Exam 1 Lecture 4: spinal cord Flashcards
MOI of SCI
Traumatic
- –MVA, Falls, GSW (gun shot wounds), war injuries
Non-traumatic
- –Vascular, vertebral subluxations, infections, abscesses, neoplasms, diseases (MS or ALS)
What is the most common age and gender?
•Males 16-30 Y/O
Employment rates 8 years post injury
–37% employment- paraplegic
–30% employment- tetraplegia/quadriplegia
- Precent of discharge from total stay (trauma & rehab)
•D/C from total stay (trauma and rehab)
- –89% home
- –5% nursing home
Average stay in acute hospital
•Acute hospital stay 15 day average
Rehabilitation stay average
•Rehabilitation average stay 44 days
Metical Cost (1st year & subsequent years)
–1st year
- •Quadriplegia
- –$300,000 to $400,000
- •Paraplegia
- –$150,000
–Subsequent years
- •Quadriplegia
- –$30,000 to $75,000
- •Paraplegia
- –$15,000 to $20,000
Numbers are out of date, so we don’t really need to know them
Life expectancy (increased, decreased, same)
decreased (didn’t say how much)
SCI Classifications
•Quad or Tetraplegia- all 4 extremities involved and trunk
- –Partial or complete cervical cord
- •Sensory, autonomic, motor
•Paraplegia- LE’s and possibly trunk involved
- –Partial or complete Thoracic or Lumbar cord or sacral roots
- •Sensory, autonomic, motor
•Named for the level of last intact or partially intact nerve root
- –C7 complete vs incomplete (can they possibly walk? How?)
- –L2 complete vs incomplete (can they walk? How?)
- –Oblique name each side separately
- •C5 on R (incomplete) and C6 on L (complete)
•Sacral Sparing- signs that lesion is incomplete
- –Toe flexion, perianal sensation, sphincter contraction (wink)
Bowel & bladder training
learn to keep track of intake and output so you can go void before it happens on its own
Classification:
•Quad or Tetraplegia
Quad or Tetraplegia- all 4 extremities involved and trunk
- Partial or complete cervical cord
- •Sensory, autonomic, motor
She has never heard of anything called
Classification: Paraplegia
•Paraplegia- LE’s and possibly trunk involved
- –Partial or complete Thoracic or Lumbar cord or sacral roots
- •Sensory, autonomic, motor
How are SCI named?
•Named for the level of last intact or partially intact nerve root
- –C7 complete vs incomplete (can they possibly walk? How?)
- –L2 complete vs incomplete (can they walk? How?)
- –Oblique name each side separately
- •C5 on R (incomplete) and C6 on L (complete)
Sacral Sparing
•Sacral Sparing- signs that lesion is incomplete
- –Toe flexion, perianal sensation, sphincter contraction (wink)
Can you use a manual wheelchair with a quadriplegic?
Yes it might be possible. Quadriplegict just means all four limbs are involved, not neccesarily useless.
what might we use with paraplegic complete with orthostatic hypotension?
Abdominal binder
arm movements
Can a C7 SCI patient walk?
there is new technology where we can imbed electrodes into leg muscles on a walker that are being created. Problem is there is no sensory feedback or correction
It is wireless now
AFO
Ankle Foot Orthosis
KAFO
Knee Ankle Foot Orthosis
KO
Knee Orthosis
Brown Sequard Syndrome
Rare (could be from stabbing or other)
Hemi-ipsilateral and contralateral loss (depending on site of lesion and what has crossed and not crossed)
- –Motor- strength deficit or loss
- –Lateral column damage- areflexia, clonus, +Babinski
- –Dorsal column damage- lack of proprioception, kinesthesia, vibration sense
- –Spinothalamic tract- Contralateral (2-4 segments above is damaged) therefore sensory loss in dermatome distribution opposite side
- •Pain and temperature, sensation
Anterior Cord Syndrome: Everything
•Mechanism of injury
- –Anterior spinal artery damage
- –Cervical flexion injury
•Corticospinal tract- carries what information?
- –Motor loss
•Spinothalamic tract- carries what information?
- –Pain and temperature, sensation
- •contralateral
•DCML involved? NO
- –Posterior spinal artery
Central Cord Syndrome
•Hyperextension injury or narrowing of spinal canal
- –Congenital or stenosis
- –Sulcus arteries
- –Most often in cervical region
Very Rare
Diplegia
Name for when both UE are paralized but not Lower extermities.
Posterior Cord Syndrome
- •Rare
- •Posterior spinal artery
- •Motor intact
- •Pain and light touch intact
- •Dorsal columns involved
- –Proprioception, vibration
Cauda Equina Injruies
- •Can be complete, usually incomplete
- •LMN lesion- significant due to possible regeneration
- •MOI- traumatic fracture or dislocation
Has the potential to regenerate because it is a lower motor neuron
Clinical Manifestations of SCI
•Spinal Shock
- –Post injury areflexia
- –Hours to weeks symptoms resolve (acute care)
•Motor and Sensory Impairments
- –Complete or partial loss below level of injury ie. C7 and below
•Body temperature regulation
- –Hypothalamus can not control blood flow or sweating
- •Diaphoresis (excessive sweating) above level of lesion
•Respiratory dysfunction
- –C1 and C2 possibly C3 lesions- phrenic nerve loss
- •Ventilator
- •Risk for pneumonia, pulmonary embolism, infections, atelectasis
- •Coughing, deep breathing, accessary muscle issues
•Spasticity
- –Hypertonicity, hyperactive stretch reflex and clonus
- •Can help or hurt with function
- •Can be treated with medication
- –Nerve blocks, intrathecal injections
- •Surgeries for spasticity
- –Myotomy- muscle release
- –Neurectomy- cut involved nerve/s (partial or complete)
- –Tenotomy- lengthening of a tendon
Clinical Manifestations (continued)-Bowel and Bladder dysfunction (see another slide for details)
Clinical Manifestations of SCI: Spinal Shock
–Post injury areflexia
–Hours to weeks symptoms resolve (acute care)
First stage
Want it to stop here
Clinical Manifestations of SCI:
•Motor and Sensory Impairments
–Complete or partial loss below level of injury ie. C7 and below
Clinical Manifestations of SCI: Body temperature regulation
- –Hypothalamus can not control blood flow or sweating
- •Diaphoresis (excessive sweating) above level of lesion
Clinical Manifestations of SCI: Respiratory Dysfunction
- –C1 and C2 possibly C3 lesions- phrenic nerve loss (if pt lives)
- •Ventilator
- •Risk for pneumonia, pulmonary embolism, infections, atelectasis
- •Coughing, deep breathing, accessary muscle issues
Clinical Manifestations of SCI: Spacticity
–Hypertonicity, hyperactive stretch reflex and clonus
- •Can help or hurt with function
- •Can be treated with medication
- –Nerve blocks, intrathecal injections
- •Surgeries for spasticity
- –Myotomy- muscle release
- –Neurectomy- cut involved nerve/s (partial or complete)
- –Tenotomy- lengthening of a tendon
Clinical Manifestations of SCI: Bowel Dysfunction
•Bladder- UTI risk due to lack of muscle tone
- –UMN spastic bladder- automatic or reflex voiding- suprapubic stimulus may elicit this
- –LMN flaccid bladder (caudia equina)- Valsalva or manual abdominal pressure to elicit voiding
•Bladder training programs- D/C catheter if possible; if not cath or adult diaper
- –Timed voiding- attempt urination prior to cath, control intake, monitor with bladder scan
Clinical Manifestations of SCI: Bladder Dysfunction
•Bowel
- –UMN spastic bowel- above conus medullaris
- –LMN flaccid bowel- below conus medullaris
- •Bowel training program- suppositories or digital stimulation; control diet, fluids, stool softeners, timing, etc.
- •Sexual function- Patients will ask
Bladder training programs (or what you must use instead)
• D/C catheter if possible; if not cath or adult diaper
- –Timed voiding- attempt urination prior to cath, control intake, monitor with bladder scan
List some Indirect Impairments & Complications (9)
- Presure Sores
- •Autonomic dysreflexia- can kill your patient
- •Postural hypotension (orthostatic hypotension)-
- •Heterotopic ossification-
- Contractures
- DVT
- Pain
- •Osteoporosis and
- Renal Calculi (kidney stone)
Indirect impairments and Complications: Autonomic dysfreflexia
•Autonomic dysreflexia- can kill your patient
- –Increased BP due to vasoconstriction initiated from noxious stimulation (bladder when cath is pinched or elevated, rectal, pressure sores/infection, urinary stones, temperature elevation)
- •Symptoms- increased BP, decreased HR, HA, sweating, spasticity, restless, flushing- due to vasodilation above lesion, vasoconstriction below lesion, pupil constriction, nasal congestion, piloerection, blurred vision, syncope.
- •Intervention- Check cath, sit up if lying down (raise the head), loosen clothing and abdominal binders, get help!
- MAKE SURE YOU NEVER EVER PUT CATHETER BAG ABOVE BLADDER
Indirect impairments and complications: Pressure sores
•Pressure sores- pressure or shearing forces combined with bowel and bladder dysfunction, decreased sensation, etc.
- –Location- bony prominences
- –Best treatment is prevention- turning schedules, pressure relief, skin care
Indirect impairments and complications: Postural Hypotension
•Postural hypotension (orthostatic hypotension)- decrease in BP supine to sit or sit to stand
- –Tilt table progression, compression hose, abdominal binder, gradual progression
Indirect impairments and complications: Heterotopic ossification
•Heterotopic ossification- growth of bone outside the skeleton ie. muscles, tendons, connective tissue
Indirect impairments and complications: Contractures
•Contractures- change in muscle length, change in capsular and pericapsular structures
Indirect impairments and complications: DVT
•DVT- can cause death if thrown- pulmonary embolus
- –Loss of muscle pump, stasis of blood, increase in thrombin
- •Symptoms- swelling, erythema, heat
- •Intervention- Drugs, hose, turning program, ROM, elevation of LE’s
Indirect impairments and complications: Pain
–Traumatic pain- injury ie. MVA, fall, etc.
–Nerve root pain- radiating, burning, etc.
–Spinal cord Dysesthesias- Deep pain from areas that lack sensation
–Musculoskeletal pain ie. shoulder, elbow, or wrist pain from assistive device with walking or W/C propulsion, transfers, etc.
Indirect impairments and complications: Osteoporosis & REnal Calculi (kidney stone)
•Osteoporosis and Renal Calculi (kidney stone)
- –Calcium metabolism issues- break down bone, increased calcium in blood, deposits in kidney
(these are related)
Multi podus boot
TLSO
TLSO = Thoracic Lumbar Sacral Orthosis
Philadelphia Collar
A hard cervical collar
