PBL - Spinal Shock And Spinal Injury

Question 1

Temporary suppression of all reflex activity below the level of injury describes what?

Answer 1

Spinal shock

Question 2

When does spinal shock occur?

Answer 2

Immediately after injury

Question 3

The return of what reflex indicates the end of spinal shock?

Answer 3

Bulcocavernosus reflex

Question 4

What are the clinical effects of spinal shock?

Answer 4

Flaccid paralysis
Areflexia
Loss of sensation
Loss of bladder and bowel reflexes

Question 5

What are the phases of spinal shock?

Answer 5

Areflexia
Initial reflex return
Initial hyperreflexia
Hyperreflexia and spasticity

Question 6

How is the motor function of someone with a spinal cord injury assessed?

Answer 6

ASIA charts

Question 7

How is sensory function after a spinal cord injury assessed?

Answer 7

Pin prick
Light touch
Sacral sparing

Question 8

Who are the people involved in caring for someone with a spinal injury?

Answer 8

Spinal injury unit
Physiotherapist
Occupational therapist
Family

Question 9

What is the role of the physiotherapist in spinal cord injury rehabilitation?

Answer 9

Teaches wheelchair skills, helps relearn balance, strengthens paralysed muscles and teaching to transfer skills

Question 10

What is the role of the occupational therapist in spinal cord injury rehabilitation?

Answer 10

Helps patients reach high level of physical and psychological independence at home and work
Help with wheelchairs, computer aids and other tools

Question 11

What is the role of the family in spinal cord injury rehabilitation?

Answer 11

Helps with income support, modifying homes, facilitates community nursing care

Question 12

In which of an upper motor neuron lesion or a lower motor neuron lesion, is there muscle wasting?

Answer 12

Lower

Question 13

In which of an upper motor neuron lesion or a lower motor neuron lesion, is there fasciculations?

Answer 13

Lower

Question 14

Describe the tone in both an upper motor neuron lesion and a lower motor neuron lesion

Answer 14

Lower motor neurons lesions lead to flaccid tone

Upper motor neurons lesions lead to spastic tone

Question 15

Describe the weakness/paralysis seen in both an upper motor neuron lesion or a lower motor neuron lesion

Answer 15

Lower - loss of muscle bulk

Upper - ineffective recruitment of alpha motor neurons

Question 16

Describe tendon jerk reflexes in both upper and lower motor neuron lesions

Answer 16

Lower - reduced or absent

Upper - hyperreflexia

Question 17

What happens to respiration if C3, 4 or 5 are damaged?

Answer 17

Phrenic nerve damage - innervates diaphragm

Patient will need artificial ventilation to survive

Question 18

What happens to respiration is C6 or C7 are damaged?

Answer 18

These nerves innervate the intercostal muscle
- paradoxical breathing
Phrenic nerve remains intact

Question 19

What happens to respiration if T1 or below are damaged?

Answer 19

No effect

Question 20

How much movement can be achieved if there is a spinal injury at C4?

Answer 20

None below the neck - quadriplegia

Question 21

How much movement can be achieved if there is a spinal injury at C5?

Answer 21

There will be some control of the should and biceps

No wrist or hand control

Question 22

How much movement can be achieved if there is a spinal injury at C7-T1?

Answer 22

They will be able to straighten their arms

May have dexterity problems with their hands and fingers

Question 23

How much movement can be achieved if there is a spinal injury at T1-T8?

Answer 23

There will be paraplegia - full use of arms
Poor control of the trunk as the abdominal muscles are effected
Balance while still quite good

Question 24

How much movement can be achieved if there is a spinal injury in the lumbar of sacral regions?

Answer 24

Decreased control of hip flexors and legs

Question 25

Do patients often lose their micturition reflex?

Answer 25

Not unless the lumbrosacral region of the cord is damaged | - if the injury avoids damaging this area, the reflex will remain intact, or recover after a few weeks

Question 26

What is the 'autonomic bladder'

Answer 26

Sensory bombardment of the cord from stretch receptors | - bladder emptying occurs when threshold is reached

Question 27

How can micturition be indirectly controlled?

Answer 27

Patient increases sensory bombardment of sacral region by scratching the inner thigh, facilitating the reflex

Question 28

Do somatic reflexes return after spinal injury?

Answer 28

Despite the fact that voluntary control of muscle never returns - somatic reflex do

Question 29

Which reflexes return first?

Answer 29

Ankle Knee Hip - in sequence

Question 30

Extensor reflexes return around 6 months after transection- what is different about them?

Answer 30

Exaggerated - leading to spastic paralysis

Question 31

Describe autonomic dysrreflexia.

Answer 31

Stage of reflex activity that follows primary flaccidity of the shock Due to massive sympathetic discharge Trivial stimulus to body below the level of injury can trigger it

Question 32

Signs and symptoms of autonomic dysrreflexia

Answer 32

``` Sweating Increased heart rate Hypertension Defecation Erection Micturition ```

Question 33

What happens to blood pressure when the bladder fills in people with a spinal cord injury?

Answer 33

It increases - flushed face seen on urination

Question 34

Does autonomic dysrreflexia resolve?

Answer 34

Primitive control of autonomic function is re-established | - BP control remains more unstable than in normal people

Question 35

What happens to the Babinski response reflex after spinal cord injury?

Answer 35

It initially disappears - and when it comes back, it occurs only in the abnormal form (positive response)

Question 36

Which reflexes permanently disappear in a spinal cord injury?

Answer 36

Abdominal reflexes | Cremasteric reflexes

Question 37

In development, what do the alar and basal plates of the spinal cord become in humans?

Answer 37

Alar - dorsal horn | Basal - ventral horn

Question 38

What are the diagnostic reasons you would perform a lumbar puncture?

Answer 38

Withdrawal CSF | Measure CSF pressure

Question 39

What are the therapeutic reasons you would perform a lumbar puncture?

Answer 39

Administration of antibiotics | Chemotherapy

Question 40

Where would you perform a lumbar puncture?

Answer 40

Between L3 and L4 or between L4 and L5

Question 41

What is the surface marker for the body of L4?

Answer 41

Supracristal line passes through the body of L4

Question 42

In which part (superficial or deep) of the dorsal horn do the spinothalamic and dorsal column tracts terminate?

Answer 42

Spinothalamic - superficial | Dorsal column - deep

Question 43

Which descending tracts are involved in muscle movement?

Answer 43

Corticospinal and corticobulbar

Question 44

What descending tracts are involved with muscle tone maintainance?

Answer 44

Reticulospinal Tectospinal Vestibulospinal

Question 45

What commonly causes central cord syndrome?

Answer 45

Hyper extension injuries | Compression of the cord anteriorly by osteophytes and posteriorly by ligamentum flavum

Question 46

Describe what brown-sequard syndrome is, and what commonly causes it.

Answer 46

Hemi-section of the cord - stab wounds - gunshot wounds

Question 47

What does brown-sequard syndrome appear as clinically?

Answer 47

Paralysis on affected side (corticospinal) Loss of proprioception and fine discrimination (dorsal column) on affected side Loss of pain and temperature loss on the opposite side (spinothalamic)

Question 48

What causes cauda equina syndrome?

Answer 48

Due to bony compression or disk protrusion in the lumbar or sacral regions

Question 49

What clinical symptoms arise from cauda equina syndrome?

Answer 49

Back pain Bowel and bladder dysfunction Leg numbness/weakness Saddles parasthesia

Question 50

What is neurogenic shock?

Answer 50

The body's response to the sudden loss of sympathic control - occurs in people who have a T6 injury or above - occurs in those who have a greater than 50% loss of sympathetic innervation

Question 51

What is the clinical triad for neurogenic shock?

Answer 51

Hypotension Bradycardia Hypothermia

Question 52

What is the desired BP to assure good perfusion of the injured spinal cord?

Answer 52

85mmHG MAP

Question 53

What are people with a spinal cord injury high risk for, and require prophylaxis for?

Answer 53

DVT | Pulmonary embolism