Case Study Analysis of Spinal Cord Injury in Elderly Patient - 2804NRS

This case study analysis examines the case of an elderly patient suffering from spinal cord injury. The analysis begins by identifying the patient's risk factors, including age, falls, re-traumatization, and joint injury, and their relationship to the injury. It then delves into the aetiology, which in this case is a fall, and the subsequent pathophysiology, including spinal shock, changes in heart rate and blood pressure, hyper-reflexia, and potential loss of movement and sensation. Clinical manifestations such as numbness, pain, weakness, and hypertension are discussed. The diagnosis involves neurological and neurovascular assessments, X-rays, CT scans, and MRIs. Interventions include complete bed rest, anti-hypertensive medications, pain management, thoraco-lumbar support, spinal decompression, and physical therapy such as sensory integration and robotic gait training. The analysis also highlights the effects and symptoms of spinal cord injury including circulatory dysfunction, loss of bladder and bowel control and the potential for stroke. The case study concludes with a comprehensive overview of the patient's condition and the management strategies employed.

Running Head: Case study
Case Study analysis
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1Case Study Analysis
Risk factors and aetiology
The risk factors of this case are age, re-traumatisation in the same area, joint injury and
fall. The patient is aged for this case study, therefore age can be a prevalent factor. The
patient felt the pain after she fell from the armchair so it can be said that fall is a risk factor
for this case study. Re-traumatisation or repeated injury in the same area can be another risk
factor as her spinal cord was affected (Adriaansen et al., 2017). Joint and bone injuries are
prevalent in this case study as the patient might have injured her bones. The symptoms of
spinal cord injury in this case study;
 Numbness in legs and hands
 Pain and stiffness in back and neck
 Weakness in limbs
 Tenderness in the area
 High blood pressure as a result of compression
Causes of spinal cord injury for this case study
Different causes can lead to spinal cord injury such as fall, spinal stenosis, tumour,
herniated disks (Ahuja et al.,2017). In this case the cause of spinal cord compression is fall
and spinal cord injury due to Bondi tension of the elderly patient.
Clinical manifestation and pathophysiology
During spinal cord injury spinal shock is developed which leads to sympathetic
outflow the systematic vascular system and parasympathetic stimulation to heart (Sweis &
Biller, 2017). The spinal shock also reduces the heart rate and as a result cardiac output is
reduced and hypertension can be regulated (Mathias & Frankel, 2019). Sympathetic and
parasympathetic sympathetic stimulation can reduce stroke volume with preload and

2Case Study Analysis
afterload of the stroke. However in this case, hyper reflection has been observed. Hyper-
reflexion is a neurological disorder where reflex exaggerated; in this case it is associated with
the bladder dysfunction and spinal cord injury which is prominent (Naumović, 2018). Shock
or injury can lead to the loss of movement and sensitivity in different organs. A person can
loss consciousness in some organs or parts of his or her body due to severe pain or shock.
Injury in between T1 and T6 results into the dysfunctions of abdominal muscle. Trunk
stability and sensation under the point of injury can be lost after occurrence of high level of
injury. Above T6 level can result in to autonomic dysreflexia (Lee & Joo, 2017). Injuries in
Thoracic level can result into paraplegia in patients. In this case hypertension for high blood
pressure can be observed in the patient. Sometimes, resulted high blood pressure can lead to
stroke in a patient. Due to hyperreflexia movement and leg movements are highly affected in
this case and pain in upper back has been detected as well.
Diagnosis and intervention:
As diagnosis neurological assessment for sensory and motor movement neurovascular
assessment should be done. Spinal cord assessment can be done by x ray and CT scan as
these assessments help to check the condition of the spinal cord by injecting a dye in the
spinal cord. Radiological evaluation is very important for this case because spinal cord injury
can easily detected by x-ray, CT scan and any kind of blood clots or herniated discs can be
detected by MRI. The patient should be suggested complete bed-rest and anti-hypertension
medications for stabilization of her condition (Cirnigliaro, Myslinski, La Fountaine,
Kirshblum, Forrest & Bauman, 2017). For managing the pain, medication (non-stroidal anti-
inflammatory) must be given to the patient along with proper support to thoraco-lumber area.
Support should be given with the help of thoracolumbar bracing. This can be helpful in
preventing the body from friction due to different physiological process such as bowel
movement, bladder control and walking. As a preliminary intervention the patient head

3Case Study Analysis
should be elevated while she lies down. After the injury spinal decompression should be
suggested in collaboration with Physiotherapist and physician. Fibre rich nutrition and diet
should be suggested to the patient for the improving bowel movement in a regular manner.
Sensory integration technique in collaboration with physical therapist must be suggested to
the patient (Karunakaran et al., 2020). Positioning is very important for this patient sleeping
positioning and sitting positioning should be accepted by gnosis and professionals cost of
Ambulatory care for foot movement and food exercises will be suggested to this position for
movements and reduce numbness. Modern wheel chair, electronic devices for daily living
and electrical stimulation devices are important. Muscles of leg and arms are stimulated by
the help of electrical stimulus of the device. Robotic gait training is also important for
mobilising the body parts and reviving the walking ability in the patient.

4Case Study Analysis
Spinal Cord Injury
Fall Age Re-Trauma Joint Injury
Risk factors
Muscle hyper-reflexion
Loss of Bladder Control
Bowel movement dysfunction
Pain
Loss of movements Circulatory dysfunction
Hypertension
and tachycardia
Stroke
Thoracic-spinal injury
Loss of control in abdominal muscles
Numbness in
legs
Loss of sense in
organs
Effects and
symptoms
References
Adriaansen, J. J., Douma-Haan, Y., van Asbeck, F. W., van Koppenhagen, C. F., de Groot,
S., Smit, C. A., ... & Post, M. W. (2017). Prevalence of hypertension and associated
risk factors in people with long-term spinal cord injury living in the

5Case Study Analysis
Netherlands. Disability and rehabilitation, 39(9), 919-927.
https://doi.org/10.3109/09638288.2016.1172349
Ahuja, C. S., Wilson, J. R., Nori, S., Kotter, M. R., Druschel, C., Curt, A., & Fehlings, M. G.
(2017). Traumatic spinal cord injury. Nature reviews Disease primers, 3(1), 1-21.
https://www.repository.cam.ac.uk/bitstream/handle/1810/265007/Ahuja_et_al-2017-
Nature_Reviews_Disease_Primers-AM.pdf?sequence=2
Cirnigliaro, C. M., Myslinski, M. J., La Fountaine, M. F., Kirshblum, S. C., Forrest, G. F., &
Bauman, W. A. (2017). Bone loss at the distal femur and proximal tibia in persons
with spinal cord injury: imaging approaches, risk of fracture, and potential treatment
options. Osteoporosis International, 28(3), 747-765. 10.1007/s00198-016-3798-x
Karunakaran, K. D., Yuan, R., He, J., Zhao, J., Cui, J. L., Zang, Y. F., ... & Biswal, B. B.
(2020). Resting-State Functional Connectivity of the Thalamus in Complete Spinal
Cord Injury. Neurorehabilitation and Neural Repair, 1545968319893299.
https://doi.org/10.1177%2F1545968319893299
Lee, E. S., & Joo, M. C. (2017). Prevalence of autonomic dysreflexia in patients with spinal
cord injury above T6. BioMed research international, 2017.
Mathias, C. J., & Frankel, H. L. (2019). 10 Cardiovascular Disorders in High Spinal Cord
Lesions. Disorders of the Autonomic Nervous System.
https://books.google.co.in/books?
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Naumović, N. (2018). Spasticity: A result of central nervous system injury. Medicinski
pregled, 71(1-2), 5-8. https://doi.org/10.2298/MPNS1802005N
Sweis, R., & Biller, J. (2017). Systemic complications of spinal cord injury. Current
neurology and neuroscience reports, 17(1), 8. https://doi.org/10.1007/s11910-017-
0715-4