6] SCI Part 2 Flashcards
Damage to central part of cord
Central cord syndrome
Central cord syndromes happens with what injuries
HYPEREXTENSION injuries
Central cord syndrome is seen with damage to what tracts
UE, trunk and LE with sacrum spared
What’s the first thing To go with central cord syndrome
Their arms!!
Ipsilateral loss of brown-sequard syndrome
Proprioception Vibration 2 point discrimination Fine touch Stereognosis Motor function
Contralateral loss of brow-sequard syndrome
Pain and temp
You see anterior cord syndrome with
Tear drop or burst fracture
Anterior cord syndrome results in loss of?
Bilateral loss of motor function, pain and temp
Anterior cord syndrome has intact
Intact proprioception
Cauda equina syndrome is damage where that results in what
Damages at L1 or below which results in flaccid paralysis
Conus medullaris is injury where
Sacral and lumbar nerve roots
What do you see with conus medullaris syndrome?
LE motor and sensory loss
Areflexic bowel and bladder
Neuro level of Asia define
Most caudal level that has intact sensation and motor on BOTH sides of the body
Motor level of Asia define
Most caudal level with 3/5 strength AND higher levels with 5/5 on both sides of the body
Sensory level of ASIA define
Most caudal level with intact sensation on both sides of the body
Used only with complete injuries; most caudal segment with some motor or sensory function
Zone of partial preservation
Asia for the trunk
No motor assessment; assume motor and sensory at same level
Complete SCI
Full loss of sensory and motor function below level of injury including sacral and anal
Incomplete SCI
Partial loss of sensory and motor below level of injury with sacral and anal spared
ASIA A
Complete motor and sensory loss below level of lesion
ASIA B
Incomplete- sensory only
ASIA C
More than 50% of KEY muscles below the neuro level have a muscle garden less than 3/5
ASIA D
More than 50% of the KEY muscles below neuro level have muscle grade more or = to 3
ASIA E
Normal
C5 muscles
Elbow flexors
Biceps, brachialis
C6 muscles
Wrist extensors
ECRL and ECRB
C7 muscles
Elbow extensors
Triceps
C8 muscles
Finger flexors
Flexor digitorum profundus
T1 muscles
Small finger abductors
Abductor digiti minimi
L2 muscles
Hip flexors
Iliopsoas
L3 muscles
Knee extensors
Quads
L4 muscles
Ankle DF
Tibialis anterior
L5 muscles
Long toe extensors
Extensor hallucis longus
S1 muscles
Ankle PF
Gastro/soleus
Examples of SCI functional outcome measures
FIM SCIM QIF WISCI Wheelchair skills test FEW
◦ Better able to distinguish paraplegia vs. tetraplegia
◦ Items are valid and responsive
◦ Items represent different aspects of mobility &
locomotor function
FIM
◦ 17 items
◦ Good reliability and validity
◦ Average change pre/post rehab for 114 pts was 5 points (statistically significant)
◦ Scale has some ceiling and floor effects
SCIM - spinal cord independence measure
Specific to cervical SCI, reliable, validity needs more research
QIF - quadriplegia index of function
Valid and most clinically useful
10 meter walk test
◦ 19 point scale that rates walking ability
◦ based on devices used, braces used, assistance required, and distance
◦ Good reliability and construct validity
◦ Most clinically useful with incomplete SCI
WISCI - walking index for SCI
50 skills, good reliability and construct validity
Wheelchair skills test
10 items, assesses ability to function in specific w/c
FEW - functioning everyday in a wheelchair
What are the medical complications of SCI?
Autonomic dysfunction, autonomic dysreflexia, Respiratory complications Skin compromise DVT UTI complications Osteoporosis GI complications HO Pain Spasticity
What is considered a medical emergency
Autonomic dysfunction
What is autonomic dysfunction
Sensory loss, motor paralysis,
Loss of bowel and bladder control
Autonomic dysreflexia happens what levels
T6 and above
What do you see with autonomic dysreflexia?
Increased BO Bradycardia Nasal congestion Pounding headache Anxiety Flushing Profuse sweating
Causes of autonomic dysreflexia
Anything that can be perceived as a noxious stimulation
Treatment for autonomic dysreflexia
Immediately sit them upright and fix the problem
Autonomic dysreflexia and what happens to the vessels
Vasodilation ABOVE level of injury
Vasoconstriction BELOW level of injury (pale, cool no sweating)
Most common cause of autonomic dysreflexia
Kinked catheter
Where is diaphragm innervated
C3-C5
Benefits of the patient sleeping prone
Air-ates different lobes of the lung but also prevents hip contractures that they might get from wheelchair
Best way to prevent DVT
Activity
Medication for HO
Didronel- slows it down
Muscle substitution is used for
Tetraplegia
What is muscle substitution?
Using fixation of distal extremity to achieve movement
Examples of muscle sub
1] shoulder ER with distal end fixed and elbows extended
2] pulling on bedrails or using loops
2 movement strategies
Head/hips relationship
Angular momentum (throwing the extremity)
Muscle substitution
