SCI

Question 1

Grey matter contains:

Answer 1

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

Question 2

White matter contains:

Answer 2

anterior (ventral), lateral, and posterior (dorsal) white columns/funiculi

Question 3

ascending pathways (4)

Answer 3

sensory pathways

dorsal columns - proprioception, vibration, tactile
spinothalamic - pain and temperature, crude touch
spinocerebellar - proprioception, deep touch, pressure
spinoreticular - deep and chronic pain

Question 4

descending pathways (5)

Answer 4

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

Question 5

complete cord lesion: UMN lesion

Answer 5

complete bilateral loss of sensation and motor function with spastic paralysis below level of lesion
loss of bladder and bowel (spastic)

Question 6

central cord lesion: UMN lesion

Answer 6

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

Question 7

Brown-Sequard Syndrome: UMN lesion

Answer 7

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

Question 8

Anterior cord syndrome: UMN lesion

Answer 8

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

Question 9

Posterior cords syndrome: UMN lesion

Answer 9

B loss of proprioception, vibration, pressure, stereognosis, 2 point discrimination
*preservation of motor function, pain, and light touch

Question 10

Cauda equina injury: LMN lesion

Answer 10

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

Question 11

CNS/PNS

Answer 11

CNS - brain and spinal cord (UMN)
PNS - cranial nerves and spinal nerves (LMN)

Question 12

UMN lesion (general symptoms)

Answer 12

• 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

Question 13

LMN lesion (general symptoms)

Answer 13

• polio, guillan barre, PNI, neuropathy, radioculopathy
• hypotonia, flaccidity
• not velocity dependent
• hyporeflexia
• fasciculations
• neurogenic atrophy (rapid/severe wasting)

Question 14

classification of SCI - ASIA Impairment scale

Answer 14

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)

Question 15

Conus medullaris

Answer 15

injury of sacral cord and lumbar nerve roots
LE motor and sensory loss
areflexic bowel/bladder

Question 16

complications of SCI

Answer 16

• 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)

Question 17

medical management of SCI

Answer 17

• pressure relief/weight shifts
• proper care for bowel/bladder, cauterization
• skin checks
• know signs of AD
• prevent heterotypic ossification: joint ROM

Question 18

C1-C3

Answer 18

• 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

Question 19

C4

Answer 19

• have diaphragm function, can breathe independently
• shoulder elevation
  C3,4,5 keep the diaphragm alive

Question 20

C5

Answer 20

• 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

Question 21

C6

Answer 21

• tenodesis grasp (has wrist extension!!)
• power w/c with arm drive control or a manual lightweight rigid or folding frame with modified rims

Question 22

C7

Answer 22

• has triceps
• can push up and lift with elbow extension

Question 23

C8

Answer 23

• wrist flexion and finger flexion, some thumb movement
• more independence
• independent with ADLs, greater hand function

Question 24

T1

Answer 24

• ab/adduction of fingers
• jazz hand

Question 25

T1-6

Answer 25

• full use of arms
• risk of AD (T6 and above)

Question 26

T7-12

Answer 26

“crunch”
- AD no longer a concern
- core control

Question 27

L1-5

Answer 27

“kick” muscles
- hip flexion
- knee extension
- dorsiflexion

Question 28

S1-5

Answer 28

“skip”
- plantar flexion
- hip extension
- knee flexion
- bowels

Question 29

C6 and C7 tenodesis splint

Answer 29

wrist driven flexor hinge splint