Lec 09: Rehabilitation of Neurogenic Bowel, Bladder, and Spinal Cord

Question 1

What are the three main functions of the spinal cord?

Answer 1

motor, sensory, ANS

Question 2

How many pairs of spinal nerves and dermatomes are there?

Answer 2

31 pairs of SNs and 28 pairs of dermatomes (no C1, S4 and S5 correspond to 1 dermatome)

Question 3

What is the topography of fibers in the anterolateral system of the spinal cord?

Answer 3

cervical, thoracic, lumbar, sacral (medial to lateral)

Question 4

How is the spinal cord supplied with blood?

Answer 4

anterior 2/3: anterior spinal artery

posterior 1/3: posterior spinal artery

Question 5

Which nerve fiber tract is responsible for proprioception?

Answer 5

medial lemniscal

Question 6

Why should a dermatomal assessment not be done above the level of T3?

Answer 6

there is overlapping of sensory fibers

Question 7

What should be the direction of the dermatomal assessment in a patient with spinal cord injury?

Answer 7

caudocephalic - to avoid conditioning

Question 8

Sympathetic and Parasympathetic fibers are mostly located at which level of the spinal cord?

Answer 8

sympathetic - thoracolumbar

parasympathetic - craniosacral

Question 9

Which drug is used to reverse the inflammatory process in spinal injury patients?

Answer 9

methylprednisolone (within 6-8 hours)

Question 10

In an incomplete injury, which area is usually spared?

Answer 10

outermost (sacral)

Question 11

How is the bulbocavernosus reflex elicited?

Answer 11

feel for anal sphincter contraction while gently pulling on the catheter (a positive sign means that there is sacral sparing)

Question 12

How long does it usually take for spinal shock to resolve?

Answer 12

within 72 hours

Question 13

Which terms are used to refer to paralysis in brain and spinal cord pathology?

Answer 13

brain pathology - quadriplegia and diplegia

spinal cord pathology - tetraplegia and paraplegia

Question 14

What are the characteristics of anterior cord syndrome?

Answer 14

• anterior 2/3 affected
• loss of pain and temp. sensation (spinothalamic tract)
• loss of motor function
• deficit is contralateral to lesion

Question 15

What are the characteristics of posterior cord syndrome?

Answer 15

• posterior 1/3 affected
• loss of proprioception
• deficit is ipsilateral to the lesion

Question 16

What are the characteristics of Brown-Sequard syndrome?

Answer 16

• contralateral loss of pain and temp. sensation and ipsilateral motor deficits
• hemisection (lateral damage)

Question 17

Which nerve innervates the respiratory muscles?

Answer 17

phrenic nerve (C3, C4, C5)

Question 18

What are the manifestations of cervical injury in the heart and GIT?

Answer 18

heart - vagus nerve is spared: bradycardia

GIT - vagus nerve is spared: parasympathetic manifestations (ex. hypermotility)

Question 19

(T/F) If the LE motor function is graded 0/5 the sphincter muscles of the bladder will be unable to contract

Answer 19

F - sphincter is controlled by the sympathetic NS (alpha innervation is intact)

Question 20

What are the requirements for bladder training?

Answer 20

intact cognitive function, hand function, sitting balance

Question 21

What 3 parameters are used in the ASIA classification?

Answer 21

motor, sensory, sacral sparing

Question 22

When can the ASIA classification be used?

Answer 22

after 72 hours (no longer in spinal shock)