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Cuccurullo Book > Ch 7 - SCI: SCI Classification > Flashcards

Ch 7 - SCI: SCI Classification Flashcards

1
Q

Describe Tetraplegia.

A

Impairment or loss of motor and/or sensory function in the cervical segments of SC l/t impairment of function in arms, trunk, legs, and pelvic organs

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2
Q

Describe Paraplegia.

A

Impairment or loss of motor and/or sensory function in thoracic, lumbar, or sacral segments of SC l/t Trunk, legs, and pelvic organs involved

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3
Q

What is a dermatome?

A

Area of skin innervated by the sensory axons within each segmental nerve (root)

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4
Q

What is a myotome?

A

Collection of muscle fibers innervated by the motor axons within each segmental nerve (root)

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5
Q

Describe the innervation of an UMN injury.

A

Begins in the prefrontal motor cortex, travels through the internal capsule and brainstem, and projects into the spinal cord

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6
Q

Describe clinical findings of an UMN injury.

A

Hyperreflexia
Pathologic reflexes
Detrusor sphincter dyssynergia (depending on level of lesions)

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7
Q

Describe the innervation of an LMN injury.

A

Begins with the anterior horn cells of the spinal cord and includes the peripheral nerves

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8
Q

Describe clinical findings of an LMN injury.

A

Hyporeflexia
Flaccid weakness
Significant muscle atrophy
Areflexic/hypotonic bladder

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9
Q

How many dermatomes are tested during an ASIA exam?

A

28 key dermatomes

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10
Q

Describe the 3-point scale is used to score light touch sensation.

A

0: Absent sensation
1: Impaired—light touch is felt but less than on the face
2: Normal—same as on the face

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11
Q

Describe the 3-point scale is used to score pinprick sensation.

A

0: No sensation at all or unable to differentiate between the sharp and dull edge
1: The pin is not felt as sharp as on the face, but able to differentiate sharp from dull
2: Pin is felt as sharp as on the face

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12
Q

What levels distinguish b/w neurologic complete and incomplete injury?

A

S4–S5 dermatome for light touch and pinprick sensation

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13
Q

How is the sensory level of injury determined?

A

Most caudal segment of the spinal cord with normal (2/2 score) sensory function on both sides of the body for both pinprick and light touch sensation

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14
Q

How is the motor level of injury determined?

A

Most caudal key muscle group that is graded ≥3/5 with all the segments above graded 5/5 in strength. Motor level can be determined for each side of the body.

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15
Q

How is the neurologic level of injury determined?

A

Most caudal segment of the spinal cord with both normal sensory and motor function ≥ 3/5 with cephalad segments graded 5/5 on both sides of the body

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16
Q

How is the neurologic level of injury determined if there is no corresponding testable motor function?

A

NLI is that which corresponds to the sensory level, if testable motor function above that level is also normal

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17
Q

What is the zone of partial preservation (ZPP)?

A

Used with neurological complete lesions and refers to the dermatomes and myotomes caudal to the NLI that remain partially innervated

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18
Q

Describe an ASIA A SCI.

A

Complete

No motor or sensory function is preserved in the S4–S5 segments

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19
Q

Describe an ASIA B SCI.

A

Incomplete
Sensory but not motor function is preserved below the neurological level and includes intact S4–S5 segments and no motor function is preserved more than 3 levels below the motor level on either side of the body.

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20
Q

Describe an ASIA C SCI.

A

Incomplete
Motor function is preserved below the neurological level and more than half of the key muscles below the neurological level have a muscle grade <3 (grades 0–2)

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21
Q

Describe an ASIA D SCI.

A

Incomplete
Motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade >3.

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22
Q

Describe an ASIA E SCI.

A

If sensation and motor function as tested with the ISNCSCI are graded as normal in all segments, and the patient had prior deficits, then the AIS grade is E

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23
Q

What is spinal shock?

A

Temporary loss or depression of all spinal reflex activity below the level of the lesion

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24
Q

Describe a delayed plantar response.

A

Stroking the sole of the foot with deep pressure and delayed toes flex and then relax slowly

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25
Q

What is a persistent delayed plantar response associated with?

A

High correlation with complete injuries with poor prognosis for lower extremity (LE) recovery.

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26
Q

Describe a Bulbocavernosus reflex.

A

Squeezing the tip of the penis, the clitoris or tugging on a Foley catheter and noting stimulation of anal sphincter contraction

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27
Q

What does a Bulbocavernosus reflex or Perianal sphincter reflex indicate?

A

UMN injury and that reflex innervation of bowel and bladder is intact

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28
Q

What does an absent Bulbocavernosus reflex or Perianal sphincter reflex indicate after 24 hours from injury?

A

LMN injury may be suspected

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29
Q

Describe a Perianal sphincter reflex (anal wink).

A

Perianal stimulation causes contraction of the anal sphincter

30
Q

What is the typical duration of spinal shock?

A

24 hours

31
Q

What is the typical order of reflex return after spinal shock?

A

Delayed plantar response
Bulbocavernosus reflex and anal wink
Muscle stretch reflexes return after 2 to 3 weeks

32
Q

What is the MC incomplete SCI syndrome?

A

Central cord syndrome

33
Q

Describe Central cord syndrome.

A

Sacral sensory sparing
Motor weakness in the upper>lower limbs
Variable loss of sensation, bowel, and bladder function

34
Q

What is the MC population of Central cord syndrome?

A

Older patients with cervical spondylosis who sustain a hyperextension injury, usually from a fall.

35
Q

Describe the order of recovery of Central cord syndrome.

A

LEs recover first and to a greater extent
Bladder function
Proximal UE
Intrinsic hand function

36
Q

What age indicates a positive prognostic indicator for recovery in central cord syndrome?

A

<50 yo

37
Q

What causes Brown-Séquard Syndrome?

A

Hemisection of the spinal cord classically with stabbing

38
Q

Describe the presentation of Brown-Séquard Syndrome.

A

Ipsilateral motor, sensory and proprioceptive loss, and contralateral loss of pain and temperature

39
Q

What causes an anterior Cord Syndrome?

A

A lesion affecting the anterior 2/3 of the spinal cord while preserving the posterior columns

40
Q

Describe the presentation of anterior Cord Syndrome.

A

Loss of motor function, sensitivity to pain/temp, and pinprick sensation, with preservation of proprioception and light touch and deep pressure sensation

41
Q

Describe Posterior cord syndrome.

A

Injury to the posterior columns results in proprioceptive loss with muscle strength, pain, and temperature modalities spared

42
Q

What is the level of injury of Conus Medullaris syndrome?

A

T12–L1–L2 vertebral level injury of sacral cord and lumbosacral nerve roots

43
Q

What are cause of Conus Medullaris syndrome?

A
  • T12–L1 fracture
  • Tumors, gliomas
  • Vascular injury
  • Spina bifida, tethering of the cord
44
Q

What is the clinical presentation of Conus Medullaris syndrome?

A
  1. Normal motor function of LEs unless S1–S2 motor involvement. LMN lesion with lumbar root.
  2. Saddle anesthesia
  3. Pain is not a significant factor
  4. Symmetric ABN
  5. Bowel, bladder, and sexual dysfunction may occur.
  6. If a high conus lesion, bulbocavernosus reflex may be present
  7. May be hyperreflexic.
45
Q

What is seen on EMG in Conus Medullaris syndrome?

A

Normal EMG (except for external sphincter or S1, S2 involvement)

46
Q

What is the level of injury of Cauda equina syndrome?

A

Below L1–L2 to sacrum vertebral level injury of lumbosacral nerve roots

47
Q

What are cause of Cauda equina syndrome?

A
  • Fracture at L1–L2 or below
  • Sacral fractures
  • Fracture of pelvic ring
  • Can be associated with spondylosis
48
Q

What is the clinical presentation of Cauda equina syndrome?

A
  1. LMN lesion, Flaccid paralysis and areflexia of involved lumbosacral nerve roots
  2. Sensory loss in root distribution
  3. Pain is a more significant feature
  4. ABN asymmetric
  5. High cauda equina lesions (lumbar roots) spare bowel and bladder.
    Lower lesions (S3–S5) causes areflexic bowel, bladder, and sexual dysfunction.
  6. Bulbocavernosus reflex is absent (in low cauda equina [sacral] lesions)
  7. Hyporeflexia or areflexia in affected muscle groups
49
Q

What is seen on EMG in Cauda equina syndrome?

A

Findings show multiple root level involvement Prognosis: Good

50
Q

Describe Functional potential outcomes of ADL’s for C1-C4 SCI.

A 
Feeding: Dependent
Grooming: Dependent
UBD: Dependent
LBD: Dependent
Bathing: Dependent
B/B: Dependent
51
Q

Describe Functional potential outcomes of transfers for C1-C4 SCI.

A

Bed mobility: Dep
Weight shifts: Indep in power WC, Dep in manual WC
Transfers: Dep

52
Q

Describe Functional potential outcomes of mobility for C1-C4 SCI.

A

WC: Indep in power WC, Dep in manual WC
Driving: unable

53
Q

Describe Functional potential outcomes of ADL’s for C5 SCI.

A 
Feeding: mod I w/ equip and set up
Grooming: min A w/ equip and set up
UBD: assistance
LBD: Dep
Bathing: max-mod A
B/B: Dep
54
Q

Describe Functional potential outcomes of transfers for C5 SCI.

A

Bed mobility: max-mod A
Weight shifts: assist unless power WC
Transfers: max-mod A

55
Q

Describe Functional potential outcomes of mobility for C5 SCI.

A

WC: Indep in power; Mod-I in manual w/ adaptations on level surfaces
Driving: Mod-I w/ adaptations

56
Q

Describe Functional potential outcomes of ADL’s for C6 SCI.

A 
Feeding: Mod-I w/ equip
Grooming: CG to Mod-I w/ equip
UBD: Mod-I 
LBD: some assisatnce
Bathing: Min A w/ equip
B/B: Mod-I w/ equip
57
Q

Describe Functional potential outcomes of transfers for C6 SCI.

A

Bed mobility: CG
Weight shifts: indep
Transfers: CG on level surfaces

58
Q

Describe Functional potential outcomes of mobility for C6 SCI.

A

WC: Indep w/ manual WC w/ coated rims on level surfaces
Driving: mod I w/ adaptations

59
Q

Describe Functional potential outcomes of ADL’s for C7 SCI.

A 
Feeding: Indep
Grooming: mod I w/ adaptations
UBD: Indep
LBD: Mod I to CG
Bathing: CG to mod I
B/B: Indep
60
Q

Describe Functional potential outcomes of transfers for C7 SCI.

A

Bed mobility: Mod I
Weight shifts: Indep
Transfers: Indep w/ or w/o board for level surfaces

61
Q

Describe Functional potential outcomes of mobility for C7 SCI.

A

WC: Independent except for curbs and uneven terrain
Driving: Car with hand controls or adapted van

62
Q

Describe Functional potential outcomes of ADL’s for C8-T1 SCI.

A 
Feeding: Indep
Grooming: Indep
UBD: Indep
LBD: usually Indep
Bathing: mod I
B/B: Indep
63
Q

Describe Functional potential outcomes of transfers for C8-T1 SCI.

A

Bed mobility: Indep
Weight shifts: Indep
Transfers: Indep

64
Q

Describe Functional potential outcomes of mobility for C8-T1 SCI.

A

WC: Indep
Driving: Car w/ hand control or adapted van

65
Q

Describe ambulation potential for T2-T9 SCI.

A

Standing in frame
Tilt table
Standing wheelchair
Exercise only

66
Q

Describe ambulation potential for T10-L2 SCI.

A

Household ambulation with orthoses

Can trial ambulation outdoors

67
Q

Describe ambulation potential for L3-L5 SCI.

A

Community ambulation is possible

68
Q

Describe braces for T2-T9 SCI.

A

Bilateral KAFO forearm crutches or walker

69
Q

Describe braces for T10-L2 SCI.

A

KAFOs forearm crutches or walker

70
Q

Describe braces for L3-L5 SCI.

A

Possibly KAFO or AFOs, with canes/crutches

71
Q

What is the highest complete SCI that can live independently w/o aid of an attendant?

A

C6 in an extremely motivated patient

72
Q

What is the usual level of SCI for achieving independence?

A

C7 SCI

Cuccurullo Book (91 decks)

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