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2) Patho 2 > 12) Spinal Cord Injury > Flashcards

12) Spinal Cord Injury Flashcards

1
Q

What is tetraplegia?

A

Impairment/loss of sensory &/or motor fxn in the C-spine that goes on to affect all limbs, trunk, & possibly respiratory muscles

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2
Q

What is paraplegia?

A

Impairment/loss of sensory &/or motor fxn in the T-, L-, or S-spine that affects the trunk & LE’s

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3
Q

What causes SCI?

A

Trauma causing compression, traction, or transection of the spinal cord

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4
Q

What does trauma to the spinal cord usually cause?

A

Vertebral fx/Dislocation

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5
Q

True or False: The spinal cord needs to be severed for permanent injury to occur.

A

False

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6
Q

When does a flexion/extension load occur & what does it cause?

A
  • Occurs when the neck is flexed
  • Causes significant bone + ligament damage & neuro injury
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7
Q

What does a flexion load injury usually require?

A

Surgical stabilization

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8
Q

What does axial loading cause?

A

Burst injury

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9
Q

What causes a burst injury?

A

Axial loading (diving into a shallow pool)

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10
Q

What causes the neuro damage associated w/burst injuries?

A

Splintering of vertebrae into the spinal cord

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11
Q

True or False:High velocity injuries (GSW, MVA, sports) are associated w/less damage & a better prognosis.

A

True

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12
Q

What infections can cause SCI’s?

A
  • TB
  • HIV
  • Syphillis
  • Transverse Myelitis
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13
Q

Besides infections, what other conditions can cause SCI?

A
  • CA
  • Syringomyelia
  • Spinal stenosis
  • RA
  • DJD
  • Spina bifida
  • Radiation
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14
Q

Syringomyelia

A

Devo of cavity on cord bc of a cyst

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15
Q

True or False: Most of the fxnl limitations seen following SCI aren’t caused by the transection itself.

A

True

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16
Q

When does primary injury occur?

A

W/in 18hrs post-injury

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17
Q

What happens during the primary injury phase?

A

Axonal death bc of direct trauma

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18
Q

W/primary injury, what can occur if the spine remains unstable?

A

Additional traumatic injury

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19
Q

When does 2° occur?

A

In the few wks following initial injury

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20
Q

What processes happen during the 2° injury phase?

A
  • Ischemia
  • Hypoxia
  • Biochem
  • Demyelination
  • Edema & scarring
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21
Q

Why does ischemia & hypoxia occur w/SCI?

A

Vessels get damaged & vasoconstrict + there’s disruption of autonomic regulation of the circulatory system

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22
Q

Why does demyelination occur w/SCI?

A

Damage to oligodendrocytes

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23
Q

What is spinal shock?

A

Occurs immediately after SCI bc abrupt loss of connections btwn the brain & spinal cord.

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24
Q

Sx’s of Spinal Shock

A
  • Areflexia for 24hrs
  • Loss of B&B fxn
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25
Q

Complete SCI

A

Absence of sensory &/or motor fxn from S4/5

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26
Q

Incomplete SCI

A

Partial loss of sensory &/or motor fxn from S4/5

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27
Q

W/an incomplete SCI, where must the pt have sensory & motor fxn?

A

B&B

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28
Q

Zone of Partial Preservation

A

Dermatomes & mytomes below the level on the injury that remain partially innervated w/a complete SCI

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29
Q

What is needed to determine if the injury is complete vs incomplete?

A

Rectal exam

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30
Q

ASIA A

A

Complete SCI

No motor or sensory fxn is left into S4/5

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31
Q

ASIA B

A

Incomplete SCI

Sensory fxn into S4/5 is present

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32
Q

ASIA C

A

Incomplete injury

Motor fxn is present, but >50% of key muscles have MMT <3

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33
Q

ASIA D

A

Incomplete

Motor fxn is present & >50% of key muscles have MMT >3

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34
Q

ASIA E

A

Normal sensory & motor fxn

35
Q

Neurological Level

A

Most caudal level of the spinal cord w/normal motor & sensory fxn bilaterally

36
Q

Motor Level

A

Most caudal, normal, or intact innervated spinal nerve bilaterally or the segment below which motor deficits exist

37
Q

When is a motor level considered to be intact?

A

If key muscles are 3/5 & level above is 5/5

38
Q

Central Cord Syndrome

A

Cervical lesion due to hyperextension of the neck causing UE weakness & sometimes B&B dysfxn

39
Q

What is the moston common incomplete SCI?

A

Central Cord Syndrome

40
Q

Prognosis for central cord syndrome

A
  • 75% regain ability to amb
  • 50% regain B&B fxn
  • 25% regain UE fxn
41
Q

Brown-Sequard Syndrome

A

Lesion that damages a hemisection of the cord

  • Causes ipsilateral proprioceptive & motor loss + contralateral loss of noci- & thermoception a few levels below the level of injury
42
Q

Prognosis for Brown-Sequard Syndrome

A

Typically good

43
Q

Anterior Cord Syndrome

A

Affects anterior 2/3 of spinal cord bc of disrupted anterior spinal artery or flexion injury

  • Causes loss of noci- & thermoception + motor fxn inferior to the level of injury
44
Q

W/anterior cord syndrome, what fxn’s are preserved?

A
  • Proprioception
  • Light Touch
  • Deep Pressure
45
Q

Conus Medullaris Syndrome

A

LMN injury in the conus

  • Causes LMN deficits of B&B & LE areflexia
46
Q

Cauda Equina Syndrome

A

LMN injury into the lumbosacral nerve roots w/in the neural canal (below L1)

47
Q

Sx’s of Cauda Equina Syndrome

A
  • Areflexic B&B
  • Saddle Region Anesthesia
  • Flaccid LE’s
48
Q

What comorbidities are associated w/cauda equina syndrome?

A
  • Fx
  • Amputation
  • TBI
  • LOC
  • Pneumo/Hemothorax
  • Burns
49
Q

What are the goals of surgical management of SCI?

A

Align spinal column, spinal canal, & decr pressure on the spinal cord

50
Q

Explain fusion & ORIF

A
  • Done w/anterior approach
  • For fusion, bone graft is taken from ASIS
  • Vertebral bodies get wired together
  • Plates, screws, & rods are inserted
51
Q

Autonomic Dysreflexia

A

Acute, life-threatening syndrome of controlled massive reflex sympathetic discharge occuring in down to T6 injuries

52
Q

Sx’s of Autonomic Dysreflexia

A
  • Severe HA
  • Sweating superior to injury level
  • Slow pulse
  • Goose bumps
  • Pallor
  • Blury vision
  • Extreme HTN (300/160)
53
Q

Is autonomic dysreflexia a medical emergency?

A

Yes

54
Q

Tx of Autonomic Dysreflexia

A
  • Have p sit up to decr cerebral BP
  • Try to remove the noxious stim
  • Seek medical assistance
55
Q

Autonomic Dysfxn

A

Decr ability to regulate body temp so pt has inability to sweat below their injury if they’re complete; Sometimes pt will have excessive sweating

56
Q

Pxn’s for pt’s w/autonomic dysreflexia

A

Keep quads cool in hot weather & warm in cold weather

57
Q

What effects on the skeletal system does autonomic dysfxn cause?

A
  • Osteoporosis/Bone demineralization
  • Incr incidence of pathological fx
  • Ligamentous changes causing jt instability
  • DJD
58
Q

Heterotopic Ossification

A

Abn bone formation in ST & around jt’s in the neurologically impaired segments

59
Q

When is the peak incidence for HO?

A

4-12wks post-SCI

60
Q

Sx’s of HO

A
  • Sudden onset of redness & swelling near large jt’s
  • Jt effusion
  • Decr ROM
  • Pain
61
Q

How is HO dx’ed?

A
  • Incr serum alkaline phosphatase
  • 3-phase bone scans
62
Q

Tx for HO

A
  • Meds
  • ROM after inflammation decr
  • Splinting for total jt ankylosis

*Forceable stretching & mobes may worse the situation

63
Q

When is surgery for HO most effective?

A

12-18mo post-onset or when bone is mature

64
Q

Post-op complications of HO

A
  • Delayed wound healing
  • Excessive bleeding
  • Infection
  • Fx
  • Recurrence
65
Q

What postural deformities are associated w/HO?

A
  • Scoliosis
  • Kyphosis
  • PPT
66
Q

Why do SCI pt’s get jt contractures?

A

Bc of loss of antagonist muscle contractions & prolonged sitting/supine positioning

67
Q
A
68
Q

What effects on the CV system can SCI have?

A
  • Peripheral circulatory clamping of vessels
  • Circulatory & lymphatic stasis
  • Venous thrombosis & PE risk
  • Cardiac muscle atrophy
  • Unstable HR, BP, & arrhythmia
  • Orthostatic hypotension
  • Decr blood & plasma vol
  • Decr CO
69
Q

Tx for Orthostatic Hypotension

A
  • Abdominal binder
  • Bilateral LE support stockings
  • Gradual acclimation to position changes
  • Reclining w/c
  • Tilt table
  • Meds
70
Q

What effects on the GI system can SCI have?

A
  • Paralytic ileus
  • Abdominal distention–>Bc of lack of muscular support
  • B&B dysfn
71
Q

Can women w/SCI normally get pregnant & give birth?

A

Yes

72
Q

Can men w/SCI have kids?

A

Yes, but will usually require medical intervention

73
Q

Nociceptive Pain

A

Pain caused by activation of noci-ceptors in response to (potential) damage to non-neural tissue

74
Q

Neuropathic Pain

A

Pain arising as a direct consequence of a lesion/disease affecting the somatosensory system

75
Q

Is nociceptive or neuropathic pain more severe?

A

Neuropathic

76
Q

Characteristics of Neuropathic Pain

A
  • Burning
  • Pricking
  • Tingling
  • Itching
  • Shock-like
  • Stabbing
  • Continuous, Intermittent, Spontaneous
  • Exaggerated
77
Q

Tx for Neuropathic Pain

A
  • Pharmocologic
  • Psychologic
  • Meds
78
Q

What is a mechanical in-exsuffalator?

A

Vacuum that applies gradual (+) pressure to the AW & then rapidly shifts to (-) pressure to stim a cough

79
Q

ROM Guidelines for the Shoulder

A

If pt doesn’t have active elbow extension, greater than normal elbow extemopms combined w/GH ER is required

80
Q

ROM Guidelines for the Elbow

A

Full extension is needed for stability

81
Q

ROM Guidelines for the Forearms

A

Full supination is essential to assist in locking elbows

82
Q

ROM Guidelines for Wrists

A
  • Full wrist flexion & extension must be preserved
  • If active wrist extension is <3/5, over stetching may occur & further weaken muscles
  • May need splints
83
Q

ROM Guidelines for the Neck

A

Attain ROM through gentle AROM

84
Q

ROM Guidelines for the Fingers

A

WB activities on hands should be done in a fisted position

2) Patho 2 (20 decks)

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