SCI Flashcards
SCI is more prevalent in (males/females)
males (80%)
What age range does SCI most commonly occur?
16-30 y/o
definition: damage due to impingement by bony or soft tissue structures in the vertebral column
vertebral injury
(true/false) non-penetrating injuries can still penetrate blood vessels.
true
(true/false) the spinal cord has to be severed for irreversible damage
FALSE
(true/false) Trauma that results in bruising or hemorrhaging of the spinal cord can often cause neurological damage that is just as complete as a severed cord.
true
definition: neuronal damage to cell bodies and axons
primary injury
Where does most damage occur? Primary or secondary injury?
secondary injury
definition: injury/damage that may last from several days to 4 weeks- ______ damage is most prevalent in the gray matter and then spreads outward into the white matter as time passes.
secondary injury
What are the underlying mechanisms of secondary damage?
Ischemia (injury to BV)
inflammation (contributes to expansion of the lesion)
ion derangement (abnormal sodium and potassium levels)
definition: programmed cell death
apoptosis
When does apoptosis occur with trauma? How long does it occur?
4-6 hours after trauma
- occurs for 24 hours at the level of injury
Apoptosis occurs after (cns/pns) injury
CNS injury
How long can apoptosis occur for if the site of injury is rostral or caudal?
up to 3 weeks
definition: spinal reflexes, voluntary motor and sensory function is absent or depressed after injury
spinal shock
Spinal shock occurs (caudal/rostral) to the lesion
caudal
What are the 2 predictors of motor return?
- degree of impairment
- preserved motor function
(true/false) It is possible to predict motor return within the 24 hours after the injury.
FALSE (wait 72 hours to 1 week)
definition:
- Axonal sprouting
Alterations of neuronal function:
- Unmasking of latent pathways
- Changes in conductive velocity
- Responsiveness to neurotransmitters
plasticity
definition: plasticity in response to afferent input
“use it or lose it”
- task specific
Activity dependent plasticity
Tetraplegia is damage to the nervous tissue in the ___ region of the spinal cord.
cervical
definition: Refers to impairment or loss of motor and/or sensory function in the UE AND LE, trunk, and pelvic organs
tetraplegia
Paraplegia is damage to nervous tissue in the _____ regions of the spinal cord.
Thoracic, lumbar, or sacral
With paraplegia, Motor and sensory function is normal in the (UE/LE).
UE
definition: Most caudal level of the SC that exhibits intact sensory and motor function bilaterally
neurologic level of injury
definition: Lesion where some sensory and/or motor function is preserved below the level of the lesion
*includes preserved function in the lowest sacral segments of the spinal cord (S4, S5) *
incomplete lesion
definition: lesion where both sensory and motor function are absent in S4 and S5
complete lesion
definition: Refers to partial preservation (or sparing) of function in dermatomes and myotomes caudal to the neurological level
zone of partial preservation
Central cord syndrome is almost always in the ____ region.
cervical
Central cord syndrome has more pronounced weakness in the (UE/LE)
UE
(true/false) central cord syndrome spares sensation in the sacral region.
true
definition: Results from damage to central aspect of the spinal cord
central cord syndrome
(true/false) peripheral aspects are NOT spared when a patient has central cord syndrome.
FALSE
definition: When one side of the spinal cord is damaged
brown-séquard syndrome
Brown- séquard syndrome is common for (incomplete/complete) lesions.
incomplete
definition:
- Preserved proprioception
Variable loss of:
- Motor function
- Pain
- Temperature
Results from damage to the anterior and anterolateral areas of the spinal cord
anterior cord syndrome
definition: Results from damage to the sacral cord and lumbar nerve roots
conus medullaris syndrome
Patients with conus medullaris syndrome mostly exhibit flaccid paralysis of the (UE/LE) along with areflexic bowel and bladder function
LE
definition:Results from injury to the cauda equina, lumbar and sacral nerve roots
- Exhibit flaccid paralysis of the LE
- Areflexic bowel and bladder
- Pattern may vary depending on where the damage occurs
cauda equina syndrome
What is the best diagnostic test to look at spinal cord compression and changes in spinal cord tissue?
MRI
What are surgical indications for Fx?
- Unstable fracture that will not reduce without surgery
- Gross spinal misalignment
- Evidence of continued cord compression with an incomplete injury
- Deteriorating neurological status
- Continued instability following conservative management
The spine is often fused with bone grafts from where?
iliac crest
fibula
spinous processes
What cervical spinal orthoses are most effective for preventing cervical motion?
Halo and Minerva
Autonomic dyslexia often occurs in lesions above ___.
T6
Autonomic dysreflexia often occurs ___ months or more after initial injury.
6 months or more
What are s/s of autonomic dysreflexia?
- Elevated BP
- Bradycardia
- pounding HA
- Sweating above the lesion
- Vasodilation above the lesion
What should you do if you identify s/s of autonomic dysreflexia?
- Place patient in upright position with legs dependent
- Remove source of problem
definition: elevation of the umbilicus when abdominal contraction occurs.
Beevor’s sign
Beevor’s sign is common with _____ segmental lesions.
T5-T12 lesions
(true/false) With SCI, both men and women have an equal change of becoming infertile.
FALSE (men have a higher possibility of becoming infertile)
Soon after SCI, ___ can occur due to peripheral vasodilation.
hypothermia (can be replaced by the tendency to move toward hyperthermia)
Performance-based measure designed to objectively evaluate manual wheelchair skills and safety
Multiple versions of this measure
- manual chairs
- powered chairs
- scooters
- both wheelchair users and their caregivers
–may be administered by a tester/trainer that supervises and scores the test or in self-report/questionnaire form (WST-Q)
Wheelchair skills test (WST)
What levels do NOT have myotomes or dermatomes?
C1-C4
T2-L1
S2-S5
For the ASIA scale, intact innervation is considered when the patient exhibits what?
3/5 or more strength
AND
The next rostral key muscle exhibits 5/5 strength
- a clinician-administered, self-report and performance-based SCI-specific ambulation measure focusing on gait abnormalities
Areas measured consist of:
- gait parameters, assistive device use, and walking mobility
only applies to SCI individuals who CAN ambulate independently
The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)
- Functional capacity scale designed to measure improvements in ambulation in persons with SCI
- Evaluates the amount of physical assistance, braces or devices required to walk 10 meters
- A score is possible even if the individual cannot walk 10m because the furthest walk distance is 10m, it may not be suitable for individuals with minor impairments
Walking Index for Spinal Cord Injury II (WISCII)
- A 2-component self-report measure of the frequency of reported muscle spasms, which is commonly used to quantify spasticity.
- was developed to augment clinical ratings of spasticity and provide a more comprehensive understanding of an individual’s spasticity status
- self-report measures of spasticity, in general, correlate only moderately with clinical examination
Penn Spasm Frequency Scale (PSFS)
ASIA score ___: patient has a complete impairment with no motor or sensory function
ASIA A
ASIA score ___: patient only has sensation
ASIA B
ASIA score ___: patient has minimal motor function below the lesion along with sensation
ASIA C
ASIA score ___: patient has a high degree of functional potential
ASIA D and E
