Intro to SCI Flashcards
Traumatics SCI
- most common
- high impact forces
- Occur at path of least resistance (C5-6; T12-L1)
- Cause hemorrhage, edema, necrosis of gray matter at/around site
Path of Least Resistance
- C5-6
- C4
- T12-L1
(areas of mobility, instability)
Traumatic SCI causes:
- hemorrhage
- edema
- necrosis of gray matter around/at site
Why are L-spine injuries more likely incomplete?
-cauda equina
Why are T-spine injuries more likely complete?
-ribs increase stability so very high forces cause SCI there
About ____% of patients with SCI also have_____
- 50%
- TBI (mod to severe)
SCI can occur with other injuries like:
- fractures of other bones
- abdominal injuries
- TBI
Flexion Injury
- most common
- tend to cause wedge fracture (ant vert body)
- spine forced into flexion
- anterior cord syndrome
Compression Injury
- vertical forces
- burst fracture (shatters)
- tear drop fracture (piece breaks off)
Flexion with Rotation Injury
- post to ant
- fracture of lamina, peduncle, facets (avulsion)
Hyperextension
- due to falls
- involve CS
- fracture of post elements
- avulsion of anterior elements
Non-traumatic SCI
- Less common
- Caused by SC pathology
- Tumor, transverse myelitis, syringomyelia, vertebral subluation (RA), infection, vascular malformations (AVM)
Syrinx
Cyst in spinal cord
Complete SCI
- motor and sensory function absent below injury (including lowest sacral levels–S4/5)
- Compensation in rehab
Incomplete SCI
-some motor and sensory function preserved below level of injury (including lowest sacral levels–S4/5)
Zone of Partial Preservation
- pts with complete SCI who have partial preservation/sparing of motor and/or sensory function below level of injury
- (some little neuron getting through to make connection)
Damage to DC/ML
-ipsilateral loss of discrimminative touch, vibration, proprioception arms/legs
Damage to Lateral Corticospinal Tract
-Ipsilateral spastic paresis
Damage to Spinocerebellar tract
-Ipsilat loss of position and motion sense
Damage to Spinothalamic tract
-contralat loss pain/temp one segment below lesion
Somatotopic Arrangement of Corticospinal tract
- -lateral fibers to S4/5 (LE)
- -medial fibers to higher up in spinal cord (UE)
Anterior Cord Syndrome
-Loss: motor function, pain, temp, crude touch below below injury level
Central Cord Syndrome
- Hyperextension injuries
- Weak UE
- Ok LE
- Sparing sacral motor/sensory function
Brown-Sequard Syndrome
- Hemisection of cord (stab/gunshot)
- Ipsilateral Loss: proprioception, deep/discrim touch, vibration, motor
- Contralateral Loss: pain, temp, crude touch
-Usually not perfect hemisection
Posterior Cord
- post spinal Aa strokes, tumors
- Loss: propioception, deep/discrim touch, vibration below injury
Deadliest time for SCI pts
- 1st 24 hours
- hypotension & neurogenic shock
Primary Injury
- due to insult–>local deformation of cord
- irreversable
Secondary Injury
- after initial trauma
- ischemia, axonal degeneration, inflammation
- may be reversable
Diagnostic Imaging Used
- CT (good at seeing whole spine and Bone)
- MRI–Soft tissue
ASIA Index
- Standardized test for SCI
- Tests myotomes/dermatomes to find sensory and motor levels (may be different)
- Rostral-caudal sequence
Stabilization Devices
- Internal/External
- stabilize spine
Halo
- C-spine
- External
- jacket with metal posts; ring screwed into cranium
- Very stable; allow mobility (not neck)
- 12 Week duration
Cervical Traction
- tongs/halo
- in ER
- when medical problems don’t allow for other devices
- increased immobility/bedrest
Cervical Surgery
- enter ant/post/both
- in halo after (or other)
- increased body mobility after
Minerva Orthosis
-body jacket with straps to head
Cervical Collars
Less stabilization
Thoracolumbar Orthosis
- many types
- stable/unstable fractures
- limit certain motions/complete stability
Harrington Rods
- rods attached to lamina above and below injury level
- avoid torque forces
Loque Rods
?
Pre-Stabilization
C SPINE
- no neck ROM
- Shoulder flex/abd to 90*
- ER may be limited
T/L SPINE
- no hip flexion past 90*
- SLR limited to 30*
Long Sitting ROM Requirements
- Full shdr extension and ER
- Full elbow extension
- Hamstrings to 110*
Transfer ROM Requirements
-neutral DF with knee flexed
ADL ROM Requirements
- tight long finger flexors needed
- full (or more) hip ER for dressing
Tenodesis Grasp
- fingers flex passively with wrist extension
- don’t over stretch long finger flexors!
Body Function/Structure Impairments with SCI
- Mm weakness
- Loss sensation
- Loss ROM
- Pain
- Respiratory/cardiovascular dysfunction
- Balance
- Endurance
- Alterations to Mm tone
Activity Limitations with SCI
- Directly related to impairments
- –bed mobility, transfers, gait, ADL/IADL, bowel/bladder, sexual functioning
Pain
- various types
- due to injury to cord/nerves/other (including overuse)
_____% of pts have chronic pain
70%
In the first month after injury pressure ulcers form in ______% of patients
30-50%
Ectopic Ossification
- (heterotopic bone)
- Ossification of soft tissues below level of injury
- larger joints involved
- Initially: hot, red, swollen, decrease ROM
- Cause? Excessive ROM?
- Rx=meds, PT, surgery
Other Complications of SCI
- Ectopic Ossification
- Postural Hypotension
- Autonomic Dysreflexia
- Anxiety/Depression
- Respiratory Problems
- DVT
- Contractures
Autonomic Dysreflexia
-pathology of ANS above T6
Autonomic Dysreflexia: Trigger
noxious stimulus below level of injury
Autonomic Dysreflexia: Reaction to Trigger
- HTN, profuse sweating
- can cause stroke, blindness, death
Autonomic Dysreflexia: Treatment
- monitor BP
- sit up (45*)
- remove noxious stimulus
- inform nurse/MD
84% of patients with _____ injuries and 60% of ____ injuries have respiratory problems
–Upper CS
–Lower CS
95% of patients with injuries above ____ require mechanical ventilation
C5
