class 5: SCI Flashcards
Asia A
no sensory or motor function is persevered in the sacral segment sS4-S5
Asia B
sensonry icomoplete
sensory function is preserved below the neurological level (light touch and or pin prick) but no motor function > than 3 levels belwo the motor levels
Asia C
motor incomplete
motor function is persevred
more the 1/2 of muscle below the neurological level have muscle grade of less then 3
Asia D
motor incomplete
motor function is persevred
more the 1/2 of muscle below the neurological level have muscle grade of > or equal then 3
Asia E
normal
seen if every is normal
or if the pt is tested again and they are normal
how do we get to neurological level - sensory
sensory level is the lowest level at which pen prick and light touch is normal (2)
with all sensory grades 2/2 above
how do we get to neurological level - motor
the lowest level where the muscle grade is a t least a 3
with all muscle grade above it a 5
what is the neurological level
the lowest level where motor and sensory are normal on both sides
- Find Motor and Sensory level
- Pick the higher one
C5 innervation
diaphragm
trasp
biceps
rhomiods
partial -serratus, RC
C6 innervation
lats and RC
ECRL/B
what level do we see impaired diaphragm function
c4
C7 innervation
triceps
C8 innervation
finger flexors
pronators
wrist flexors
thumb abd and ext
T1 innervation
pect major and minor
rest of finger hand muscluature
throacic innervation
fully intact UE
Vertebral Level
talking about the vert
Spinal Level
talking about the spinal cord
Ascending tracts
DCML, ALS
descending
Corticospinal tracts
what is the function of the DCML
JPS
pressure touch
vibration
what is the function of the ALS tract
pain and temp
- Anterior STT: Crude touch
- Lateral STT: Pain and temperature
what is the function of Corticospinal tracts
- To control the voluntary movement of contralateral limbs
is a nerve root lesion a LMN or UMN
LMN
what level does the spinal cord end at
L1-L2
what tract is effected with Posterior Cord Syndrome
DCML
what does the SC become after L1-2
codus medularris and cauda equina
if you have a lesion at the codus medularris is it UMN or LMN
LMN
if you have a lesion at the cauda equina is it UMN or LMN
UMN + LMN
what is effected with Posterior Cord Syndrome
JPS
pressure touch
vibration
what causes posterior cord syndrome
Iatrogenic -
relating to illness caused by medical examination or treatment.
“drugs may cause side effects which can lead to iatrogenic disease”
what tracts is effected in anterior cord syndrome
STT and Corticospinal
what are the sym of anterior cord syndrome
hyperesthesia and hypoalgesia below the level of the lesion
what is hypoalgesia
condition that causes a decreased sensitivity to pain, or a diminished response to a stimulus that is normally painful
what is hyperesthesia
neurological condition that causes increased sensitivity to stimuli, such as touch, sound, light, taste, smell, and temperature.
what causes anteiror cord syndrome
hyperflexion unjury
what is central cord syndrome
in the cervical region
more weakness in the UE compared to the LE
spare sensation and motor in the sacral region
what part of the spinal cord is effected in Brown Sequard Syndrome
hemi section of the spinal cord
what do we see with Brown Sequard Syndrome
more sever motor loss and priopercietion on the side ispierlateral of the lesion
or loss of pain and temp of the contralateral side
Ipsilateral Symptoms - brown
DCML sensory function
loss below injury level
Conus Medullaris location
Bilateral and symmetrical in
perineum and thighs
Cauda Equina location
Unilateral and asymmetrical in
perineum, thighs, leg, back
Sensory - Conus Medullaris
Saddle distribution
Bilateral, symmetric
Sensory - Cauda Equina
Saddle distribution
unilateral, asymmetric
Complete SCI injury
No sensory or motor function in the lowest sacral segments
(S4 and S5)
what is Incomplete SCI injury
Motor and/or sensory function below the neurological level
including sensory and/or motor function at S4 and S5
what are some examples of incompleteed SCI injuries
- Anterior cord syndrome
- Posterior cord syndrome
- Brown Sequard syndrome
- Central cord syndrome
2 point descrimnation test
filiments
C5 - Muscular
elb flexors
C6 - Muscular
wrist flexors
C7 - Muscular
triceps
elb extensors
T1 - musc
5th finger abd
L2 - musc
hip flexors
L3 - musc
knee ext
L4 - musc
ankle dorsiflexors
L5 - musc
big toe extnesor
S1 - musc
ankle PF
Cardiac: SCI
Orthostatic Hypotension, Autonomic dysreflexia
Pulmonary: SCI
Respiratory Dysfunction
GI: SCI
Urinary and bowel retention +/- incontinence
Integumentary: SCI
Pressure Ulcers
MSK : SCI
Contracture, weakness, tone
Autonomic Dysreflexia/Hyperreflexia is seen at what level and above
At or above T6
Autonomic Dysreflexia/Hyperreflexia what causes this
Noxious stimuli below level of lesion
what are the symptoms seen with Autonomic Dysreflexia
HBP
bradycardia
sweating above the level of the lesion
flushing and blotching of the skin
goose bumps
blurred vision
what are the most common cuase of brown sequard
gun shot or stab wound
what are causes of Autonomic Dysreflexia
- Ingrown toenail, kink/clogged in the catheter, bladder, UTI, pressure injury
what do we do if some has Autonomic Dysreflexia
SIT UP and LOWER LEGS
Remove painful stimuli
Monitor vitals throughout:
what is the most common cuase of central cord lesion
neck hyperext - whip lash
if you have small central cord lesion what is the only thing that is effects
bilateral pain and temp
if you have large central cord lesion what is the only thing that is effects
every thing
UE > LE
what level do we do spinal taps
L3-L4
