PBL - Spinal Shock And Spinal Injury Flashcards
Temporary suppression of all reflex activity below the level of injury describes what?
Spinal shock
When does spinal shock occur?
Immediately after injury
The return of what reflex indicates the end of spinal shock?
Bulcocavernosus reflex
What are the clinical effects of spinal shock?
Flaccid paralysis
Areflexia
Loss of sensation
Loss of bladder and bowel reflexes
What are the phases of spinal shock?
Areflexia
Initial reflex return
Initial hyperreflexia
Hyperreflexia and spasticity
How is the motor function of someone with a spinal cord injury assessed?
ASIA charts
How is sensory function after a spinal cord injury assessed?
Pin prick
Light touch
Sacral sparing
Who are the people involved in caring for someone with a spinal injury?
Spinal injury unit
Physiotherapist
Occupational therapist
Family
What is the role of the physiotherapist in spinal cord injury rehabilitation?
Teaches wheelchair skills, helps relearn balance, strengthens paralysed muscles and teaching to transfer skills
What is the role of the occupational therapist in spinal cord injury rehabilitation?
Helps patients reach high level of physical and psychological independence at home and work
Help with wheelchairs, computer aids and other tools
What is the role of the family in spinal cord injury rehabilitation?
Helps with income support, modifying homes, facilitates community nursing care
In which of an upper motor neuron lesion or a lower motor neuron lesion, is there muscle wasting?
Lower
In which of an upper motor neuron lesion or a lower motor neuron lesion, is there fasciculations?
Lower
Describe the tone in both an upper motor neuron lesion and a lower motor neuron lesion
Lower motor neurons lesions lead to flaccid tone
Upper motor neurons lesions lead to spastic tone
Describe the weakness/paralysis seen in both an upper motor neuron lesion or a lower motor neuron lesion
Lower - loss of muscle bulk
Upper - ineffective recruitment of alpha motor neurons
Describe tendon jerk reflexes in both upper and lower motor neuron lesions
Lower - reduced or absent
Upper - hyperreflexia
What happens to respiration if C3, 4 or 5 are damaged?
Phrenic nerve damage - innervates diaphragm
Patient will need artificial ventilation to survive
What happens to respiration is C6 or C7 are damaged?
These nerves innervate the intercostal muscle
- paradoxical breathing
Phrenic nerve remains intact
What happens to respiration if T1 or below are damaged?
No effect
How much movement can be achieved if there is a spinal injury at C4?
None below the neck - quadriplegia
How much movement can be achieved if there is a spinal injury at C5?
There will be some control of the should and biceps
No wrist or hand control
How much movement can be achieved if there is a spinal injury at C7-T1?
They will be able to straighten their arms
May have dexterity problems with their hands and fingers
How much movement can be achieved if there is a spinal injury at T1-T8?
There will be paraplegia - full use of arms
Poor control of the trunk as the abdominal muscles are effected
Balance while still quite good
How much movement can be achieved if there is a spinal injury in the lumbar of sacral regions?
Decreased control of hip flexors and legs
Do patients often lose their micturition reflex?
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
What is the ‘autonomic bladder’
Sensory bombardment of the cord from stretch receptors
- bladder emptying occurs when threshold is reached
How can micturition be indirectly controlled?
Patient increases sensory bombardment of sacral region by scratching the inner thigh, facilitating the reflex
Do somatic reflexes return after spinal injury?
Despite the fact that voluntary control of muscle never returns
- somatic reflex do
Which reflexes return first?
Ankle
Knee
Hip
- in sequence
Extensor reflexes return around 6 months after transection- what is different about them?
Exaggerated - leading to spastic paralysis
Describe autonomic dysrreflexia.
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
Signs and symptoms of autonomic dysrreflexia
Sweating Increased heart rate Hypertension Defecation Erection Micturition
What happens to blood pressure when the bladder fills in people with a spinal cord injury?
It increases - flushed face seen on urination
Does autonomic dysrreflexia resolve?
Primitive control of autonomic function is re-established
- BP control remains more unstable than in normal people
What happens to the Babinski response reflex after spinal cord injury?
It initially disappears - and when it comes back, it occurs only in the abnormal form (positive response)
Which reflexes permanently disappear in a spinal cord injury?
Abdominal reflexes
Cremasteric reflexes
In development, what do the alar and basal plates of the spinal cord become in humans?
Alar - dorsal horn
Basal - ventral horn
What are the diagnostic reasons you would perform a lumbar puncture?
Withdrawal CSF
Measure CSF pressure
What are the therapeutic reasons you would perform a lumbar puncture?
Administration of antibiotics
Chemotherapy
Where would you perform a lumbar puncture?
Between L3 and L4 or between L4 and L5
What is the surface marker for the body of L4?
Supracristal line passes through the body of L4
In which part (superficial or deep) of the dorsal horn do the spinothalamic and dorsal column tracts terminate?
Spinothalamic - superficial
Dorsal column - deep
Which descending tracts are involved in muscle movement?
Corticospinal and corticobulbar
What descending tracts are involved with muscle tone maintainance?
Reticulospinal
Tectospinal
Vestibulospinal
What commonly causes central cord syndrome?
Hyper extension injuries
Compression of the cord anteriorly by osteophytes and posteriorly by ligamentum flavum
Describe what brown-sequard syndrome is, and what commonly causes it.
Hemi-section of the cord
- stab wounds
- gunshot wounds
What does brown-sequard syndrome appear as clinically?
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)
What causes cauda equina syndrome?
Due to bony compression or disk protrusion in the lumbar or sacral regions
What clinical symptoms arise from cauda equina syndrome?
Back pain
Bowel and bladder dysfunction
Leg numbness/weakness
Saddles parasthesia
What is neurogenic shock?
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
What is the clinical triad for neurogenic shock?
Hypotension
Bradycardia
Hypothermia
What is the desired BP to assure good perfusion of the injured spinal cord?
85mmHG MAP
What are people with a spinal cord injury high risk for, and require prophylaxis for?
DVT
Pulmonary embolism
