SCI Flashcards
Grey matter contains:
2 anterior (ventral) horns - efferent motor neurons (alpha motor neurons to muscles and gamma motor neurons to muscle spindles)
2 posterior (dorsal) horns - afferent sensory neurons with cell bodies located in the dorsal root gangilia
White matter contains:
anterior (ventral), lateral, and posterior (dorsal) white columns/funiculi
ascending pathways (4)
sensory pathways
dorsal columns - proprioception, vibration, tactile
spinothalamic - pain and temperature, crude touch
spinocerebellar - proprioception, deep touch, pressure
spinoreticular - deep and chronic pain
descending pathways (5)
motor pathways
corticospinal - voluntary motor control
vestibulospinal - control of muscle tone, antigravity muscles, postural reflexes
rubrospinal - assists in motor function
reticulopsinal - modifies transmission of sensation, especially pain
tectopsinal - head turning responses to visual stimuli
complete cord lesion: UMN lesion
complete bilateral loss of sensation and motor function with spastic paralysis below level of lesion
loss of bladder and bowel (spastic)
central cord lesion: UMN lesion
loss of spinothalamic tracts (bilateral loss of pain and temp)
loss of ventral horn with b loss motor function (UEs)
*preservation of proprioception and discrimination sensation
Brown-Sequard Syndrome: UMN lesion
hemisection of SC; caused by trauma
ipsilateral loss of dorsal columns - loss of tactile, pressure, vibration, proprioception
ipsilateral loss of corticospinaltracts - loss of motor function and spastic paralysis below lesion
contralateral loss of spinothalamic tract - loss of pain/temp below lesion
Anterior cord syndrome: UMN lesion
loss of lateral cortciospinal tracts - b loss of motor function, spastic paralysis below lesion
b loss spinothalamic (pain and temp)
*preservation of dorsal columns: proprioception, kinesthesia, vibration
Posterior cords syndrome: UMN lesion
B loss of proprioception, vibration, pressure, stereognosis, 2 point discrimination
*preservation of motor function, pain, and light touch
Cauda equina injury: LMN lesion
loss of long nerve roots at or below L1
variable nerve root damage; incomplete lesions common
flaccid paralysis or bowel/bladder
no spinal reflex activity
potential for nerve regeneration
CNS/PNS
CNS - brain and spinal cord (UMN)
PNS - cranial nerves and spinal nerves (LMN)
UMN lesion (general symptoms)
- stroke, TBI, SCI
- hypertonia
- hyperreflexia, clonus, exaggerated reflexes
- muscle spasms
- velocity dependent
- voluntary movements impaired or absent
- stroke and corticospinal lesions - contralateral weakness; SC lesion bilateral loss below level
LMN lesion (general symptoms)
- polio, guillan barre, PNI, neuropathy, radioculopathy
- hypotonia, flaccidity
- not velocity dependent
- hyporeflexia
- fasciculations
- neurogenic atrophy (rapid/severe wasting)
classification of SCI - ASIA Impairment scale
A = complete (no sensory/motor function)
B = incomplete (no motor function; sensory is preserved below the level)
C = incomplete (motor function preserved below level with muscle grade below 3/5)
D = incomplete (motor function preserved below level with muscle grade equal/greater than 3/5)
E = normal (sensory and motor function)
Conus medullaris
injury of sacral cord and lumbar nerve roots
LE motor and sensory loss
areflexic bowel/bladder
complications of SCI
- respiratory: pneumonia
- ulcers
- orthostatic hypotension: excessive drop in BP when upright (lay back down)
- DVTs (can turn into a PE, life threatening)
- autonomic dysreflexia: extreme rise in BP, pounding headache, profuse sweating (med emergency, must find the cause/stimulus, keep them sitting up)
medical management of SCI
- pressure relief/weight shifts
- proper care for bowel/bladder, cauterization
- skin checks
- know signs of AD
- prevent heterotypic ossification: joint ROM
C1-C3
- ventilator is a MUST
- only head and neck movement (neck flex, ext, rotation)
- need total assistance 24/7
- power wheelchair that tilts/reclines for pressure relief
- head/chin/puff control for w/c
C4
- have diaphragm function, can breathe independently
- shoulder elevation
C3,4,5 keep the diaphragm alive
C5
- needs universal cuff (no wrist or hand movements)
- can flex elbows (has innervation to the biceps)
- can begin participating in some ADLs
- wrist cock up splint, long opponent splint, dorsal wrist splint to attach u cuff
- mobile arm splint/device
- suspension sling
- wheelchair: arm drive control
C6
- tenodesis grasp (has wrist extension!!)
- power w/c with arm drive control or a manual lightweight rigid or folding frame with modified rims
C7
- has triceps
- can push up and lift with elbow extension
C8
- wrist flexion and finger flexion, some thumb movement
- more independence
- independent with ADLs, greater hand function
T1
- ab/adduction of fingers
- jazz hand
T1-6
- full use of arms
- risk of AD (T6 and above)
T7-12
“crunch”
- AD no longer a concern
- core control
L1-5
“kick” muscles
- hip flexion
- knee extension
- dorsiflexion
S1-5
“skip”
- plantar flexion
- hip extension
- knee flexion
- bowels
C6 and C7 tenodesis splint
wrist driven flexor hinge splint
