Referensi

Current Intervention of Physiotherapy regarding SCI

based on neurological aspect and lastest evidence available
Wisnu Prasetyo Adhi, SSt. Ftr

A: Normal spinal cord.

B: Anterior cord syndrome/infarct. Damage marked in red.
C: Posterior cord syndrome or tabes dorsalis of tertiary syphilis.
D: Subacute combined degeneration from B12 deficiency.
E: Brown-Sequard cord hemisection.
F: Central cord syndrome or syrinx.
G: Poliomyelitis.
H: Amyotrophic lateral sclerosis.
 THE NEUROLOGICAL
ASPECT

THE DEVELOPMENT OF THE MENINGES

SPINAL CORD
 THE CORRELATION BETWEEN THE
THE LAMINAE PATHWAYS IN SPINAL CORD WITH
SENSOMOTOR INTEGRATION

Posterior Column-Medial Lemniscal pathway Posterior Column-Medial Lemniscal pathway

Fasciculus Gracilis and Fasciculus Cuneatus Fasciculus Gracilis and Fasciculus Cuneatus
(Discriminative Touch, Vibratory sense and Propioceptive)

• Uncrossed
• Proprioception
• Touch (2 point
discrimination)

Copyright © 2013 Pearson Education, Inc., publishing as Benjamin Cummings.

 FUNCTIONAL JOINT CENTRATION

SPINOTHALAMIC PATHWAY

LSTT ASTT
(pain and temperatur) (light touch and pressure)

Thermal
noxious

Crossed
Touch

Copyright © 2013 Pearson Education, Inc., publishing as Benjamin

Cummings.
 SPINOCEREBELLAR PATHWAYS
• 4 fiber tracts dari spinal cord menuju cerebellum
1. PSCT (posterior spinocerebellar)
Non-conscious proprioception
non-conscious proprioception
2. cuneocerebellar
3. ASCT (anterior spinocerebellar) Melaporkan secara terus menerus kondisi
internuncial di spinal cord
4. RSCT (rostral spinocerebellar) (1)Stretch reflex
(2)Ia internuncial serving
reciprocal inhibition
(3)non-conscious
proprioception
(4)kinesthesia

Copyright © 2013 Pearson Education, Inc., publishing as Benjamin Cummings.

Copyright © 2013 Pearson Education, Inc., publishing as Benjamin Cummings.

SPINORETICULAR PATHWAYS OTHER ASCENDING PATHWAYS

• somatosensory pathways tertua/terlama
• ST (spinotectal tract):
• Sebagian SR fibers mungkin uncrossed - Berada disepanjang spinothalamic pathway
• Tanpa pengaturan somatotopically - Dan sangat menyerupai spinothalamic (asal
• Dari post gray column, root ganglion à SR neurons dan komposisi fungsionalnya)
fibers melewati laminae V-VII à menemani - Berakhir di superior colliculus (joins crossed
spinothalamic pathway à brainstem (medulla, visual inputs)
pons, midbrain)
à Terlibat dalam visuospinal reflex
• 2 fungsi yang saling berhubungan
1. menstimulasi cerebral cortex à waking
state à level kesadaran
2. Menyampaikan informasi ke limbic cortex
area ant. cingulate gyrus mengenai
stimulasi situasi lingkungan sekitar à
menyenangkan atau tidak menyenangkan
• phylogenetically old à 'paleospinothalamic'
pathways à reticular formation à emotional
somatic sensory sti.
Copyright © 2013 Pearson Education, Inc., publishing as Benjamin Cummings.
THE CONNECTION
SPINOOLIVARY TRACT
Menyilang
Mengirim informasi tactile ke inf.
olivary nucleus di medulla oblongata
Berperan penting pada motor learning
à memodifikasi aktivitas cerebellar
dalam merespon perubahan
lingkungan
àmotor adaptation
• spinocervical tract
cat (small spinothalamic pathways)
Tidak terdapat pada manusia

Copyright © 2013 Pearson Education, Inc., publishing as Benjamin Cummings.

SUMMARY OF ASCENDING PATHWAYS Question 1

PCML (motor)

Spinocerebellar

emotional
Spinothalamic heel-to-knee test
(Pain, Touch)

1 2Ö 3 4
Question 4 (2 point) Question 5 (2 point)
• pathway for this • Location of the soma for this 2nd-order afferent
functional performance 1. Left nucleus gracilis
1. PSCT 2. Right nucleus gracilis
2. RSCT 3. Left nucleus cuneatus
3. Spinothalamic 4. Right nucleus cuneatus Move “up” & “down”

4. PCML

CONUS MEDULLARIS AND CAUDA EQUINA

THE VISCERAL
EFFERENT PATHWAYS
THE PROPIOSPINAL AND THE PROPIOSPINAL AND
CENTRAL PATTERN CENTRAL PATTERN
GENERATORS GENERATORS

The relevant parameters determining

this neurological pattern

• Spatial and temporal progression of symptom

presentation
• Location, quality, and severity of sensory dysfunction NEUROLOGICAL
• Location and severity of motor dysfunction (paresis,
plegia) COMPLICATION
• Spastic versus accid paresis
• Quality and severity of bladder/bowel/cardiovascular
dysfunction 

 International Spinal Cord Injury Pain
(ISCIP) Classification
THE PAIN

NEUROPATHIC PAIN

NOCICEPTIVE
PAIN

International Spinal Cord Injury Pain

THE PAIN
(ISCIP) Classification
NEUROPATHIC NOCIVEPTIVE
PAIN PAIN

• Cognitive Behavior Therapy,

• Biofeedback Relaxation,
• Self Hypnosis,
• Transcranial direct current stimulation and repetitive
transcranial magnetic stimulation
 SPASTICITY SPASTICITY
After upper motoneuron damage due to spinal
cord injury, spinal circuitry receives unbalanced
input from peripheral afferent fibers and
segmental interneuronal circuits relative to
descending supraspinal pathways.

• increased muscle tone,

• increased muscle reactivity,
• decreased precision of voluntary muscle control,
the emergence of involuntary motor output
•

SPASTICITY
SPASTICITY
SPASTICITY
SPASTICITY

Spasticity Goal treatment for spasticity

in SCI

Control pasif tone

Control active tone

Control of The duality of Supraspinal effect
 Spasticity Autonomic Regulation of
Cardiovascular

Six neuroanatomical changes that

Timeline of changes in autonomic
influence autonomic cardiovascular control
cardiovascular function
1.Initial sympathetic hypoactivity due to loss of supraspinal
tonic sympathetic excitation.
2.Alterations in the morphology of sympathetic
preganglionic neurons (SPNs).
3.Plastic changes of the spinal circuits (i.e., dorsal root
afferent sprouting, poten- tial formation of aberrant
synaptic connections, or aberrant inputs to the spinal
interneurons).
4.Altered sympatho-sensory plasticity.
5.Altered peripheral neurovascular responsiveness.
 Three phase of Plasticity in
Consequences
Cardiovascular autonomic system Cardiovascular after SCI
Low Resting Blood Presure
Autonomic Pathways and SPN Plasticity Autonomic Disreflexia

Dorsal Afferent and intraspinal Plasticity Orthostatic hypotension

Vascular Pheriperal component Plasticity Other contributing factors to cardiovascular

disease after SCI physical inactivity, impaired
glycemic control, inflammation, and lipid
abnormalities

URINARY DETRUSOR/SPHINCTER FUNCTION

DETRUSOR/SPHINCTHER FUNCTION FLOW CHART DIAGNOSTIC
PROCEDURE

FLOWCHART THEURAPEUTIC PROCEDURE

Temporal Electrical
Electrical Stimulation
30-40 x session
15 min stimulation/session
pulsed sinusoidal waveform (50 Hz)
pulse duration 200 ms
pulse pause interval 1000 ms
intensity 15-20 mA
 FERTILITY NEUROGASTROINTESTINAL
MEN

Spermatogenesis and epididymal function are temperature sensitive, and

prolonged sitting in a wheelchair may result in elevated scrotal temperature and
consequently in dyspermia

Transrectal electrical stimulation and penile vibratory stimulation—-80-90%

WOMEN

Following a phase of amenorrhea, which occurs in about a third of

patients after acute SCI, lasts for about 4 months, and is presumed to
be due to a temporary rise in prolactin, reoccurrence of ovulation can
be demonstrated, reestablishing the possibility of becoming pregnant
for women with SCI

RESPIRATORY Mucus and secretion management

1. The decreased strength of
respiratory muscles 


2. A reduced compliance of lungs

and thoracic wall 


3. A chronic central
hypoventilation 


4.Changes of the patency and

reactivity of the airways 


5. Dyssynergies concerning the

muscles of the thorax and
abdomen 

 Pertanyaan yang akan muncul oleh
ULCUS keluarga dan pasien
MEDICAL TEAM

PHYSIOTHERAPIST

THE MOST CONTACT/

COMMUNICATION
WITH THEM
 Pain: Biological, Psychological or Social?

The biopsychosocial factors

Biological associated with pain and distress
following spinal cord injury.

PAIN
Social Psychological

Margaret Tilley
margaret.tilley@buckingham.ac.uk

Mr. Ferry Kana

Social factors associated with pain

• Social models (e.g. Craig, 2009)

– Communicative function, family, role of others, support,
interpersonal and intrapersonal factors.
Patient Record
 Patient Record Patient Record

“Jangan menjadi orang hebat, tetapi jadilah orang

yang bermanfaat” “TERIMA KASIH”
–Wisnu Prasetyo Adhi, SST.FT., Ftr