Spinal Cord Injury Assessment Among Older Adults
Ageing is a complex process that is multi-factorial in origin, the process entails decline in normal physiological functions that is accompany with functional decline, predisposition to some certain age related disease and increase in mortality rate. Likewise, as the older adults population is on increase recent evidence also shows that the incidence of spinal cord injury among this population is on increase and this is considered double disability among this population. Recently, attention has been drawn to aging with spinal cord injury, however, there is dearth of literature in this area. This page will give us an overview of assessment of ageing with spinal cord injury to bridge some of the existing gap in the literature.
Framework: International Classification of Function
The International Classification of Functioning, Disability and Health (ICF) is framework designed by WHO to describe function and disability in a range of health conditions. The applicability of this in spinal cord injury assessment has been discussed in the earlier discussion on assessment of spinal cord injury physiopedia page. Please see the link for further details(assessment of spinal cord injury).
Assessment of Spinal cord injury
Effective management of patients with spinal cord injury (SCI) requires a multi-displinary approach and knowledge of assessment of spinal cord injury and age specific is essential to see desire therapeutic goals such as in ageing with SCI, Thus clinician like Physiotherapist who are usually involved right from the onset of SCI management will benefit from specific objective assessment of SCI among older adult. The main objective assessment that I will consider in this page will include neurological and cardio-respiratory assessment.
Assessment of Impairments
Objective assessment should address concerns in spinal cord injury (SCI) that include impairment in neurological system and cardio-respiratory system. Neurological system assessment should entails assessment for neuromucular integrity such as muscle tone and spasticity, in cardiovascular system such as compromise of cardiovascular control, with associated short- and long-term consequences. For example, impaired control of the autonomic nervous system (ANS), especially in individuals with high thoracic and cervical SCI that can lead to hypo-tension, bradycardia, and autonomic dysreflexia.
Ageing reduces muscle function and tone.Sarcopenia is also prevalent in older adults and it accounts for massive loss in muscle mass and or function among this population, Also ageing reduce numbers of motor neurons and fast-twitch fibers, which further impaired muscle function.Therefore, it is essential to consider the impact of ageing while evaluating SCI patients for muscle function. Noreau and Vachon noted that myometry technique(hand-held myometry) of assessing muscle function might be chosen over manual muscle test (MMT) and the isokinetic dynamometry (Cybex) in spinal cord injury patients. And this can be deemed suitable for the older adults population. Another measure of motor function among SCI patient is the American Spinal Injury Association (ASIA) Standards It is important to note that while considering management for spinal cord injury alleviating osteoporosis and sarcopenia, especially among older adults with SCI, is essential as these are part of complications that are associated with SCI.
Neuromuscular integrity is reduced due to ageing and this can be expressed in form of reduction in sensation including preconception and delayed in nerve conduction, Therefore, this changes is important to note while assessing this population with SCI. The American Spinal Injury Association (ASIA) Standards is one of among the common way to evaluate pin-prick and light-touch sensory function in SCI patients.
Other nervous system assessment
Ageing decrease older adults reaction time, fine motor skills, deterioration of gait or difficulty walking, and there is increased increased neuropathic pain with nerve entrapment and or carpal tunnel syndrome among the aged. Thus, therapist should assess for:
- functional assessment (FIM),
- Hand / Upper Extremity assessment,
- Gait assessment ( balance, coordination, step length and width, cadence etc.)
- Pain assessment
- Non-verbal pain assessment tool can also be considered among this population as the older adult population with cognitive impairment might be challenging to evaluate for pain on a self reported tools.
Cardio-respiratory system assessment
For cardiovascular system, ageing with SCI impacts result in decreases stroke volume, and loss of elasticity of arterial wall. also ageing with sci has implication in increasing in systolic and diastolic pressures, increased orthostatic hypo-tension and increased risk for deep venous thrombosis or pulmonary oedema. Ageing with sci impact on respiratory system results in diminished respiratory capacity, loss of lung and chest wall compliance, vital capacity and there is increased susceptibility to respiratory infection and increased incidence of sleep apnea Therapist should assess for physical activity level, breathing ,coughing among other cardiorespiratory assessment.
Ageing with SCI needs to consider impacts of ageing on body system when choosing assessment tool for older adults with SCI.
- McCormick MA, Tsai SY, Kennedy BK. TOR and ageing: a complex pathway for a complex process. Philosophical Transactions of the Royal Society B: Biological Sciences. 2011 Jan 12;366(1561):17-27.
- Borysławski KR, Chmielewski PI. A prescription for healthy aging. Aging. Psychological, biological and social dimensions. Wrocław: Agencja Wydawnicza „Argi. 2012:33-40.
- Pili R, Gaviano L, Pili L, Petretto DR. Ageing, Disability, and Spinal Cord Injury: Some Issues of Analysis. Current Gerontology and Geriatrics Research. 2018 Nov 19;2018.
- Noreau L, Vachon J. Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal cord. 1998 Oct;36(10):716-23.
- Giangregorio L, McCartney N. Bone loss and muscle atrophy in spinal cord injury: epidemiology, fracture prediction, and rehabilitation strategies. The journal of spinal cord medicine. 2006 Jan 1;29(5):489-500.