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In this episode, Dr. Michael Powers continues the spinal cord injury (SCI) series by exploring its impact on body systems, function, and participation. He discusses acute management and the cardiovascular, autonomic, respiratory, integumentary, and genitourinary changes that influence rehabilitation. Dr. Powers highlights key considerations for safe mobility training and emphasizes the importance of looking beyond functional independence to community fitness, employment, and quality of life.

Key Takeaways

• The SCI continuum of care, from acute management to community fitness and wellness
• Acute medical management and spinal stabilization
• Social determinants of health and disparities in SCI care
• Spinal shock vs neurogenic shock
• Autonomic dysreflexia: recognizing triggers, signs, and appropriate responses
• Orthostatic hypotension and impaired thermoregulation
• Respiratory function, cough, and airway clearance
• Skin protection, pressure relief, and patient education
• Changes in bowel, bladder, and sexual function
• How spasticity can impair—and sometimes assist—function
• Rethinking movement strategies for bed mobility, transfers, and locomotion
• The importance of physical activity, sports, and employment for community participation
• Quality of life after SCI: self-efficacy, optimism, and adaptation

References

• O'Sullivan & Schmitz's Physical Rehabilitation
• Neurogenic Shock
• Race and Socioeconomic Disparity in Treatment and Outcome of Traumatic Cervical SCI with Fracture
• Influence of Physical Activity on QOL in Individuals with SCI
• Evidence-based Scientific Exercise Guidelines for Adults with SCI
• Facilitators and Barriers to Sustainable Employment After SCI or TBI
• Labour Market Participation after SCI
• Traumatic Cervical SCI and Income and Employment Status
• The Economic Argument for Hiring People with Disabilities

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In this episode, Dr. Michael Powers explores spinal cord injury (SCI). Although SCI has a relatively low prevalence and incidence, it is a high impact condition which carries not only significant functional cost but also tremendous financial cost. Dr. Powers highlights the importance of key ascending and descending spinal cord tracts both for recognizing common clinical SCI syndromes and for examining individuals with SCI to determine neurologic level of injury. He discusses the importance of determining neurologic level of injury, and how combining neurologic level of injury with ASIA Impairment Scale provides physical therapists with critical information to establish diagnosis, prognosis, and plan of care.

Key Takeaways

• Incidence and prevalence of SCI
• Cost of SCI, including consideration of lost wages/productivity
• The 3 most important SCI tracts to know
• The 4 most common SCI clinical syndromes
• The ISNCSCI and ASIA exam
• What information is (and isn't) conveyed by the neurologic level of injury
• What information is (and isn't) conveyed by the ASIA Impairment Scale
• Why both neurologic level of injury and ASIA Impairment Scale are needed to determine diagnosis, prognosis, and plan of care

Go Deeper With Your Learning

• Dr. Powers works through a patient case to determine neurologic level of injury and ASIA Impairment Scale (YouTube)

References

• O'Sullivan & Schmitz's Physical Rehabilitation
• SCI Key Data
• Costs of Living with SCI
• International Standards for Neurological Classification of Spinal Cord Injury
• ISNCSCI Worksheets
• Common Errors Made During ISNCSCI Exam (YouTube)

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In this episode, Dr. Michael Powers explores Amyotrophic Lateral Sclerosis (ALS). Although ALS has a relatively low prevalence and incidence, the progressive loss of motor neurons has a devastating effect on function, quality of life, psychosocial wellness, and lifespan. Dr. Powers discusses the important role that physical therapists play in ALS management, including the framework for rehabilitation, exercise prescription, and psychosocial considerations.

Key Takeaways

• ALS as motor neuron disease
• Pathophysiology of motor unit loss
• Known risk factors for ALS
• Limb-onset vs bulbar-onset ALS
• Importance of diffuse upper and lower motor neuron findings in ALS diagnosis
• "Fasciculations are known by the company they keep"
• Pseudobulbar affect and psychosocial considerations
• ALS progression and mortality
• Framework of restoration, compensation, and prevention
• Evidence-informed exercise prescription

References

• O'Sullivan & Schmitz's Physical Rehabilitation
• ALS Environmental and Lifestyle Factors
• Meta-analysis of Military Service and ALS Risk
• Systematic Review Military Service and Related Risk Factors for ALS
• Pseudobulbar Affect
• El Escorial Criteria for ALS
• Physical Exercise in ALS

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

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