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
