Chapter 21 Spinal Cord Injury Flashcards
What type of SCI is most common?
Incomplete Tetraplegia.
Name the 4 SCI in order from most common to least common.
Incomplete tetraplegia,
Complete paraplegia,
Incomplete paraplegia,
Complete tetraplegia.
Name, in order from most common, 3 causes of SCI.
MVA, falls, violence, sports.
Describe the course of the the descending corticospinal motor fibers. What is it’s function?
The majority of descending corticospinal motor fibers cross at the medulla to become the lateral corticospinal tract (CST). A small number of CST fibers do not decussate at the medulla and descend via the anterior CST before crossing at the level of the anterior white commissure.
Describe the course of the ascending dorsal white columns. What is it’s function?
The ascending dorsal white columns cross in the medulla, via the medial lemniscus, then go on to the thalamus. These fibers carry joint position, vibration, and light touch (LT) sensation.
Describe the course of the spinothalamic tracts. What is its function?
The spinothalamic tracts, which carry pain, temperature, and nondiscriminative tactile sensations, cross to the contralateral side shortly after entry to the cord in the ventral white commissure of the spinal cord.
In SCI Sensory Classification, describe:
1-# of dermatomes to examine.
2-What 3 sensory tests are done.
3-How is sensory level determined.
Perform a supine sensory examination of the 28 dermatomes at the key sensory points for pin prick (PP) and LT, including rectal sensation.
The sensory level is the most caudal level with intact (grade 2) sensation for both PP and LT.
Name the 2 parts of the Rectal sensory examination.
Rectal sensory examination includes evaluation of deep rectal sensation as determined by the patient’s ability to feel the examiner’s finger during digital rectal examination.
In SCI Motor Classification, describe:
1-# of muscles to examine.
2-What 2 motor tests are done.
3-How is motor level determined.
Perform a supine motor examination of 10 key muscle groups and voluntary anal contraction.
The motor level for each side is the most caudal level with grade ≥3, where all muscles rostral to it are grade 5.
How is the single neurologic level determined?
Determine the single neurologic level, which is the most caudal level at which both sensory and motor modalities are intact bilaterally, as defined earlier.
Describe the difference in classifying complete SCI VS. incomplete SCI.
Classify injury as complete or incomplete.
Complete injuries have no motor or sensory function, including deep anal sensation, preserved in sacral segments S4-5.
When is Somatosensory evoked potentials helpful in SCI classification?
Somatosensory evoked potentials (SSEPs) may be useful in differentiating complete versus incomplete SCI in patients who are uncooperative or unconscious.
Categorize by American Spinal Injury Association (ASIA) Impairment Scale (AIS) A to E.
What is ZPP? When is it applicable?
Determine the zone of partial preservation (ZPP) if ASIA A. ZPP is defined as preserved segments below the neurologic level of injury (NLOI) and used in complete injuries.
What key muscle movement pertains to C5?
Elbow flexion.
What key muscle movement pertains to C6?
Wrist extension.
What key muscle movement pertains to C7?
Elbow extension.
What key muscle movement pertains to C8?
Flexor digitorum profundus of 3rd digit.
What key muscle movement pertains to T1?
Small finger abduction.
What key muscle movement pertains to L2?
Hip flexion.
What key muscle movement pertains to L3?
Knee extension.
What key muscle movement pertains to L4?
Ankle dorsiflexion.
What key muscle movement pertains to L5?
Extensor hallucis longus.
What key muscle movement pertains to S1?
Ankle plantar flexion.
Sensation of what anatomic location pertains to C2?
Occipital protuberance.
Sensation of what anatomic location pertains to C3?
Supraclavicular fossa.
Sensation of what anatomic location pertains to C4?
AC joint (top part).
Sensation of what anatomic location pertains to C5?
Antecubital fossa (lateral part).
Sensation of what anatomic location pertains to C6?
Dorsal Proximal thumb.