SCI Flashcards
Flexion injuries occur most often at which spinal levels?
Extension injuries occur most often at which spinal levels?
What are some other mechanisms for spinal cord damage?
C5-C6
C4-C5
axial loading and rotatory injuries
SCI will have a primary area of damage and then a secondary area that can…
extend multiple segments beyond initial segment
Anterior cord syndrome
compression of anterior portion or spinal artery
caused by cervical flexion
loss of motor function and pain and temp below lesion due to damage of corticospinal and spinothalamic tracts
Brown-Sequard syndrome
caused by stab wound
paralysis and loss of vibratory and position sense on the same side as the lesion because of corticospinal and dorsal column tracts.
loss of pain and temp on opposite side from spinothalamic tract
pure brown-sequard is rare
Cauda Equina injuries are below what level?
They are…
it is considered what kind of injury?
Characteristics?
L1
incomplete
peripheral nerve injuries
flaccidity, areflexia, and impairment of bowel and bladder function.
Full recovery is not typical due to distance needed for axonal regneration
Central cord syndrome
due to cervical hyperextension damages spinothalamic, corticospinal and dorsal columns.
UE present with greater involvement and greater motor deficits
Posterior cord syndrome
relatively rare
caused by compression to posterior spinal artery
loss of proprioception, two-point discrimination and stereognosis.
Motor function is preserved
ASIA Scale:
A
complete
no sensory or motor preserved in sacral segments S4-S5
ASIA Scale:
B
sensory incomplete
sensory function preserved below neurological level including S4-S5 AND no motor function preserved more than 3 levels below on either side
ASIA Scale:
C
Motor incomplete
motor function preserved for voluntary anal contraction OR
pt meets sensory incomplete and has motor function more than 3 levels below motor level on either side.
Less than half the muscles below neurologic level have a grade greater than or equal to 3.
ASIA Scale:
D
Motor incomplete
C but with half or more of key muscles functions below having a muscle grade of greater than or equal to 3.
ASIA Scale:
E
normal
Motor level
most caudal key muscles that have muscle strength of 3 or more with the superior segment tested as normal 5.
Motor index scoring
testing each key muscle using 0-5 scaling totaling 25 points per extremity for total of 100
Sensory level
determined by most caudal dermatome with normal score of 2/2 for pinprick and light touch
Key muscles tested:
C5
elbow flexors (biceps, brachialis)
Key muscles tested:
C6
wrist extensors (extensor carpi radialis longus and brevis)
Key muscles tested:
C7
elbow extensors (triceps)
Key muscles tested:
C8
finger flexors (flexor digitorum profundus) to the middle finger
Key muscles tested:
T1
small finger abduction (abductor digiti minimi)
Key muscles tested:
L2
hip flexors (iliopsoas)
Key muscles tested:
L3
knee extensors (quads)
Key muscles tested:
L4
DF (anterior tib)
Key muscles tested:
L5
long toe extensors (extensor hallucis longus)
Key muscles tested:
S1
ankle plantar flexors (gastroc and soleus)
Sensory testing for light touch and pinprick
see photo
Complications with SCI
DVT
ectopic bone
orthostatic hypotension
pressure ulcers
spasticity
DVT prevention
prophylactic anticoagulant therapy
maintaining positioning schedule
ROM
proper positioning to avoid excessive venous stasis and use of elastic stockings
DVT is suspected then what
no active or passive movement
bed rest and anticoagulant therapy
Autonomic Dysreflexia
occurs in pts with SCI in T6 or above
sudden elevation in BP
caused by distended or full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, extreme temp changes, tight clothing or ingrown toenail
Symptoms of Autonomic Dysreflexia
HBP, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, vasodilation above level of injury.
How to treat Autonomic Dysreflexia
immediately check the catheter
lying the patient down is a contraindication
potentially check for bowel obstruction
pt should receive immediate medical intervention
Ectopic bone is aka
heterotrophic ossification
Ectopic bone typically occurs where?
Symptoms?
larger joints like knees and hips
edema, decreased ROM, increased temp of involved joint
Orthostatic hypotension is due to …
What is common during early stages of rehab?
Decrease of how much systolic BP and how much diastolic BP is considered orthostatic?
loss of sympathetic control of vasoconstriction in combo with absent or severely reduced muscle tone.
venous pooling
20 mmHg
10 mmHg
Pressure ulcers common areas
coccyx, sacrum, ischium, trochanter, elbows, buttocks, malleoli, scapulae, and prominent vertebrae
How often should they change positions to avoid pressure ulcers?
How often should weight shift?
2 hours
15-20 min
How can spasticity be enhanced?
Symptoms?
internal and external sources: stress, decubiti, UTI, bowl or bladder obstruction, temp changes or touch
increased tonic stretch reflexes and exaggerated DTRs