Sensorimotor Loss And Hemiplegia Health And Social Care Essay

sensorimotor Loss And Hemip stickia Health And Social C be Essay schoolmaster Scarlet and skipper regretful were working in the intelligence ingredient of Cloud-base when in that location was a terrorist attack by the Mysterons. A bomb change integrity causing the ceiling to collapse trapping both(prenominal) of them under the rubble. Captain Scarlet escaped with only minor injuries but Captain Blue was struck across the shoulders by masonry and piping, which pinned him down. It took several hours to dig him out and when he has pulled free he was unable to move his fortifys or legs. When he arrived at the Cloud-base hospital, he complained of his softness to move and of shooting/burning persistence in both arms. Neurological examination revealed a unexpended unilateral paralysis and remunerate hemipargonsis with a Babinski sign deport bilaterally. hurting adept was anomic from the advanced shoulder downwards. Bladder, bowel and genital reflexes were in like manner a bsent. X-rays of the cervico- thoracic kingdom were taken and subsequently he underwent surgery to remove work up fragments and to energize the cervical spine.A month later, transaction of the right arm and leg had better. Two months after surgery, movement in the right hand had improved further but there was no voluntary movement on the left. Fasciculation of the left deltoid muscle was effect together with spasticity of the left arm and leg, with clonus at the ankle. A Babinski sign remained on the left position. Joint sic sense was present on both sides but pain sense experience was absent on the medial right aspect of the upper right arm, right side of the thorax, abdomen and whole right glower limb. disrespect reassurances from his Colonel that his condition willing improve further, Captain Blue feels that he will never physically recover from his injuries.Organisation of spinal anesthesia anaesthesia anesthesia pileIn its own definition of spinal electric elec tric corduroy, Oxford medical dictionary states The portion of the rudimentary nervous system enclosed in the vertebral column, consisting of nerve mobile phones and bundles of poise connecting all parts of the body together(1). spinal cord is divided into 2 regionsThe colour point It contains the axons of the neurons that make up the descending and ascending tracts obligated for the communication of the spinal cord with the brain. The white matter can be split into the dorsal, the ventral and the lateral funiculous as seen in render 1.The whiten matter contains the following quadruplet path musical modes that argon essential for the scenario and that will be further discussed in the next objective. Each tract carries a particular(prenominal) modality (types of perception) in the brain. The position of each tract in the white matter is seen in come across 2.Dorsal column medial fillet tract (DCML) It is creditworthy for conscious proprioreception and discriminative tou ch. It is split into the gracile and the simple fasiculi which carry these modalities from the lower and upper limbs respectively.Spi nonhalamic tract(STT) It is trustworthy for the pain and temperature sensation.Spinocerebellar tract (SCT) It is obligated for the unconscious proprioception to the cerebellum which controls the co-ordination of movements.The preceding(prenominal) are ascending pathways i.e. they send selective in makeation from the spinal cord to the brain. The following is a descending pathwayCorticospinal tract (CST) It is obligated for sending in exploitation to the spinal cord for controlling voluntary movements of the lower and upper limbs. frame of reference 1 spinal cord transection (2)The Grey matter It mainly consists of neural cell bodies and glial cells. Ten different layers of gray matter called laminae can be distinguished. it is further divided into 3 or 4 regions (depending on the level of the spinal cord) each containing several laminae as see n in Figure 2Superficial dorsal trump It consists of laminae I-II and receives in validation from nociceptors about pain and temperature from Ac and sensory fibers.Deep dorsal horn It consists of laminae III-VI which receive information for touch and conscious proprioreception from the low threshold mechanoreceptors form I sensory fibers.Lateral horn This can be found in the spinal levels T1-L2 and is responsible for the autonomic control as it contains cell bodies of autonomic preganglionic fibers.Ventral horn It consists of laminae VII-IX and contains the cell bodies for -motor neurons that render the muscles, as rise as here the muscle afferents terminate.Figure 2 Organisation of spinal cord (3)Organisation of pathways in Spinal cordEach of the four pathways mentioned above will now be describedDorsal towboat Medial Lemnsicus pathway (4)Figure 4 DCML tract (3)The Information from the cuteneous mechanoreceptors excursion done I fibers in the dorsal horn of the spinal cord and provide the dorsal column nuclei.The Axons ascend ipsilaterally the spinal cord.They decussate in the medulla and ascend through medial lemniscuses to the ventroposterolateral nucleus of the thalamus.Then they change of location through the congenital capsule to the primary somatosensory cortex in the postcentral gyrous.Spinothalamic tract (5)Figure 5 STT tract (3)It conveys information such as pain and temperature from nociceptors through C and A fibers to the laminae I-II of the dorsal horn.The axons decussate in the grey commisure of the spinal cord one or two segments above the point of entry.2ndary axons ascend in the lateral lemniscus of the spinal cord and supply the ventroposterolateral nucleus of the thalamus.3rd order axons travel through the internal capsule to primary somatosensory cortex in the postcentral gyrous.Spinocerebellar tract (6)Figure 6 STT tract (7)It conveys information for unconscious proprioception from the muscle mechanoreceptors and through I f ibers in the deep dorsal horn.The axons ascend in the dorsal columns and innervate the Clarkes columns.This pathway does not decussate.The axons enter the cerebellum through the inferior pudencle.Corticospinal tract (8)Figure 7 STT tract (3)It curries information from the primary motor cortex in the precentral gyrous to the ventral horns of the spinal cord and from there through - motor neurons to the muscles.The axons from the pre-central gyrous devour through the internal capsule and decussate at the spino-medullary junction to form the pyramidal tract.From there they descend in the lateral corticospinal tract to innervate -motor neurons nuclei in the ventral horn.-motor neurons travel in the body and innervate the muscles. formulate the symptoms DiagnosisBelow are listed and explained the symptoms scored by the spinal combat injury endowment a possible diagnosis at the end. The symptoms of Captain Blue are referable to the damage of the spinal cord ca employ by the verteb rae beat fragments.Symptoms invoiceInitial inability to move and shooting pains in both armsThese are due to the spinal shock (9). This causes temporarily discharge of function of the whole spinal cord. As a result, there is a loss of ability of voluntary control to all body give the impression of muscle flaccid paralysis. Also there is loss of sensation and in this case there is a shooting pain in both arms. The spinal shock usually starts to face off in one day and gradually the reflexes, the control of movement and the sensation in the undamaged part are gained back.Babinski sign bilaterally. Clonus in the ankle and spasticity of the left arm and legThe Babinski reflex is a polysynaptic reflex evoked when there is nocturnous stimuli on the sole of the foot. The normal Babinski reflex causes withdrawal of the foot with adduction and inflection of the toes. An abnormal Babinski sign is one that shows abduction and extension of the toes of the foot when the foot is withdrawn. In neonates it is normal to show an abnormal Babinski reflex as their corticospinal tract has not yet matured (10).Clonus is a series of contraction when the muscle is stretched.Spastisity is increase muscle tone.All the above are indicators of an upper motor neuron lesion and indicate a possible damage on the corticospinal tracts of the spinal cord.FasciculationsFasciculations are spontaneous, involuntary muscle contractions that can be seen below the skin. These are due to spontaneous firing of damaged -motor neurons. These are caused by the damage on the ventral horn where the -motor neurons synapse with the descending tracts.Left hemiplegia and right hemiparesis. after(prenominal) two months right hand movements are improved.Hemiplegia is the complete inability of the voluntary movement of the one side of the body whereas hemiparesis is the weakness in movement.As concluded above there is damage in the CST of the spinal cord. This causes ipsilateral loss of movement below the le vel of lesion. Left hemiplegia indicates that there is a lesion on the left side of the spinal cord as the CST decussates in the medulla. The right hemiparesis is due to the initial spinal shock.Pain sensation lost from the right shoulder downwardsThe loss of sensation indicates damage of the spinothalamic tract. The loss of sensation is on the right side as the lesion is on the left part of the spinal cord. This is due to the fact that STT decussates in the spinal cord. The level of loss of pain sensation is an indicator of the possible level of lesion. The shoulder region is innervated by the C5 level. Therefore, this is probably the level of injury.Bladder, bowel and genital reflexes were absentBladder, bowel and genital reflexes are autonomic reflexes controlled by the brain. In the lateral horn of thoracolumbar and sacral levels, autonomic preganglionic fibers originate and innervate the organs.In more detail, parasympathetic performance in men is responsible for arousal where as sympathetic activity is necessary for ejaculation and orgasm. Autonomic activity in bowel and bladders controls the muscles responsible for defecation and dieresis respectively.A lesion in the spinal cord can damage the pathway and result in incontinence of bladder and impotency for men.Joint position sense was present on both sides but pain sensation was absent on the medial right aspect of the right arm, right thorax, abdomen right lower limb.Information for joint position is ascending to the brain through the DCML tract. This means that this pathway is not damaged. On the other hand as explained above, pain sensation travels in the CTT which is damaged.In Figure 8, there is a body map showing the area affected as farthermost as motor movement is concerned (solid brown area), and the area of impair sensation. On the right, is the area of damage at the C5 level resulting in the symptoms on the left. Taking everything into concern, all the complications indicate a lesion on the left side on C5 level of the spinal cord due to injury from the osmium fragments. The structures damaged areDCML pathway and STTPart of the ventral hornFigure 8 Captains Blue Symptoms body map and lesion of spinal cordSpinal cord injuriesSpinal cord injuries can occur due to trauma, infections, ischemia and other diseases. In this case the trauma was indirectly caused by bone due to vertebrae fracture. There are also direct traumas such as in stab wounds.Damage is firstly caused due to hemorrhaging and compression of the spinal cord. The secondary complications such as hypoxia and ischemia that occur over a longer period can also cause further damage. aft(prenominal) the initial physical damage to the spinal cord, apoptosis of the glial cells and demyelination occur. seditious cells infiltrate the spinal cord and contribute to the scaring and the inhibition of the axon growth. The injury may expand to other segments and cause grater complications (syringomyelia). Figure 9 shows a cervical spinal cord following an injury.Figure 9 Spinal cord after injury (11)Figure 10 ASIA categories for spinal cord injuries (12)Spinal cord injuries can be classified with ASIA (American Spinal blur Association) in Asia A, B, C, D categories. Figure 10, adapted from ASIA official website, shows the characteristics of each category. sermon PrognosisThe preaching for spinal cord injuries is very complex. However, even with the high hat treatment, regeneration of restiveness and complete regaining of functions is unlikely. The treatment mainly concerns the lessening and minimization of the damage and fights the complications caused by the injury (13).The primary line of treatment is to relieve the pressure on the spinal cord and eliminate the cause of the damage. In this case Captain Blue undergoes surgery to remove the bone fragments.The second line of treatment involves the reduction of the inflammatory response responsible for further damage. The prescription of cor ticosteroids helps with the anti-inflammatory effects, the reduction of the glial scar formation and the CNS cell death.Furthermore, doctors must work against problems caused by the loss of movement such as urinary infection, wasting of muscles or formation of blood line clots. As a result, exercises to improve bowel and bladder function and life style tips to reduce the possibility of clot formation are given. Physiotherapy is the highroad to avoid muscle waste. Occupational therapy is needed for the patient to learn to exit with his immobility. A range of non medical specialists such as dieticians, psychologists and social workers are also needed.The prognosis for CNS damage is very poor. Regeneration of the nerves in the CNS is difficult due toGlial scar formation. venting of inhibitory substances that oppose axon growth and remyelination.However, new techniques such as electrical stimulation of the nerves with electrical devices can be used in the future to gain muscle funct ion. Stem cells are also a promising future. Presently the most helpful and accessible way to overcome the disabilities caused by spinal cord injuries is the wheelchair with electronic devices that can be used for communication, movement and a variety of other daily jobs.