Intro to SCI Flashcards
What is SCI?
Gamage to the spinal cord resulting in symptoms below the level of injury
How many cases annually of SCI happen in the USA?
-18,000 new cases annually in the USA
What is the most common age does SCI happen?
Between ages 16-30 with most being 19
What is the percentage of men and women that get SCI?
Men: 80%
Women: 20
What is the mechanism of injury with traumantic SCI? (in order)
- MVA: 38%
- Falls 32%
- Violence: 14%
- Sport related injuries: 9%
What is the mechanism of injury for non traumatic SCI?
-Arterial venous malformation
-Thrombus, embolus, or hemorrhage to arterial supply of the spinal cord
-Infection of the cord (common in setting og IV drug abuse)
-MS with lesions to spinal cord
-ALS
-Spinal stenosis
What is the life expectancy of incomplete SCI?
INcomplete is longer than complete
What is the life expectancy of paraplegia SCI?
Paraplegia is longer than tetraplegia
What is the life expectancy of lower cervical tetraplegia SCI?
Lower cervical tetraplegia longer than higher cervical tetraplegia
When is mortalitiy rate the highest?
Highest in the first year after injury
When does spinal shock occur?
Happens immediately after SCI
How long does areflexia happen agfter a SCI?
Around 24 hours
When doe reflexes gradually return after SCI?
Over 1 to 3 days
When would you perform the ASIA exam after SCI?
Between 1 to 3 days when reflexes gradually return?
How long can a patient have after SCI?
About 1 to 4 weeks
How are SCI named?
Spinal level of injury
Anatomical location of injury in cord
Completeness of injury
What are the AISA and ISNCSCI used for?
Looks at motor and sensory levels bilateral as well as sacral tone and sensation to determine:
1. Motor level of injury
2. Sensory level of injury
3. Neurological level of injury
4. Complete or incomplete
5. Zone of partial preservation
What is ASIA level A?
Complete
No motor or sensory function is preserved below the neurological level and includes
What is ASIA level B?
Incomplete
Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4 to S5
What is ASIA level C?
Incomplete
Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3
What is AISA level D?
Incomplete
Motor function is preserved below the neurological level of injury, and more than half of key muscles below the neurological level have a muscle grade of 3 or more
What is ASIA level E?
Normal
Motor and sensory function is normal
How is motor level of injury determined?
Determined by testing 10 key muscles on the right and left side of the body
(the lowest myotome that has a grade of at least a three if the one above it is a 5
How is the sensory level of injury determined?
Determined nu light touch and pin prick on both right and left side of the body
(the most caudal level with normal light touch and pinprick sensation)
What is the neurological level of injury?
The most caudal level of the spinal cord with normal motor and sensory function both the right and left side of the body
What is zone of patrial preservation?
Used to apply only to complete injuries (ASIA A) and defined as:
Dermatomes and myotomes caudal to the sensory or motor level that remain partially innervated
What are the different types of spinal cord syndromes?
Anterior cord
Central cord
Brown sequard
Posterior cord
Conus medullaris syndrome
Cauda equina syndrome
What is brown sequard syndrome?
Occurs from hemisection of the spinal cord (damage to one side) and is typically a penetration wound (gunshot or stab)
What happens on the ipsilateral and contralateral side of the body during brown sequard syndrome?
Ipsilateral: Loss of proprioception, light touch, and vibratory sense
Contralateral: Loss of sense of pain and temperature
What tract is involved with the ipsilateral side of the body with brown sequard syndrome?
DCML and Lateral corticospinal tract
What tract is involved with the contralateral side of the body with brown sequard syndrome?
Spinothalamic tract
What is the cause of anterior cord syndrome?
Frequently related to flexion injuries of the cervical region with resultant damage to the anterior portion of the cord or vascular supply from the anterior spinal artery
What type of functions do you lose during the anterior cord syndrome?
Loss of motor function and loss of sense of pain and temperature below the level of lesion
What tracts are injured during anterior cord syndrome?
Bilateral loss of Corticospinal tract and Spinothalamic tract
What is the most common cause of central cord syndrome?
Occurs from hyperextension injuries to the cervical region
Also associated with congenital, degenerative narrowing of the spinal canal
What are the symptoms of central cord syndrome?
UE’s more affected than LE’s, varying degrees of sensory impairment, sacral sparing
What are the symptoms of posterior cord syndrome?
Bilateral loss of DCML
What are the symptoms of conus medullaris?
Mixed LMN and UMN
What are the symptoms of cauda equina syndrome?
LMN, flaccid paresis, saddle anesthesia
Where are UMN injuries present?
Above the conus medullaris
Where are LMN injuries present?
Below the conus medullaris
What are the signs and symptoms present of LMN injuries?
Generally below T12
Hyporeflexia
Flaccidity
Decreased tone/spasticity
Negative UMN signs
Flaccid bladder and bowel
Psychogenic responses for sexual function
What are the signs and symptoms present of UMN injuries?
Generally above T12
Hyperreflexia
Increased tone/spasticity
Positive UMN Signs (Babinski and Hoffmans)
Spastic or hyperreflexive bladder and bowel
Refleogenic arcs for sexual function
What are the general considerations for acute care settings?
ICU
Floor
1 to 3 weeks
Getting upright tolerance
Basic mobility
What are the general considerations for acute rehab settings?
4 to 12 weeks
Learning ADL’s
Mobility
Wheelchair training
Bracing
What are the general considerations for LTACH settings?
Usually patients with higher level SCI on vents
Or after flap surgery
What are the general considerations for out-patient settings?
Community integration
MSK injury prevention
Sports
What are secondary complications for cardiovascular/pulmonary function?
Pneumonia (PNA)
Aspiration
Diaphragmatic/respiratory muscle impairment
PE/DVT
BP management (Orthostatic hypotension in T6 and above injuries
What are secondary complications to autonomic functions?
Autonmic dysreflexia - can be fatal (T6 ad above)
BP management
Sweating response
Loss of descending control of ascending sympathetic reflexes
Lack of inhibition from higher centers
What are symtoms of autonomic dysreflexia?
HTN (raise of 20-30 mmHg systolic)
Bradycardia
Headache (severe and pounding)
Profuse sweating
Increases spasticity
Vasodilation above level of injury (leading to flushing)
Constricted pupils
Nasal congestion
Piloerection
Blurred vision
Dry, pale skin due to vasoconstriction (below level of injury)
What are the secondary neurological complications?
Tone/spasticity changes (depends on LMN vs UMN
Neuropathic pain
Sensory loss
What are secondary musculoskeletal complication?
Motor loss
Osteoporosis
Secondary overuse injuries
Heterotrophic ossification
Osteomyelitis (in setting of pressure injuries)
What are secondary psychological complications?
Adjustment to trauma and/or loss
Higher depression rates
Higher psychiatric illness diagnoses post injury
Higher care utilization for psychiatric diagnosis
What are the secondary GI/GU complications?
UTI (leading type of infection following SCI
Reflexive bladder/bowel
Flaccid bladder/bowel
What are secondary integumentary complications?
High risk for pressure injuries due to:
-Decreased sensation
-Decreased mobility
-Decreased blood flow
-Increased potential for incontinence
What is stage 1 for secondary integumentary complications?
Intact skin, non-blancheable
What is stage 2 for secondary integumentary complications?
Partial thickness, looks like blister or scrape
What is stage 3 for secondary integumentary complications?
Full thickness, into subcutaneous fat layer
What is stage 4 for secondary integumentary complications?
Full thickness involving muscle or bone
What are deep pressure injuries?
It is persistent, non-blanchable discoloration with dark wound bed due to prolonged pressure or shear
May evolve rapidly to a stage 3 or 4 level
What is the PT management for acute care?
-Early mobility once medically stable
-Focus exam on sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations
What are the (PT management) interventions for acute care?
PROM/contracture prevention
Skin prevention
BP management with change in position
Respiratory function
Education
Upright positioning
Basic mobility
What is the PT management for acute rehab?
ROM, strength, outcome measure, functional mobility level
What are the (PT management) interventions for acute rehab?
Aerobic capacity
Skin integrity/management
ADL’s/functional mobility
Pain/spasticity management
Education
Strengthening
DME, w/c, and bracing needs
What is PT management for LTACH?
Mobility as able
Focus exam on sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations
What are the (PT management) interventions for LTACH?
PROM/contracture prevention
Skin prevention or treatment
BP management with change in position
Respiratory function
Education
Upright positioning
Basic mobility
What is PT management for out patient?
MSK, neuro, CV, Pulm, integumentary integrity
Knowledge of SCI and level of independence
What are the (PT management) interventions for outpatient?
Community reintegration/navigation
Goal-directed activities: return to sport, childcare, work, etc.
Prevent MSK repetitive use injuries
Overall strengthening
CV endurance
Pain management
