Neuro SCI, Parkinson's, MS Flashcards
Asia A
Complete: No sensory or motor function is preserved in sacral segments S4-55.
Asia B
Sensory Incomplete:
Sensory function is preserved below the neurologic level, including S4-55, AND no motor function is preserved more than 3 levels below the motor level on either side of the body.
Asia C
Motor Incomplete:
Motor function is preserved for voluntary anal contraction, OR the patient meets “Sensory Incomplete” status and has motor function more than 3 levels below the motor level on either side of the body. Less than half of key muscle functions below the neurologic level have a muscle grade ≥ 3.
Asia D
Motor Incomplete:
“Motor Incomplete” status as defined above, with at least half (half or more) of key muscle functions below the neurologic level having a muscle grade greater than or equal to 3.
Asia E
Normal:
Sensory and motor functions are normal in a pt that had prior deficits
How to determine SCI motor level
Most caudal key muscles that have a strength of 3 or greater with the superior segment tested as a 5
How to determine SCI sensory level
Most caudal dermatome with a normal score of 2/2 for pinprick AND light touch
Key muscles tested for SCI motor level determination
C5 -Elbow flexors (biceps, brachialis)
C6 -Wrist extensors (extensor carpi radialis longus and brevis)
C7 - Elbow extensors (triceps)
C8 -Finger flexors (flexor digitorum profundus) to the middle finger
TI - Small finger abductors (abductor digiti minimi)
L2 -Hip flexors (iliopsoas)
L3 - Knee extensors (quadriceps)
L4 -Ankle dorsiflexors (tibialis anterior)
L5 -Long toe extensors (extensor hallucis longs)
S1 -Ankle plantar flexors (gastrocnemius, soles)
Main sensory areas tested for SCI (that have fairly specific locations)
C2 - occipital protuberance
C3 - supraclavicular fossa
C4 - top of AC joint
C5 - lateral antecubital fossa
C6 - dorsal thumb (proximal phalanx)
C7 - Dorsal middle finger (proximal phalanx)
C8 - Dorsal little finger (proximal phalanx)
T1 - medial side of antecubital fossa
T2 - apex of axilla
T3-5 - spots of the ribs that associate
T 6 - level of xiphesternumb
T 7-9 - their adjoining rib spaces
T 10 - level of umbilicus
T12 - midpoint inguinal ligament
L1 - anteromedial thigh
L3 - medial femoral condyle
L4 - medial malleolus
L5 - dorsal surface of 3rd MTP
S1 - lateral heel
S2 - popliteal fossa at midline
S3 - ischial tuberosity
S4-5 - perianal area
Scoring given to sensory testing when testing light touch and pinprick for SCI
0 = Absent
1 = imparied/hypersthesia
2 = intact
What does ASIA stand for
American Spinal Cord Injury Association
SCI C4 (complete) Gross functional outcome
•Bed Mobility: dependent
.Transfers: dependent
•Weight Shift: modified independent with power recline/tilt weight shifts; dependent for manual shifts
• Wheelchair Management: dependent
•Wheelchair Mobility: supervision to modified independent with power wheelchair
•ROM/positioning: dependent
SCI C5 (complete) Gross functional outcome
•Bed Mobility: moderate to maximal assist
•Transfers: maximal assist with sliding board
•Weight Shift: modified independent with power recline/tilt weight shifts
•Wheelchair Management: dependent
• Wheelchair Mobility: modified independent with manual wheelchair on smooth surface in forward direction; maximal assist in all other situations
•ROM/positioning: dependent
SCI C6 (complete) Gross functional outcome
Bed Mobility: minimal assist to modified independent with equipment
•Transfers: minimal assist to modified independent with sliding board
•Weight Shift: modified independent with power recline/tilt weight shift, minimal assist to modified independent with side to side or forward lean shift
• Wheelchair Management: some assistance required
•Wheelchair Mobility: modified independent on smooth surface with power and manual wheelchair; may need assist with rough terrain and ramps
•ROM/positioning: moderate assist to modified independent with all
SCI C7-C8 (complete) Gross functional outcome
•Bed Mobility: independent
•Transfers: modified independent to independent with level surface transfers
Weight Shift: modified independent with side to side, forward lean, and depression weight shift
•Wheelchair Management: may require assist with cushion adjustment, anti-tip levers, and maintenance
•Wheelchair Mobility: modified independent on most to all surfaces
•ROM/positioning: minimal assist to modified independent with all
SCI Paraplegia (complete) Gross functional outcome
•Bed Mobility: independent
•Transfers: independent for level surfaces and with car transfers
•Weight Shift: modified independent with depression weight shift
• Wheelchair Management: independent
•Wheelchair Mobility: independent on all surfaces; minimal assist to modified independent for curbs
•ROM/positioning: independent
•Gait: varies on level of injury from standing only to community ambulation with or without orthoses
A patient with which 2 level SCI would be most reliant on tenodesis
C6 and C7
What are the symptoms of spinal shock?
- areflexia
- impairment in autonomic regulation which causes the following:
- hypotension
- loss of control of sweating
- loss of cremasteric reflex
- loss of Babinski response.
Spinal shock occurs in the first 24 hours post SCI
Which statement regarding sexuality in males is most accurate following a spinal cord injury?
the ability to ejaculate is more common with incomplete lower motor neuron lesions
Ejaculation is a complicated neurological process. Following a spinal cord injury in males, there is a higher likelihood of ejaculation with incomplete lower motor neuron lesions compared to upper motor neuron lesions as well as complete lesions. Lower motor neuron lesions may have psychogenic erections which increase the capacity for ejaculation.
Which SCI level is the highest level that will household ambulate with KAFOs?
L3
Partial innervation of the gracilis, iliopsoas, QL, RF, and sartorius. Hip flexion, add, knee extension.
Will use KAFO and Lofstrands (forearm crutches)
Sensory testing for S3 (ASIA scale)
Ischial tuberosity
Sensory testing for S1 (ASIA scale)
Lateral heel
Sensory testing for S2 (ASIA scale)
Popliteal fossa midline
Key muscles tested for C8 with ASIA scale
Finger flexors (flexor digitorum profundus) to the middle finger
Sensory testing for L5 (with ASIA scale)
dorsum of foot 3rd MTP
Sensory testing for L3 (with ASIA scale)
medial femoral condyle
Sensory testing for L2 (ASIA scale)
anteromedial thigh
Sensory testing of L4 (ASIA scale)
Medial malleolus
What lesion(s) does autonomic dysreflexia occur?
T6 and above
Autonomic Dysreflexia
Vasodilation above NLI (parasympathetic) - increased BP, flushed face, HA, distended neck veins, decreased HR, increased sweating
Vasoconstriction below NLI (sympathetic) - pale, cool, no sweating
- Sudden rise in systolic blood pressure of 20-40 mm Hg above baseline observation of signs and symptoms.
- Signs and symptoms of AD include bradycardia, hypertension, increased spasticity, blurred vision, constricted pupils, nasal congestion and feeling of anxiety.
Steps for Autonomic Dysreflexia
1) Sit patient UP
2) Check for stimulus - full bladder, UTI, fecal impaction, restrictive clothing, pressure areas
3) Activate EMS
**Must react quickly due to increased BP may cause hemorrhagic CVA
AD vs OH
AD: flushed/red face, increased BP, sit pt up
**If face goes red - raise the head
OH: pallor, diaphoresis, decreased BP, position changes, lie pt down
**If face goes pale - raise the tail
Brown Sequard Syndrome
Cause: gunshot or knife wound injuries
Contralateral loss of pain, temperature and crude touch (Antero-lateral system)
Ipsilateral loss of vibration, proprioception, 2 touch discrimination, fine touch (Dorsal Column-medial lemniscus)
What will be the presentation of a SCI pt with Brown Sequard Syndrome at right T12?
Left sided loss of pain and temperature
Right sided loss of motor, fine touch, and proprioception
Central Cord Syndrome
Most common cause: extension injury
UE > LE deficit
Distal muscle deficit > Proximal mm
Still have have fine touch, vibration, and proprioception due to dorsum column intact
Hand function last to come back
Normally ambulates
Anterior Cord Syndrome
Rare
Complete loss of motor, pain, and temperature below injury
Retains proprioception and vibration sensory
Cause is due to flexion or vascular injury
Poor prognosis
Damages anterior spinal artery (which feeds 2/3 of SC)
Posterior Cord Syndrome
Rare
Cause: Compression due to disc which impacts the posterior spinal artery; Vit. B12 deficiency; Infarction
Presentation: loss of vibration, proprioception, light touch, and 2 point discrimination.
Cauda Equina Syndrome
Impacts lumbosacral region
Below the SC (L1 or L2)
LMN lesion
Presentation: Areflexic Bowel and bladder; saddle anesthesia
Conus Medullaris Syndrome
Combo of UMN and LMN s/s
Lesion right at the end of the SC = L1, L2
How much hamstring flexibility for SCI?
about 100 deg.
Lesion to S2-S4 above L1 will cause:
Spastic or flaccid bladder/bowel?
Spastic/hyperreflexive bladder and bowel
Lesion above conus medullaris (L1)
Is a spastic bladder an UMN or LMN lesion?
UMN
Tx for spastic bladder
tapping without dyssynergia
Lesion of S2-4 below L1 will cause:
Spastic or flaccid bladder/bowel?
Flaccid/areflexic bladder and bowel
Flaccid bladder is an UMN or LMN lesion?
LMN
Tx for flaccid bladder?
catheter or valsalva
Tx for spastic bowel
reflex def or digital stimulation
Tx for flaccid bowel
manual evac or gentle valsalva
MS
Sclerotic plaques throughout CNS
Most common - relapsing remitting
block neural transmission, inflammation, and demyelination
Progressive Disability overtime
MS s/s
fatigue
spasticity
weakness
optic neuritis
heat intolerance
unilateral visual loss
paresthesia
ataxia
bowel and bladder dysfunction
Best tx for MS
Cool environment
Can use cooling vest
In the morning due to fatigue
PD
destruction in substantia nigra
decreased Dopamine - initiation of movement
PD cardinal signs
Rigidity
Bradykinesia/akinesia
Tremor (pin rolling)
Postural instability (causes falling)
**TRAP
PD clinical manifestations
fatigue; contractures (hip flexors)
freezing gait; start hesitation
kyphosis, forward head, scapular protraction
tonal asymmetries
decreased stride and cadence
shuffling; festinating gait
decreased trunk rotation
PD interventions
Early - determine need for AD and environmental modifications
Middle - body moves more slowly, increased stiffness
Late/advances - hospital bed, w/c, lift; requires full-time assistance
Cueing strategies - rhythmic auditory stimulation, amplitude-based behavioral interventions, big & loud
Flexibility exercises - hip rotation, hip extension (prone lying)
Resistance training - bilateral D2 flexion; chop and lift
Bed mobility skills - bridges; rolling
Balance training
Hoehn and Yahr Scale
1 - unilateral involvement
2 - bilateral involvement without balance affected
3 - balance is affected
4 - requires AD or assistance
5 - w/c bound
What level of assistance with a C8 SCI require for using a manual w/c while negotiating curbs initially?
Moderate assistance …a pt with a complete C8 SCI may be able to achieve modI.
Question from PTFE
