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Neuromuscular System Evaluation and Management > Lecture SCI - Intro and Syndromes > Flashcards

Lecture SCI - Intro and Syndromes Flashcards

1
Q

SCI goal for PT

A

Empower
Enable
Inspire

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2
Q

What is a complete injury

A

Sensory and motor are lost below the level of injury

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3
Q

What is an incomplete injury

A

So many different things can happen depending on the level and extent of the injury and how many tracks are affected.
This leads to how the patent presents

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4
Q

How do spinal cord injuries occur and what is the most common cause

A

Traumatic - 50%
other 50% is from non-traumatic
-myelopathies
(Disc herniation, spondylosis, neoplasms)
-circulatory compromise (CVA in SC)
-transverse myelitis (inflammation of the SC)

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5
Q

What are the most common risks of mortality for SCI (5)

A
  1. Respiratory
  2. Cardiac –> deconditioning
  3. Sepsis –> could have injuries that they are unaware of
  4. PE –> DVT
  5. Suicide –> from their condition
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6
Q

What level of SCI would you be totally ventilatory dependent

A

C3

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7
Q

What would people with a C4 to T1 injury have difficulty doing

A

Coughing –> aspiration

Have trouble with deep breathing because of intercostal muscles

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8
Q

What is a tetra or quadriplegic and what level

A

Uppers and lowers affected

T1? would have problems with hands

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9
Q

What is a paraplegic and what level

A

uppers are spared and lowers are affected

T6 and below

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10
Q

Where are the most vulnerable SC sites on injury

A

C5-6 (most common level of tetraplegia)

T4-7

T12-L1 (most common level of paraplegia)

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11
Q

What is a complete lesion

A

Spinal reflex function is present below the level of the lesion, but no ascending or descending influences are present
Is due to complete transection, compression or vascular impairment of the cord

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12
Q

What is a incomplete lesion

A

Some amount of sensory and/or motor function; includes the lowest sacral segments S4-5 sensory and motor innervation to the anus (sacral sparing)
Can be due to contusion, swelling in the spinal canal, or partial transection of the cord

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13
Q

Name 6 incomplete spinal cord syndromes

A 
Anterior cord
Central cord
Posterior cord
Brown-sequard (hemi cord) 
Conus Medullaris
Cauda Equina
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14
Q

What is the most common incomplete syndrome

A

Anterior cord syndrome

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15
Q

How does anterior cord syndrome usually happen

A

Usually due to hyperflexion injury
Head-on collision in MVA
Blow to the back of the head

Common associated fx
Wedge fx of ant. vertebral body
Fx of posterior elements (SP, laminae and pedicles)

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16
Q

How would someone with anterior cord syndrome present

A

Loss of voluntary motor function
Damage to corticospinal

Loss of pain and temperature sensation
Damage to spinothalamic

Sparing of LT, proprioception & kinesthesia
Dorsal column is generally intact

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17
Q

What is spared with anterior cord syndrome

A

Dorsal column

  • Proprioception
  • Kinesthesia
  • light touch
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18
Q

What tracts are affected with a Anterior cord syndrome

A

Damage to the corticospinal tract and the spinothalamic tract

Corticospinal Tract
-Voluntary muscle function

Spinothalamic Tract
-Pain and temp

19
Q

How does Central Cord Syndrome

usually happen and what region is commonly affected

A

Common with hyperextension injuries to the C/S

Associated with congenital or degenerative narrowing of the vertebral canal
Seen often in the elderly 2o spinal stenosis

Occurs most commonly in the cervical region

Frequently caused by
Rear-end MVA
Elderly fallers when the chin contacts a stationary object

20
Q

Are hyperextension injuries common

A

No, bc of spinal processes

21
Q

What does the central cord syndrome result in

A

Results in edema and/or bleeding into the central gray matter

Results in loss of UE function with relative sparing of LE function
AKA “Walking Quad”
How is ambulation affected?
↑ risk of falls & subsequent injuries

22
Q

Do people with central cord syndrome have problems with ADLs

A

Yes, uppers more affected than lowers
and
they have difficulty utilizing assistive devices

23
Q

Why does central cord syndrome affect uppers more than lowers

A

Because of the location of the tracts

24
Q

If you have a posterior cord syndrome what is most affected

A

Damage to dorsal column
Loss of somatosensation below the level of injury, often results in a wide based gait and distal signs of ataxia

Fine touch, Proprioception, kinesthesia

25
Q

If you have a posterior cord syndrome what is least affected

A

Motor spared

26
Q

How would someone with posterior cord syndrome present

A

Risk of falls

Might walk wide base of support - looks like ataxia

27
Q

Etiology of posterior cord syndrome and what type of disease can cause this

A

compression or compromise of the posterior spinal artery, tumors, disease

long term consequence of Tabes Dorsalis (from advanced syphilis)

28
Q

What is Tabes Dorsalis

A

demyelination of the spinal tracts of the dorsal column due to advanced syphilis

29
Q

Brown-Sequard Syndrome aka

A

Hemi-cord Syndrome

- half the SC affected

30
Q

What are possible causes of brown-sequard syndrome

A

Often caused by a penetrating wound to the cord – GSW or stabbing

31
Q

What is the prognosis for Brown-Sequard Syndrome

A

Prognosis is generally good for regaining ambulation, hand and B&B function

32
Q

What 3 primary tracts are we concerned about with Brown-Sequard Syndrome

A

Dorsal column
Corticospinal tract
Spinothalamic tract

33
Q

With Brown-Sequard Syndrome what would be the ipsilateral damage and which tracts

A

Lateral corticospinal tract & dorsal column

Ipsilateral motor function & position sense (proprioception), 2-point discrimination, fine touch, stereognosis below the level of the lesion

34
Q

With Brown-Sequard Syndrome what would be the contralateral damage and which tracts

A

Lateral spinothalamic tract, which ascends ipsilaterally for a few segments before crossing

Contralateral pain and temperature sensation beginning a few levels below the lesion

35
Q

What is stereognosis

A

The mental perception of depth or three-dimensionality by the senses, usually in reference to the ability to perceive the form of solid objects by touch.

36
Q

Is the conus medullaris an UMN or LMN injury

A

Both! It is considered a transition area so you might see a blend of UMN and LMN impairments

37
Q

Possible impairments from conus medullaris syndrome

A

Erectile dysfn
Possibly areflexic bowel/bladder
Variable sensory loss
Anesthesia in sacral dermatomes
Possible spasticity in sacrally innervated ms – hams, toe flexors, plantarflexors
Possible diminished reflexes if lumbar n. roots affected

occurs with CE syndrome

38
Q

What is the conus medullaris and where is it

A

Transition between CNS and PNS it is around L1/2

39
Q

Causes of Conus Medullaris Syndrome

A

Central disc herniations, lumbar/sacral burst fractures

40
Q

Is Conus Medullaris Syndrome bilateral or ipsilateral and what other syndrome would be present

A

Likely to be bilateral involvement & occurs w/ CE syndrome

41
Q

What is Cauda Equina Syndrome

and at what level

A

Below level of L1

Considered a LMN injury

42
Q

Cauda Equina Syndrome dysfunctions

A

Flaccid paralysis, absent spinal reflexes, lack of automatic bowel & bladder (areflexic) function

Sacral reflexes (anal wink) may or may not be present

43
Q

Are LMN injuries good or bad for recovery

A

better compared to the SC because of the possibility for regeneration
The PNS nerves are surrounded by a neural tube

44
Q

Regeneration of PNS nerves are limited by

A

Distance between the lesion & the point of innervation

Axonal regeneration may not occur along the original nerve distribution

May be blocked by collagen scarring (if you have a scar in between it is hard for the nerves to regenerate )

End organ may no longer be functioning once regeneration is complete

Rate of regeneration slows & stops after 1 year

Neuromuscular System Evaluation and Management (21 decks)

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