Intro to SCI Flashcards
What patient population is mostly affected by spinal cord injuries.
Young adult males
Name some of the most common types of traumatic injuries?
MVA
Falls
Violence
Sports
Name some non-traumatic injuries that can cause SCI?
AVM-arterial venous malformation Hemorrhage Subluxation Abscess infections such as syphilis or transverse myelitis
Are cervical or thoracolumbar SCIs more common?
Cervical
What is the most common type of SCI?
Incomplete Tetraplegia - 39.5%
Complete paraplegia - 22.1%
Incomplete paraplegia - 21.7%
Complete tetraplegia - 16.3%
What is the average length of stay for a patient in the acute care setting and inpatient rehab setting?
Acute Care - 12 days
Inpatient rehab - 37 days
What is the life expectancy after SCI?
If injured at 20 y/0
- 50 years with incomplete
- 35 years with complete
Describe the neurological level.
Most caudal level of the spinal cord with normal motor and sensory function on both sides
What is the motor and sensory level?
Most caudal segment with normal motor or sensory function bilaterally
How is the motor level tested and what do you if there is a myotome that is not clinically testable (C1-C4, T1-L1, S2-S5)?
Standard MMT scale of 0-5
When you can’t test it, the motor level is the same as the sensory level.
How is the sensory level tested?
Tested with light touch and pin prick
It’s scored on a 3 point scale
0-Absent, 1-Impaired, 2-normal
Describe a complete injury.
No sensory or motor function in lower sacral segments
Describe an incomplete injury
Having motor and/or sensory function below level of injury INCLUDING sensory and/or motor function at S4 and S5.
How do you determine motor or sensory function at sacral segments S4-S5?
Determine anal sensation and voluntary contraction of exterior anal sphincter.
What is it called if an individual has motor and/or sensory function below neurological level of injury but does not have function at S4 and S5?
Zones of Partial Preservation
Describe the ASIA scale.
A - Complete no sensory or motor in sacral segments
B - Incomplete. Sensory but not motor function below neurological level
C - Incomplete. Motor function is preserved below neurological level, and more than half of key muscles have grade or equal to 3 in at least half of muscles
E - Normal
Describe Brown-Sequard Syndrome.
Damage to 1 side of the cord
Typically caused by penetration wounds (gunshot, stab)
Asymmetrical features
Ipsilateral paralysis and sensory loss (light touch, vibratory)
Contralateral loss of sense of pain and temp
Achieve good functional gains during rehab
Which syndrome is related to flexion injuries?
Anterior cord syndrome
Does anterior cord syndrome have a longer or shorter length of stay compared to those with other syndromes.
Longer
What is the most common SCI syndrome?
Central Cord Syndrome
How does central cord syndrome normally occur?
Hyperextension injuries to the cervical region (falls)
Also associated with congenital or degenerative narrowing of spinal canal
Are upper extremities or lower extremities more involved with central cord syndrome?
Upper extremities
typically recover ability to ambulate but have distal weakness and loss of fine motor control
Are cauda equina injuries typically complete or incomplete?
Incomplete (due to big # of nerve roots in large area)
Is cauda equina injuries considered an upper motor neuron or lower motor neuron lesion?
Lower motor neuron lesion (LMN)
Name some common causes of cauda equina injuries.
Herniated disc in lumbar area Spinal tumors and lesions spinal inflammation Violent injuries Birth complications Lumbar spinal stenosis
What is spinal shock?
Period of areflexia that occurs immediately following SCI
Impairment of autonomic regulation with hypotension and loss of control of sweating and piloerection
How long does spinal shock last?
Initial period lasts - 24 hours
Gradual return of reflexes up to 1-3 days after injury
Increasing hyperreflexia lasting 1-4 weeks
Final hyperreflexia 1-6 months after injury
What is autonomic dysreflexia?
Acute onset of autonomic activity from noxious stimulus below level of lesion.
Does blood pressure elevate or go down during autonomic dysreflexia.
Mass reflex response results in ELEVATED BP
What levels do you typically see autonomic dysreflexia?
SCI lesion above T6
more common in chronic stage of recovery (3-6 months after
What’s the most common cause of autonomic dysreflexia?
Bladder and bowel distention/irritation
Other causes include: pressure sores, noxious cutaneous stimuli, sexual activity, labor, skeletal fracture
Name some symptoms of autonomic dysreflexia.
HYPERTENSION Bradycardia Headache (severe, pounding) Profuse sweating Increased spasticity
What is it important to do if you see someone having an autonomic dysreflexia episode?
Medical emergency
Move to upright position to lower BP (avoid supine)
Loosen any tight clothing or restrictive devices
Monitor BP and pulse
What is the cardiovascular system regulated by?
Brainstem and hypthalamus via sympathetic and parasympathetic nervous system
Parasympathetic - vagus nerve
Sympathetic - spinal segments T1-L2
With upper SCI injuries there is a loss in sympathetic communication between brainstem and heart but parasympathetic remains intact. What does this tend to cause?
Bradycardia and dilation of peripheral vasculature below level of lesion
Why does orthostatic hypotension occur?
Imbalance in sympathetic and parasympathetic systems, decrease in active muscle contraction, prolonged time in bed
Usually only significant in people with SCI above T6
What are some things you should do when moving a patient to upright position to prevent orthostatic hypotension?
Vital signs should be monitored
Use compression stockings and abdominal binder
Medications may be necessary (ephedrine increase BP, diuretics relieve edema
Patient must always be moved slowly
How is temperature control impaired with SCI injuries?
Hypothalamus can no longer control cutaneous blood flow
Loss of internal theroregulatory responses
Ability to shiver is lost below injury
At what level of SCI injury will you see near normal pulmonary function?
T10 and below
What percentage of people with complete tetraplegia develop pneumonia within 1 year?
10 percent
What level of lesions require artificial ventilator?
C1, C2
phrenic nerve is lost
What levels innervate the phrenic nerve/diaphragm?
C3, C4, C5
What is paradoxical breathing?
Altered breathing pattern
Flattening of upper chest wall
Decreased chest wall expansion
Dominant epigastric rise during inspiration
Where does spinal control for micturition originate?
S2, S3, S4
When will there be a spastic/hyperrflexic bladder or a flaccid/areflexic bladder?
Spastic = above conus medullaris and sacral segments (UMN) Flaccid = at conus medullaris or sacral segments (LMN)
Describe some characteristics of a spastic bladder?
Contracts and reflexively empties
Reflex arc is intact
Detruser muscle is hyperreflexive
Lack of coordination between detruser and sphincters
How often do you initially want to cathertization?
every 4 hours
How common are UTIs in SCI injuries?
50%
Major cause of mortality
What levels will you see bowell dysfunction?
Lesions above S2
S2-S4 or cauda equine lesions = Flaccid or areflexive bowell (LMN)
What are some secondary medical complications with SCI?
Pressure Sores (36%) DVT Pain Contractures Heterotopic Ossification Osteoporosis and Fractures
What is the difference between nociceptive and neuropathic pain?
Nociceptive - Musculoskeletal or visceral above level
Neuropathic - pain due to injury to central or peripheral nervous system (below level of lesion)
