S3_L1: Spinal Cord Injury Flashcards by MindMed Official

Most common vehicle in MVA that is associated with SCI

Motorbike / Motorcycle

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Category of Spinal cord injuries to the neural tissues like concussion, contusion, laceration, transection, hemorrhage and damage to blood vessels supplying spinal cord resulting in neurological deficits

Traumatic injuries

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This person fell from a horse & landed directly on the helmet, in a near-perpendicular position, resulting in a spinal cord injury. MOI: Running with high velocity > horse suddenly stopped > the individual continued to move forward then fell on the ground.

Christopher Reeve

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TRUE OR FALSE: The higher the spinal cord level is affected, the more disabling the impact of SCI is.

True

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TRUE OR FALSE: The more cranial the level of the spinal cord lesion is, the faster the recovery process.

False. More caudal, faster recovery

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Individuals with an incomplete neurological SCI have a longer life expectancy than those with a complete injury. Individuals with more caudal injuries have a lower life expectancy.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A. Only the 1st statement is true
for the 2nd statement to be true: they have a greater life expectancy

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The spinal cord exits the foramen magnum and extends
to approximately what vertebral level?

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In adults, the spinal cord ends in what structure?

conus medullaris

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At the end of the spinal cord, the cord becomes a mass of nerve roots known as the?

Cauda equina (Horse’s tail)

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TRUE OR FALSE: The spinal cord contains white matter, which consists of ascending sensory tracts, descending motor tracts, and an H-shaped central area of gray matter.

True

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Primary Descending Tracts: Major pathway for voluntary movements and is responsible for speed and agility of movements
A. Lateral corticospinal tract
B. Anterior corticospinal tract
C. Medial vestibulospinal tract
D. Lateral vestibulospinal tract
E. Both C and D

A. Lateral corticospinal tract

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Primary Descending Tracts: For voluntary movement of axial muscles. It has minimal clinical significance due to small size.
A. Lateral corticospinal tract
B. Anterior corticospinal tract
C. Medial vestibulospinal tract
D. Lateral vestibulospinal tract
E. Both C and D

B. Anterior corticospinal tract

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Primary Descending Tracts: For positioning of head and neck
A. Lateral corticospinal tract
B. Anterior corticospinal tract
C. Medial vestibulospinal tract
D. Lateral vestibulospinal tract
E. Both C and D

C. Medial vestibulospinal tract

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Primary Descending Tracts: For posture and balance. Inhibition of flexor and promotion of extensor muscle activity.
A. Lateral corticospinal tract
B. Anterior corticospinal tract
C. Medial vestibulospinal tract
D. Lateral vestibulospinal tract
E. Both C and D

E. Both C and D

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Primary Descending Tracts: For movement of limbs. Promotion of flexor and inhibition of extensor muscle activity.
A. Rubrospinal tract
B. Lateral reticulospinal tract
C. Medial reticulospinal tract
D. Tectospinal tract
E. Both B and C

A. Rubrospinal tract

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Primary Descending Tracts: For posture, balance, and automatic gait-related movements. Regulation to voluntary movements and reflexes.
A. Rubrospinal tract
B. Lateral reticulospinal tract
C. Medial reticulospinal tract
D. Tectospinal tract
E. Both B and C

E. Both B and C

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Ascending Tracts: Conveys proprioception, vibratory sensation, deep touch, two-point discrimination, and discriminative touch
A. Dorsal column medial lemniscal tract
B. Dorsal spinocerebellar tract
C. Ventral spinocerebellar tract
D. Both B and C

A. Dorsal column medial lemniscal tract

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Ascending Tracts: Conveys unconscious proprioception in joints and muscles
A. Dorsal column medial lemniscal tract
B. Dorsal spinocerebellar tract
C. Ventral spinocerebellar tract
D. Both B and C

D. Both B and C

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Ascending Tracts: Pain and temperature
A. Lateral spinothalamic tract
B. Anterior spinothalamic tract
C. Spino-olivary tract
D. Spinoreticular tract
E. Spinotectal tract

A. Lateral spinothalamic tract

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Primary Descending Tracts: Postural movements from visual stimuli
A. Rubrospinal tract
B. Lateral reticulospinal tract
C. Medial reticulospinal tract
D. Tectospinal tract
E. Both B and C

D. Tectospinal tract

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Ascending Tracts: Crude (light, non-discriminative) touch and pressure
A. Lateral spinothalamic tract
B. Anterior spinothalamic tract
C. Spino-olivary tract
D. Spinoreticular tract
E. Spinotectal tract

B. Anterior spinothalamic tract

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Ascending Tracts: Tactile, painful, and thermal stimuli
A. Lateral spinothalamic tract
B. Anterior spinothalamic tract
C. Spino-olivary tract
D. Spinoreticular tract
E. Spinotectal tract

E. Spinotectal tract

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Ascending Tracts: Integration of stimuli from joints and muscles into the reticular formation
A. Lateral spinothalamic tract
B. Anterior spinothalamic tract
C. Spino-olivary tract
D. Spinoreticular tract
E. Spinotectal tract

D. Spinoreticular tract

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Ascending Tracts: Additional information to the cerebellum as an accessory pathway.
A. Lateral spinothalamic tract
B. Anterior spinothalamic tract
C. Spino-olivary tract
D. Spinoreticular tract
E. Spinotectal tract

C. Spino-olivary tract

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Second order neuron of the dorsal column medial lemniscal tract

Nuclei gracilis and cuneatus

Second order neuron of the anterolateral spinothalamic tract

Substantia Gelatinosa

First order neuron of the anterolateral spinothalamic tract

Posterior/Dorsal Root Ganglion (Lissauer’s tract)

First order neuron of the dorsal column medial lemniscal tract

Posterior/Dorsal Root Ganglion

The H-shaped grey matter is arranged such that the: (1)___ section in each half contains neurons involved in sensory function, the (2)___ portion contains interneurons, and (3)___ section contains neurons involved in motor function (anterior horn cells) that project to the peripheral muscles.

1. dorsal 2. middle 3. ventral

Complete paralysis of all or part of the trunk and both lower extremities (LEs), resulting from lesions of the lumbar spinal cord or cauda equina.

Paraplegia

Tetraplegia or Quadriplegia refers to complete paralysis of all four extremities and trunk, including the respiratory muscles, and results from lesions of the ____ segment of the spinal cord.

cervical

ASIA ISNCSCI impairment: No sensory or motor function is preserved in the sacral segments S4-5. a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

a. A - Complete

ASIA ISNCSCI impairment: less than half of key muscle functions below the single NLI have a muscle grade ≥ 3. a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

c. C - Incomplete

ASIA ISNCSCI impairment: with at least half (half or more) of key muscle functions below the single NLI having a muscle grade ≥ 3 a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

d. D - Incomplete

ASIA ISNCSCI impairment: sensation and motor function are normal in all segments, and the patient had prior deficits. a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

e. E - Normal

ASIA ISNCSCI impairment: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-5 (light touch or pinprick at S4-5 or deep anal pressure), AND no motor function is preserved more than three levels below the motor level on either side of the body. a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

b. B - Incomplete

ASIA ISNCSCI impairment: Motor function is preserved at the most caudal sacral segments for voluntary anal contraction (VAC) a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

c. C - Incomplete

ASIA ISNCSCI impairment: patient has some sparing of motor function more than three levels below the ipsilateral motor level on either side of the body a. A - Complete b. B - Incomplete c. C - Incomplete d. D - Incomplete e. E - Normal

c. C - Incomplete

TRUE OR FALSE: A patient whose sensory input has returned has a good sign/prognosis.

True Additional: Progression of recovery: Sensory → Motor → Complete

TRUE OR FALSE: An incomplete lesion (ASIA B, C, or D) is a good prognostic indicator of a greater likelihood of recovery of motor function.

True

Even with complete lesions (ASIA A), 70% of patients with cervical-level injuries are likely to experience ___ level/s of motor recovery below the original neurological level.

one

Preservation of (1)___ sensation at (2)___ months after injury in the LEs or sacral region is associated with a good prognosis for motor recovery at 1 year after injury.

1. pinprick 2. four

Recovery of motor function generally plateaus around _____ months after spinal cord injury.

12 to 18

TRUE OR FALSE: A complete spinal cord injury is defined as having no sensory or motor function in the lowest sacral segments (S4 and S5).

True

Sensory and motor function at S4 and S5 are determined by?

Anal sensation and voluntary external anal sphincter contraction

Spinal cord injury described as having a motor and/or sensory function below the neurological level, including sensory and/or motor function at S4 and S5.

Incomplete

What must be present for an injury to be classified as incomplete?

Perianal sensation

Sacral sparing can be evaluated through 3 Tests. Enumerate these

1. (+) Perianal sensation 2. Able to flex the great toe 3. Voluntary control over the rectal sphincter muscle

TRUE OR FALSE: Patients with incomplete SCI display more abnormal tone or muscle spasticity than patients with complete SCI.

True

Decreased inhibition from ____ pathways may be the reason for abnormal tone or muscle spasticity.

descending supraspinal

Paralysis and sensory loss on the ipsilateral side of lesion as a result of damage to the lateral corticospinal tract A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

A. Brown Sequard Syndrome

Loss of motor function, proprioception, and vibration sense on the ipsilateral side as the injury due to damage to the dorsal column of the spinal cord A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

A. Brown Sequard Syndrome

Most common incomplete SCI, but has a good prognosis and pts typically achieve good functional gains during inpatient rehabilitation A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

A. Brown Sequard Syndrome

Has intact position and vibration sense due to separate vascular supply from the posterior spinal arteries A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

C. Anterior Cord Syndrome

Pts with this SCI require a longer length of stay during inpatient rehabilitation A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

C. Anterior Cord Syndrome

Damage to all 3 tracts (lateral corticospinal, DCML, lateral spinothalamic) and the UE are more involved than LE A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

B. Central Cord Syndrome

Pts with this SCI typically recover the ability to ambulate, however, may present with moderate to severe limitations in the ability to perform functional tasks due to some distal UE weaknesses and loss of fine motor control A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

B. Central Cord Syndrome

Loss of proprioception and vibration sense bilaterally A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

D. Dorsal Column or Posterior Cord Syndrome

Caused by compression of the posterior spinal artery by tumor or vascular infarction A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

D. Dorsal Column or Posterior Cord Syndrome

Considered as Lower Motor Neuron (LMN) Diseases or Peripheral Nerve Injuries (PNI) A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

E. Cauda Equina Injuries

Upper and lower motor neuron signs are possible — flaccidity, reflexion, loss of bowel and bladder function A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

E. Cauda Equina Injuries

In this condition, affected structures have the same potential to regenerate as peripheral nerves elsewhere in the body A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

E. Cauda Equina Injuries

Sensory affectation begins several dermatome segments below the level of injury. A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

A. Brown Sequard Syndrome Discrepancy in levels occurs because the lateral spinothalamic tracts ascend 2-4 segments on the same side before crossing

Caused by penetrating injuries such as gunshot or stab wounds A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

A. Brown Sequard Syndrome

In the Brown Sequard syndrome, what sensations are lost on the contralateral side due to damage to spinothalamic tracts?

Pain and temperature

Which part of the spinal cord has the least blood supply?

Anterior Greatest to least: Lateral, posterior, anterior

Cauda equina injuries are caused by direct trauma from a fracture dislocation below what spinal cord level?

Causes are flexion injury with fracture, dislocation of the cervical disc, protrusion of the vertebrae A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

C. Anterior Cord Syndrome

Presents with loss of motor function, pain sensation, and temperature below the lesion A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

C. Anterior Cord Syndrome

A hx of disc herniation or Degenerative Disk Disease (DDD) can lead to this syndrome A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

C. Anterior Cord Syndrome

Individuals who are weightlifters, who have RA of the spine or Pott's disease (TB of the spine) are at risk A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

C. Anterior Cord Syndrome

Causes are progressive stenosis and hyperextension injuries. It is also associated with congenital or degenerative narrowing of the spinal canal. A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

B. Central Cord Syndrome

Common in gymnasts or any sport that is prone to hyperextension of the neck A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

B. Central Cord Syndrome

Prognosis is average and patients usually become paraplegic A. Brown Sequard Syndrome B. Central Cord Syndrome C. Anterior Cord Syndrome D. Dorsal Column or Posterior Cord Syndrome E. Cauda Equina Injuries

B. Central Cord Syndrome

Central cord syndrome can be caused by fracture of the upper cervical spine due to hyperextension. The most common traumatic spondylolisthesis of C2 (a part of the atlanto-axial joint / "no" joint) is referred to as?

Hangman's fracture

Somatotopic arrangement of the spinal cord for the dorsal column medial lemniscal tracts A. Cervical most medial B. Thoracic most medial C. Lumbar most medial D. Sacral most medial

D. Sacral most medial

Somatotopic arrangement of the spinal cord for the lateral corticospinal tract A. Cervical most medial B. Thoracic most medial C. Lumbar most medial D. Sacral most medial

A. Cervical most medial

Somatotopic arrangement of the spinal cord for the spinothalamic tracts A. Cervical most medial B. Thoracic most medial C. Lumbar most medial D. Sacral most medial

A. Cervical most medial

One year after injury, what are the three most common secondary complications during rehabilitation of SCI?

1. Pressure ulcers 2. Pneumonia 3. Deep vein thrombosis

1. Injury to the central or peripheral nervous system 2. Due to overuse or poor posture and commonly occur in the shoulder, elbow, or wrist joint 3. Pain can be attributed to decreased flexibility, incorrect positioning in bed, older age, and higher body mass index 4. Can occur below, at, or above the level of the spinal cord lesion 5. Musculoskeletal or visceral pain A. Nociceptive pain B. Neuropathic pain C. Both D. Neither

1. B 2. A 3. A 4. B 5. A

Pain that is not caused by a painful stimulus (e.g., light touch, tickles)

Allodynia

Increased perception of pain from a painful stimulus

Hyperalgesia

Heterotrophic ossification most often occurs in what 2 joints of the body?

hip and knee joints

Osteoporosis is most common in what body structure?

Lower extremity

Deep vein thrombosis is due to a lack of mobility and active muscle contraction of the LEs. It is most common in which stage of recovery?

Acute Note: Anticoagulants are prescribed for this.

Most common symptom that will appear in SCI patients

Spinal shock

Orthostatic hypotension is usually only significant in people with SCI above what spinal cord level?

People with SCI below or within the ___ will exhibit a reduced exercise tolerance, lower stroke volume, and reduced cardiac output

thoracolumbar sympathetic output

What is the first aid when a pt experiences bradycardia?

Ankle pumping & wrist pumping (using a squeeze ball)

After damage to the spinal cord, the ____ can no longer control cutaneous blood flow or level of sweating.

hypothalamus Note: This impaired temperature control (autonomic, sympathetic dysfunction) results in loss of internal thermoregulatory responses. The ability to shiver below the level of the injury is also lost.

TRUE OR FALSE: Individuals with cervical-level injuries and complete injuries demonstrate more impairment with temperature control.

True

Immediately following SCI there is a period of total areflexia (total disconnection) in the first ___ hrs. Abrupt withdrawal of connections between higher centers and the spinal cord from level of neurologic lesion below.

Spinal shock is the absence of all reflex activity, and impairment of autonomic regulation resulting in what 3 symptoms?

1. Hypotension 2. Loss of control of sweating 3. Piloerection

In spinal shock, there is gradual return of reflexes how many days after injury?

1 to 3

In spinal shock, there is a period of increasing hyperreflexia lasting (1)___ weeks, followed by final hyperreflexia lasting (2)___ months after injury.

1. 1 to 4 2. 1 to 6

Disruption of all the ____ fibers following SCI results in impaired or absent sensation below the level of the lesion

ascending sensory

This type of fibers is commonly the first to be affected following a SCI, but also the first to recover/return

Sensory fibers

In addition to the loss of deep tendon reflexes, there is (-) bulbocavernosus reflex, cremasteric reflex, Babinski response, and a delayed plantar response. A. Spinal shock B. Autonomic dysreflexia C. Impaired temperature control D. Spastic hypertonia

A. Spinal shock

(+) reflexogenic stimulation, but psychogenic response is (-). Reflex arc remains intact. A. Female pt with UMNL B. Female pt with LMNL C. Male pt with UMNL D. Male pt with LMNL

A. Female pt with UMNL

The menstrual cycle typically is interrupted for a period of 4 to 5 months following injury, goes back at the 6th month. A. Female pt with UMNL B. Female pt with LMNL C. Male pt with UMNL D. Male pt with LMNL

B. Female pt with LMNL Note: Higher chances of getting pregnant. PT's role is to inform her about this.

Erectile capacity is greater, but unable to ejaculate. A. Female pt with UMNL B. Female pt with LMNL C. Male pt with UMNL D. Male pt with LMNL

C. Male pt with UMNL

Higher incidence of ability to ejaculate A. Female pt with UMNL B. Female pt with LMNL C. Male pt with UMNL D. Male pt with LMNL

D. Male pt with LMNL

Erection caused by external physical stimulation of the genitals or perineum (touch)

Reflexogenic

Erection through cognitive ability stimulation (touch and imagine)

Psychogenic Additional: 45% of men with SCI report achieving orgasm with this type of erection.

Bladder and bowel dysfunction is usually seen in ___ lesions.

Caudal

____ testing is done after spinal shock resolves, approximately 3 months after injury, to help diagnose the specific type of bladder dysfunction and guide the selection of management strategies.

Urodynamic

1. Seen in S2-S4 or cauda equina lesion 2. Contraction and reflexive emptying of bladder in response to certain level of feeling 3. Cannot control micturition, no action from detrusor muscle 4. In lesions above S2 A. Hyperreflexic / Spastic reflex bowel B. Hyperreflexive / Spastic bladder C. Flaccid or areflexic bowel D. Flaccid / Areflexic bladder

1. C 2. B (Lesion above conus medullaris) 3. D (Lesion occurring in conus medullaris) 4. A

Technique used to void urine from the bladder of an individual who, due to disease, cannot do so without aid

Crede’s maneuver

Rapid bone mineral loss in the first 4 to 6 months after injury due to a combination of no (or limited) muscle action and limited (or no) weight bearing

Osteoporosis

What are the 4 risk factors for fractures in SCI?

1. Female 2. Lower body mass index 3. Paraplegia 4. Complete injury

Early symptoms of heterotrophic ossification: 1. Swelling 2. (1)___ pain 3. (2)___ ROM 4. Erythema 5. Local (3)___ near a joint

1. Joint and muscle 2. Decreased 3. warmth

TRUE OR FALSE: In females, those with LMN are less likely to achieve orgasm than those with UMN. Signs of fertility disappear in female SCI pts.

True

Increased collagen formation that is related to a complete SCI, trauma, severe spasticity, UTI, pressure sores, and forceful movements.

Heterotrophic ossification

Autonomic dysreflexia is a pathological autonomic reflex that can be life threatening. Typically, it occurs in lesions above ___

T6 (above the sympathetic splanchnic outflow).

Autonomic dysreflexia is most common in (1)___ injury and (2)___ stage of recovery.

1. complete 2. chronic (more than 3-6 mos after injury) Note: AD may also occur in the early stages after SCI.

Top complaint in Autonomic Dysreflexia

Pain

TRUE OR FALSE: In autonomic dysreflexia, above the level of lesion (e.g., T5), there is signs of flushing, vasodilation, and oversweating, while below the lesion, there is vasoconstriction and heat.

True

Impaired sensory function and the inability to make appropriate and timely positional changes are influential factors in the development of ___

pressure sores

Common sites of pressure sores in side-lying, supine, and sitting

Side-lying: lateral malleolus, greater trochanter Supine: Sacrum, heels Sitting: Ischial tuberosities

Prevalence of SCI demographics: gender and ethnic distribution

Male and non-Hispanic Whites

Average age of SCI

43 years old

A ___ SCI will result in a loss of sympathetic communication between the brainstem and the heart, while parasympathetic input remains intact. This causes bradycardia and dilation of the peripheral vasculature below the level of the lesion.

rostral

Paralysis or paresis of the scalenes and intercostal muscles also results in the development of an altered breathing pattern, known as ___

paradoxical breathing pattern: hyperactive movement of the diaphragm and all inspiration muscles (since diaphragm is weak), abs are collapsed

With high spinal cord lesions at C1 and C2, ___ nerve innervation and spontaneous respiration are lost

phrenic Additional: Injuries at C5–C8 have a fully innervated diaphragm, as well as many accessory muscles. Pulmonary impairment increases with the more rostral the injury. Individuals with weak or absent abdominal and intercostal musculature will have impaired airway clearance ability and be at a greater risk for developing pneumonia and atelectasis (lung collapse).

What are the most and least mobile segments of the spine?

Most mobile: Cervical Least mobile: Thoracic

Site of decussation for corticospinal tract

Spinal cord Note: It does not follow the rule of decussation (where the tract decussates on the second order neuron)

Site of decussation for sensory ascending pathways

Second order neuron (Substantia gelatinosa for spinothalamic tracts, nuclei cuneatus and gracilis for DCML)

Commonly used OMT for SCI 1. Modified ashworth scale 2. Grasp and release test 3. Walking index for spinal cord injury II 4. 6 minute arm test 5. Spinal cord injury independence measure A. Self care and home management B. Muscle performance C. Motor function D. Environmental or work barriers, gait, locomotion, and balance E. Aerobic capacity / endurance

1. C 2. B 3. D 4. E 5. A

A patient is graded AIS C on T5 level due to transverse myelitis. The SCI is incomplete. Document the result of the ASIA ISCOS.

Atraumatic INC SCI 2' Transverse Myelitis c ASIA classification of AIS C on T5 level.