sports injuries (4.87%). As

3400-530: The annual ranking as one of the nation's best hospitals for physical rehabilitation. http://health.usnews.com/best-hospitals/rankings/rehabilitation?page=2 MedStar NRH is fully accredited by both the Joint Commission on Accreditation of Healthcare Organizations JCAHO , and the Commission on Accreditation of Rehabilitation Facilities CARF , earning an impressive fourteen CARF commendations in

3485-571: The area, the NCCR is a joint service of MedStar NRH and Children's National Medical Center and offers an innovative approach to children's rehab in a state-of-the-art and secure unit. Advanced rehabilitation technology such as the Zero/G gait training tool and Alter/G anti-gravity treadmill has earned MedStar NRH the reputation as one of the leading participants in research for rehabilitation technology. The Christoph Ruesch Research Center at MedStar NRH

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3570-405: The areas innervated by S4 to S5, including voluntary external anal sphincter contraction. The nerves in this area are connected to the very lowest region of the spinal cord, and retaining sensation and function in these parts of the body indicates that the spinal cord is only partially damaged. Incomplete injury by definition includes a phenomenon known as sacral sparing: some degree of sensation

3655-440: The areas supplied by the affected level of the spinal cord. Congenital conditions and tumors that compress the cord can also cause SCI, as can vertebral spondylosis and ischemia . Multiple sclerosis is a disease that can damage the spinal cord, as can infectious or inflammatory conditions such as tuberculosis , herpes zoster or herpes simplex , meningitis , myelitis , and syphilis . Vehicle-related spinal cord injury

3740-415: The bladder permanently. The use of intermittent catheterization to empty the bladder at regular intervals throughout the day has decreased the mortality due to kidney failure from UTI in the first world, but it is still a serious problem in developing countries. An estimated 24–45% of people with spinal cord injuries have major depressive disorder , and the suicide rate is as much as six times that of

3825-426: The bladder that can damage the kidneys. Spinal cord injuries at the cervical vertebrae (neck) level result in full or partial tetraplegia , also called quadriplegia. Depending on the specific location and severity of trauma, limited function may be retained. Additional symptoms of cervical injuries include low heart rate , low blood pressure , problems regulating body temperature , and breathing dysfunction. If

3910-460: The cell death that occurs immediately in the original injury, and biochemical cascades that are initiated by the original insult and cause further tissue damage. These secondary injury pathways include the ischemic cascade , inflammation , swelling , cell suicide , and neurotransmitter imbalances. They can take place for minutes or weeks following the injury. At each level of the spinal column, spinal nerves branch off from either side of

3995-420: The cervical spine, as may occur in attempted suicide . Military conflicts are another cause, and when they occur they are associated with increased rates of SCI. Another potential cause of SCI is iatrogenic injury, caused by an improperly done medical procedure such as an injection into the spinal column. SCI can also be of a nontraumatic origin. Nontraumatic lesions cause anywhere from 30 to 80% of all SCI;

4080-403: The damage of crashes, such as head restraints, air bags, seat belts, and child safety seats. Falls can be prevented by making changes to the environment, such as nonslip materials and grab bars in bathtubs and showers, railings for stairs, child and safety gates for windows. Gun-related injuries can be prevented with conflict resolution training, gun safety education campaigns, and changes to

4165-436: The greatest detail. Thus it is the standard for anyone who has neurological deficits found in SCI or is thought to have an unstable spinal column injury. Neurological evaluations to help determine the degree of impairment are performed initially and repeatedly in the early stages of treatment; this determines the rate of improvement or deterioration and informs treatment and prognosis. The ASIA Impairment Scale outlined above

4250-558: The head); hyperextension (backward movement); lateral stress (sideways movement); rotation (twisting of the head); compression (force along the axis of the spine downward from the head or upward from the pelvis); or distraction (pulling apart of the vertebrae). Traumatic SCI can result in contusion , compression , or stretch injury. It is a major risk of many types of vertebral fracture . Pre-existing asymptomatic congenital anomalies can cause major neurological deficits, such as hemiparesis , to result from otherwise minor trauma. In

4335-713: The hospital's more than 2,200 inpatient admissions . Since its inception, MedStar NRH has admitted in excess of 35,000 inpatients and provided over 2 million outpatient visits. Eckenhoff founded the hospital in 1986 and is currently the President Emeritus of MedStar NRH. After suffering a spinal cord injury which left him paralyzed from the waist down Edward A. Eckenhoff founded the National Rehabilitation Hospital. On February 6, 1986, MedStar NRH opened its doors with 230 staff members and one patient. MedStar NRH soon grew to be one of

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4420-641: The hospital. In 2011, MedStar NRH celebrated their 25th anniversary with their annual Gala Victory Award's in which they recognized several key contributors to the advancement of rehab. MedStar NRH has been accredited by The Joint Commission and CARF as one of the most reliable rehabilitation hospitals in the country. They are the Commission on Accreditation of Rehabilitation Facilities . CARF Accredited Medstar NRH with Specialty Programs in Stroke Recovery, Spinal Cord Injury and Brain Injury. Being

4505-402: The injury (same side), the body loses motor function, proprioception , and senses of vibration and touch. On the contralateral (opposite side) of the injury, there is a loss of pain and temperature sensations. If the injury is above pyramidal decussation there is contralateral hemiplegia, at the level of decussation there is completed motor loss on both sides and below pyramidal decussation there

4590-536: The injury is high enough in the neck to impair the muscles involved in breathing, the person may not be able to breathe without the help of an endotracheal tube and mechanical ventilator. The effects of injuries at or above the lumbar or sacral regions of the spinal cord (lower back and pelvis) include decreased control of the legs and hips , genitourinary system , and anus. People injured below level L2 may still have use of their hip flexor and knee extensor muscles. Bowel and bladder function are regulated by

4675-410: The injury itself, particularly in the case of multiple or massive trauma, some of it reflects the failure to adequately restrict motion of the spine. SCI can impair the body's ability to keep warm, so warming blankets may be needed. Initial care in the hospital, as in the prehospital setting, aims to ensure adequate airway, breathing, cardiovascular function, and spinal motion restriction. Imaging of

4760-445: The injury site. In the long term, the loss of muscle function can have additional effects from disuse, including muscle atrophy . Immobility also can lead to pressure sores , particularly in bony areas, requiring precautions such as extra cushioning and turning in bed every two hours (in the acute setting) to relieve pressure. In the long term, people in wheelchairs must shift periodically to relieve pressure. Another complication

4845-503: The largest programs in the country. MedStar NRH patients benefit the area's only CARF Accredited Specialty Program for Strokes. The MedStar NRH Brain Injury Program uses repetition to expand on small incremental gains in recovery—to achieve their outcome. The orthopedic programs at MedStar NRH utilize technological diagnostic and therapeutic equipment to address such issues as arthritis, amputation, joint replacement, and

4930-715: The largest stroke programs in the region. Over 600 stroke patients are cared for each year at MedStar NRH with 96 percent being able to return home within 90 days. The stroke recovery program aims to offer stroke comprehensive inpatient, day treatment, and outpatient rehabilitation that are tailored to each patient's needs and abilities. Created when the hospital opened in 1986, the Victory Awards honor individuals who have overcome physical adversity and inspired others. Awards have been given out to people from many different areas such as art, entertainment, sports, and politics. This event also raises money to advance treatments and

5015-401: The leading cause of death in people with SCI, followed by infections, usually of pressure sores, urinary tract infections , and respiratory infections . Pneumonia can be accompanied by shortness of breath , fever, and anxiety . Another potentially deadly threat to respiration is deep venous thrombosis (DVT), in which blood forms a clot in immobile limbs; the clot can break off and form

5100-545: The level of injury, the less extensive its effects. Injuries from T9 to T12 result in partial loss of trunk and abdominal muscle control. Thoracic spinal injuries result in paraplegia , but function of the hands, arms, and neck are not affected. One condition that occurs typically in lesions above the T6 level is autonomic dysreflexia (AD), in which the blood pressure increases to dangerous levels, high enough to cause potentially deadly stroke . It results from an overreaction of

5185-477: The location and extent of the injury, from bed rest to surgery. In many cases, spinal cord injuries require long-term physical and occupational therapy , especially if it interferes with activities of daily living . In the United States , about 12,000 people annually survive a spinal cord injury. The most commonly affected group are young adult males. SCI has seen great improvements in its care since

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5270-494: The lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. There may be bilateral sciatica with central disc prolapse and altered gait. Unlike conus medullaris syndrome, symptoms often occur only on one side of the body. The cause is often compression, e.g. by a ruptured intervertebral disk or tumor. Since the nerves damaged in CES are actually peripheral nerves because they have already branched off from

5355-435: The majority of cases the damage results from physical trauma such as car accidents , gunshot wounds , falls , or sports injuries , but it can also result from nontraumatic causes such as infection , insufficient blood flow , and tumors . Just over half of injuries affect the cervical spine , while 15% occur in each of the thoracic spine , border between the thoracic and lumbar spine , and lumbar spine alone. Diagnosis

5440-475: The middle of the 20th century. Research into potential treatments includes stem cell implantation, hypothermia, engineered materials for tissue support, epidural spinal stimulation , and wearable robotic exoskeletons . Spinal cord injury can be traumatic or nontraumatic, and can be classified into three types based on cause: mechanical forces, toxic, and ischemic from lack of blood flow. The damage can also be divided into primary and secondary injury :

5525-399: The middle of the neck and no other painful injuries that could distract from neck pain. If these are all absent, no spinal motion restriction is necessary. If an unstable spinal column injury is moved, damage may occur to the spinal cord. Between 3 and 25% of SCIs occur not at the time of the initial trauma but later during treatment or transport. While some of this is due to the nature of

5610-514: The most well recognized hospitals in the country. It has hosted guests like Nancy Reagan, Barbara Bush, Queen Sofia of Spain, Bob Dole, and Stevie Wonder. Eckenhoff has also received numerous awards including "Washingtonian of the year" by the Washingtonian magazine and was named “Alumnus of the Year” by Washington University School of Medicine. Eckenhoff played a major role in the passing of

5695-584: The needs of patients with a wide range of neurological , and orthopedic conditions. The MedStar NRH provides highly specialized acute inpatient rehabilitative care at its Washington, D.C., location on a campus adjacent to its MedStar Health sister hospital, the MedStar Washington Hospital Center . NRH works in partnership not only with the MedStar Washington Hospital Center, but also with

5780-534: The percentage varies by locale, influenced by efforts to prevent trauma. Developed countries have higher percentages of SCI due to degenerative conditions and tumors than developing countries. In developed countries, the most common cause of nontraumatic SCI is degenerative diseases, followed by tumors; in many developing countries the leading cause is infection such as HIV and tuberculosis. SCI may occur in intervertebral disc disease, and spinal cord vascular disease. Spontaneous bleeding can occur within or outside of

5865-421: The protective membranes that line the cord, and intervertebral disks can herniate. Damage can result from dysfunction of the blood vessels, as in arteriovenous malformation , or when a blood clot becomes lodged in a blood vessel and cuts off blood supply to the cord. When systemic blood pressure drops, blood flow to the spinal cord may be reduced, potentially causing a loss of sensation and voluntary movement in

5950-418: The relative locations of the spinal tracts responsible for each type of function. Brown-Séquard syndrome occurs when the spinal cord is injured on one side much more than the other. It is rare for the spinal cord to be truly hemisected (severed on one side), but partial lesions due to penetrating wounds (such as gunshot or knife wounds) or fractured vertebrae or tumors are common. On the ipsilateral side of

6035-438: The rest of the population. The risk of suicide is worst in the first five years after injury. In young people with SCI, suicide is the leading cause of death. Depression is associated with an increased risk of other complications such as UTI and pressure ulcers that occur more when self-care is neglected. Spinal cord injuries are most often caused by physical trauma . Forces involved can be hyperflexion (forward movement of

6120-455: The risk of contractures ( shortening of muscles , tendons, or ligaments that result from lack of use of a limb); this problem can be prevented by moving the limb through its full range of motion multiple times a day. Another problem lack of mobility can cause is loss of bone density and changes in bone structure. Loss of bone density ( bone demineralization ), thought to be due to lack of input from weakened or paralysed muscles, can increase

6205-505: The risk of fractures. Conversely, a poorly understood phenomenon is the overgrowth of bone tissue in soft tissue areas, called heterotopic ossification . It occurs below the level of injury, possibly as a result of inflammation, and happens to a clinically significant extent in 27% of people. People with spinal cord injury are at especially high risk for respiratory and cardiovascular problems, so hospital staff must be watchful to avoid them. Respiratory problems (especially pneumonia) are

6290-438: The spinal column and have spinal motion restricted to prevent damage to the spinal cord. Injuries or fractures in the head, neck, or pelvis as well as penetrating trauma near the spine and falls from heights are assumed to be associated with an unstable spinal column until it is ruled out in the hospital. High-speed vehicle crashes, sports injuries involving the head or neck, and diving injuries are other mechanisms that indicate

6375-744: The spinal cord and can be complete , with a total loss of sensation and muscle function at lower sacral segments, or incomplete , meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis , including bowel or bladder incontinence . Long term outcomes also range widely, from full recovery to permanent tetraplegia (also called quadriplegia) or paraplegia . Complications can include muscle atrophy , loss of voluntary motor control, spasticity , pressure sores , infections , and breathing problems . In

6460-494: The spinal cord and exit between a pair of vertebrae , to innervate a specific part of the body. The area of skin innervated by a specific spinal nerve is called a dermatome , and the group of muscles innervated by a single spinal nerve is called a myotome . The part of the spinal cord that was damaged corresponds to the spinal nerves at that level and below. Injuries can be cervical 1–8 (C1–C8), thoracic 1–12 (T1–T12), lumbar 1–5 (L1–L5), or sacral (S1–S5). A person's level of injury

6545-547: The spinal cord by a tumor or intervertebral disc . Anterior spinal artery syndrome also known as anterior spinal cord syndrome , due to damage to the front portion of the spinal cord or reduction in the blood supply from the anterior spinal artery , can be caused by fractures or dislocations of vertebrae or herniated disks. Below the level of injury, motor function, pain sensation, and temperature sensation are lost, while sense of touch and proprioception (sense of position in space) remain intact. These differences are due to

6630-406: The spinal cord or displacement of ligaments or disks that do not have accompanying spinal column damage. Thus when X-ray findings are normal but SCI is still suspected due to pain or SCI symptoms, CT or MRI scans are used. CT gives greater detail than X-rays, but exposes the patient to more radiation , and it still does not give images of the spinal cord or ligaments; MRI shows body structures in

6715-400: The spinal cord, the injury has better prognosis for recovery of function: the peripheral nervous system has a greater capacity for healing than the central nervous system . Signs (observed by a clinician) and symptoms (experienced by a patient) vary depending on where the spine is injured and the extent of the injury. A section of skin innervated through a specific part of the spine

6800-469: The spinal cord, while the corticospinal fibers destined for the legs are spared due to their more external location. The most common of the incomplete SCI syndromes, central cord syndrome usually results from neck hyperextension in older people with spinal stenosis . In younger people, it most commonly results from neck flexion. The most common causes are falls and vehicle accidents; however other possible causes include spinal stenosis and impingement on

6885-462: The spine if they are still inside a vehicle or other confined space. The use of a cervical collar has been shown to increase mortality in people with penetrating trauma and is thus not routinely recommended in this group. Modern trauma care includes a step called clearing the cervical spine , ruling out spinal cord injury if the patient is fully conscious and not under the influence of drugs or alcohol, displays no neurological deficits, has no pain in

6970-451: The spine to determine the presence of a SCI may need to wait if emergency surgery is needed to stabilize other life-threatening injuries. Acute SCI merits treatment in an intensive care unit , especially injuries to the cervical spinal cord. People with SCI need repeated neurological assessments and treatment by neurosurgeons. People should be removed from the spine board as rapidly as possible to prevent complications from its use. If

7055-621: The system to a stimulus such as pain below the level of injury, because inhibitory signals from the brain cannot pass the lesion to dampen the excitatory sympathetic nervous system response. Signs and symptoms of AD include anxiety, headache , nausea , ringing in the ears , blurred vision, flushed skin, and nasal congestion . It can occur shortly after the injury or not until years later. Other autonomic functions may also be disrupted. For example, problems with body temperature regulation mostly occur in injuries at T8 and above. Another serious complication that can result from lesions above T6

7140-417: The technology of guns, including trigger locks to improve their safety. Sports injuries can be prevented with changes to sports rules and equipment to increase safety, and education campaigns to reduce risky practices such as diving into water of unknown depth or head-first tackling in association football. A person's presentation in context of trauma or non-traumatic background determines suspicion for

7225-444: Was in common use. Central cord syndrome , almost always resulting from damage to the cervical spinal cord, is characterized by weakness in the arms with relative sparing of the legs, and spared sensation in regions served by the sacral segments. There is loss of sensation of pain, temperature, light touch, and pressure below the level of injury. The spinal tracts that serve the arms are more affected due to their central location in

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