Ch 7 - SCI: SCI Classification Flashcards
Describe Tetraplegia.
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
Describe Paraplegia.
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
What is a dermatome?
Area of skin innervated by the sensory axons within each segmental nerve (root)
What is a myotome?
Collection of muscle fibers innervated by the motor axons within each segmental nerve (root)
Describe the innervation of an UMN injury.
Begins in the prefrontal motor cortex, travels through the internal capsule and brainstem, and projects into the spinal cord
Describe clinical findings of an UMN injury.
Hyperreflexia
Pathologic reflexes
Detrusor sphincter dyssynergia (depending on level of lesions)
Describe the innervation of an LMN injury.
Begins with the anterior horn cells of the spinal cord and includes the peripheral nerves
Describe clinical findings of an LMN injury.
Hyporeflexia
Flaccid weakness
Significant muscle atrophy
Areflexic/hypotonic bladder
How many dermatomes are tested during an ASIA exam?
28 key dermatomes
Describe the 3-point scale is used to score light touch sensation.
0: Absent sensation
1: Impaired—light touch is felt but less than on the face
2: Normal—same as on the face
Describe the 3-point scale is used to score pinprick sensation.
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
What levels distinguish b/w neurologic complete and incomplete injury?
S4–S5 dermatome for light touch and pinprick sensation
How is the sensory level of injury determined?
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
How is the motor level of injury determined?
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.
How is the neurologic level of injury determined?
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
How is the neurologic level of injury determined if there is no corresponding testable motor function?
NLI is that which corresponds to the sensory level, if testable motor function above that level is also normal
What is the zone of partial preservation (ZPP)?
Used with neurological complete lesions and refers to the dermatomes and myotomes caudal to the NLI that remain partially innervated
Describe an ASIA A SCI.
Complete
No motor or sensory function is preserved in the S4–S5 segments
Describe an ASIA B SCI.
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.
Describe an ASIA C SCI.
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)
Describe an ASIA D SCI.
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.
Describe an ASIA E SCI.
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
What is spinal shock?
Temporary loss or depression of all spinal reflex activity below the level of the lesion
Describe a delayed plantar response.
Stroking the sole of the foot with deep pressure and delayed toes flex and then relax slowly
What is a persistent delayed plantar response associated with?
High correlation with complete injuries with poor prognosis for lower extremity (LE) recovery.
Describe a Bulbocavernosus reflex.
Squeezing the tip of the penis, the clitoris or tugging on a Foley catheter and noting stimulation of anal sphincter contraction
What does a Bulbocavernosus reflex or Perianal sphincter reflex indicate?
UMN injury and that reflex innervation of bowel and bladder is intact
What does an absent Bulbocavernosus reflex or Perianal sphincter reflex indicate after 24 hours from injury?
LMN injury may be suspected
Describe a Perianal sphincter reflex (anal wink).
Perianal stimulation causes contraction of the anal sphincter
What is the typical duration of spinal shock?
24 hours
What is the typical order of reflex return after spinal shock?
Delayed plantar response
Bulbocavernosus reflex and anal wink
Muscle stretch reflexes return after 2 to 3 weeks
What is the MC incomplete SCI syndrome?
Central cord syndrome
Describe Central cord syndrome.
Sacral sensory sparing
Motor weakness in the upper>lower limbs
Variable loss of sensation, bowel, and bladder function
What is the MC population of Central cord syndrome?
Older patients with cervical spondylosis who sustain a hyperextension injury, usually from a fall.
Describe the order of recovery of Central cord syndrome.
LEs recover first and to a greater extent
Bladder function
Proximal UE
Intrinsic hand function
What age indicates a positive prognostic indicator for recovery in central cord syndrome?
<50 yo
What causes Brown-Séquard Syndrome?
Hemisection of the spinal cord classically with stabbing
Describe the presentation of Brown-Séquard Syndrome.
Ipsilateral motor, sensory and proprioceptive loss, and contralateral loss of pain and temperature
What causes an anterior Cord Syndrome?
A lesion affecting the anterior 2/3 of the spinal cord while preserving the posterior columns
Describe the presentation of anterior Cord Syndrome.
Loss of motor function, sensitivity to pain/temp, and pinprick sensation, with preservation of proprioception and light touch and deep pressure sensation
Describe Posterior cord syndrome.
Injury to the posterior columns results in proprioceptive loss with muscle strength, pain, and temperature modalities spared
What is the level of injury of Conus Medullaris syndrome?
T12–L1–L2 vertebral level injury of sacral cord and lumbosacral nerve roots
What are cause of Conus Medullaris syndrome?
- T12–L1 fracture
- Tumors, gliomas
- Vascular injury
- Spina bifida, tethering of the cord
What is the clinical presentation of Conus Medullaris syndrome?
- Normal motor function of LEs unless S1–S2 motor involvement. LMN lesion with lumbar root.
- Saddle anesthesia
- Pain is not a significant factor
- Symmetric ABN
- Bowel, bladder, and sexual dysfunction may occur.
- If a high conus lesion, bulbocavernosus reflex may be present
- May be hyperreflexic.
What is seen on EMG in Conus Medullaris syndrome?
Normal EMG (except for external sphincter or S1, S2 involvement)
What is the level of injury of Cauda equina syndrome?
Below L1–L2 to sacrum vertebral level injury of lumbosacral nerve roots
What are cause of Cauda equina syndrome?
- Fracture at L1–L2 or below
- Sacral fractures
- Fracture of pelvic ring
- Can be associated with spondylosis
What is the clinical presentation of Cauda equina syndrome?
- LMN lesion, Flaccid paralysis and areflexia of involved lumbosacral nerve roots
- Sensory loss in root distribution
- Pain is a more significant feature
- ABN asymmetric
- High cauda equina lesions (lumbar roots) spare bowel and bladder.
Lower lesions (S3–S5) causes areflexic bowel, bladder, and sexual dysfunction. - Bulbocavernosus reflex is absent (in low cauda equina [sacral] lesions)
- Hyporeflexia or areflexia in affected muscle groups
What is seen on EMG in Cauda equina syndrome?
Findings show multiple root level involvement Prognosis: Good
Describe Functional potential outcomes of ADL’s for C1-C4 SCI.
Feeding: Dependent Grooming: Dependent UBD: Dependent LBD: Dependent Bathing: Dependent B/B: Dependent
Describe Functional potential outcomes of transfers for C1-C4 SCI.
Bed mobility: Dep
Weight shifts: Indep in power WC, Dep in manual WC
Transfers: Dep
Describe Functional potential outcomes of mobility for C1-C4 SCI.
WC: Indep in power WC, Dep in manual WC
Driving: unable
Describe Functional potential outcomes of ADL’s for C5 SCI.
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
Describe Functional potential outcomes of transfers for C5 SCI.
Bed mobility: max-mod A
Weight shifts: assist unless power WC
Transfers: max-mod A
Describe Functional potential outcomes of mobility for C5 SCI.
WC: Indep in power; Mod-I in manual w/ adaptations on level surfaces
Driving: Mod-I w/ adaptations
Describe Functional potential outcomes of ADL’s for C6 SCI.
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
Describe Functional potential outcomes of transfers for C6 SCI.
Bed mobility: CG
Weight shifts: indep
Transfers: CG on level surfaces
Describe Functional potential outcomes of mobility for C6 SCI.
WC: Indep w/ manual WC w/ coated rims on level surfaces
Driving: mod I w/ adaptations
Describe Functional potential outcomes of ADL’s for C7 SCI.
Feeding: Indep Grooming: mod I w/ adaptations UBD: Indep LBD: Mod I to CG Bathing: CG to mod I B/B: Indep
Describe Functional potential outcomes of transfers for C7 SCI.
Bed mobility: Mod I
Weight shifts: Indep
Transfers: Indep w/ or w/o board for level surfaces
Describe Functional potential outcomes of mobility for C7 SCI.
WC: Independent except for curbs and uneven terrain
Driving: Car with hand controls or adapted van
Describe Functional potential outcomes of ADL’s for C8-T1 SCI.
Feeding: Indep Grooming: Indep UBD: Indep LBD: usually Indep Bathing: mod I B/B: Indep
Describe Functional potential outcomes of transfers for C8-T1 SCI.
Bed mobility: Indep
Weight shifts: Indep
Transfers: Indep
Describe Functional potential outcomes of mobility for C8-T1 SCI.
WC: Indep
Driving: Car w/ hand control or adapted van
Describe ambulation potential for T2-T9 SCI.
Standing in frame
Tilt table
Standing wheelchair
Exercise only
Describe ambulation potential for T10-L2 SCI.
Household ambulation with orthoses
Can trial ambulation outdoors
Describe ambulation potential for L3-L5 SCI.
Community ambulation is possible
Describe braces for T2-T9 SCI.
Bilateral KAFO forearm crutches or walker
Describe braces for T10-L2 SCI.
KAFOs forearm crutches or walker
Describe braces for L3-L5 SCI.
Possibly KAFO or AFOs, with canes/crutches
What is the highest complete SCI that can live independently w/o aid of an attendant?
C6 in an extremely motivated patient
What is the usual level of SCI for achieving independence?
C7 SCI
