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
Bed Mobility levels of assist for High Tetraplegia (C1-C5)
dependent (C1-C4)
Moderate to max assist (C5)
Bed Mobility levels of assist for mid-level tetra (C6)
minimal assist to mod I with equipment
Bed mobility levels of assist for low tetra (C7-C8)
independent
Bed mobility levels of assist for paraplegia
independent
Transfers level of assist for high tetra (C1-C5)
dependent (C1-C4)
max A with level slide board transfer (C5)
Transfers level of assist for mid-level tetra (C6)
min A to mod I for slide board transfers
dep with w/c loading
dep with floor transfers and uprighting w/c
Transfers level of assist for low tetra (C7-C8)
mod I to I with level surface slide board
Mod A to Mod I with car transfer
Max to Mod A with floor transfers and uprighting w/c
Transfer level of assist for paraplegia
Indep with level surface and car transfers
minA to I with floor transfers and uprighting w/c
Weight shift level of assist for high tetra (C1-C5)
setup to Mod I with power recline
dep with manual
Weight shift level of assist for mid-level tetra (C6)
Mod I with power recline
Min A to Mod I with manual
Weight shift level of assist for low tetra (C7-C8)
Mod I with side to side, forward lean and depression
Weight shift level of assist for paraplegia
Mod I for depression weight shift
W/c management level of assist in high tetra (C1-C5)
dependent
W/c management level of assist in mid-level tetra (C6)
some assistance
W/c management level of assist in low tetra (C7-C8)
may require assistance with cushion adjustment, anti-tip levers, and w/c maintenance
W/c management level of assist in paraplegia
independent
w/c mobility level of assist in high tetra (C1-C5)
Sup/setup to Mod I on smooth, ramp and rough terrain in power w/c
Mod I with manual w/c on smooth surface (C5)
Max A to Dep with manual w/c in all other situations
w/c mobility level of assist in mid-level tetra (C6)
Mod I in smooth, ramp and rough terrain in power w/c
dep to max A up/down curb with power w/c
Mod I on smooth surface in manual w/c
Mod to min A on ramps and rough terrain with manual w/c
max to mod A up/down curbs with manual w/c
w/c mobility level of assist in low tetra (C7-C8)
Mod I on smooth, ramp and rough terrain with power w/c.
Dep to Max A up/down curb with power w/c.
Mod I on smooth surfaces and up/down ramps with manual w/c.
Min A to Mod I on rough terrain.
Mod to Min A up/down curbs with manual w/c.
Dep to Max A up/down steps with manual w/c
w/c mobility level of assist in paraplegia
min A to Mod I up/down 6” curbs in manual w/c.
Mod I with descending steps with manual w/c.
Max to min A to ascend steps with manual w/c.
Gait level of assist in paraplegia
exercise only with KAFO
household gait with KAFO
limited community gait with KAFO or AFO
functional community ambulation with or without orthoses
ROM/positioning level of assist in high tetra (C1-C5)
dependent
ROM/positioning level of assist in mid-level tetra (C6)
mod A to mod I with all
ROM/positioning level of assist in low tetra (C7-C8)
Min A to mod I with all
ROM/positioning level of assist in paraplegia
indepenent
Feeding level of assist in high tetra (C1-C5)
dependent (C1-C4)
Min A with adaptive equipment in C5
Feeding level of assist in mid-level tetra (C6)
Mod I with adaptive equipment
Feeding level of assist in low tetra (C7-C8)
Mod I with adaptive equipment (C7)
Feeding level of assist in paraplegia
independent
Grooming level of assist in high level tetra (C1-C5)
dependent (C1-C4)
Min A with adaptive equipment for face, teeth, makeup/shaving (C5)
Max/mod A for assistance for hair grooming (C5)
Grooming level of assist in mid-level tetra (C6)
mod I with adaptive equipment
Grooming level of assist in low level tetra (C7-C8)
Mod I
Grooming level of assist in paraplegia
Independent
Dressing level of assist in High tetra (C1-C5)
dependent
Dressing level of assist in mid-level tetra (C6)
Mod I for upper body in bed or w/c.
Min A with lower body dressing in bed.
Moderate A with lower body undressing in bed.
Dressing level of assist in low tetra (C7-C8)
Mod I for upper/lower body dressing in bed.
Min A with lower body dressing/undressing in w/c (C7).
Mod I for upper/lower body dressing and undressing in w/c (C8).
Dressing level of assist in paraplegia.
Mod I
Bathing level of assist in high tetra (C1-C5)
dependent
Bathing level of assist in mid-level tetra (C6)
Min A for upper body bathing and drying.
Mod A for lower body bathing and drying.
Use of shower or tub chair.
Bathing level of assist for low tetra (C7-C8)
Mod I with all using shower or tub chair
Bathing level of assist for paraplegia
Mod I with all on tub bench or tub bottom cushion
Bowel/bladder problems level of assist for high tetra (C1-C5)
dependent
Bowel/bladder problems level of assist for mid-level tetra (C6)
Bladder:
Min A for male in bed or w/c
Mod A for female in bed
Bowel:
Mod A with use of equipment
Bowel/bladder problems level of assist for low tetra (C7-C8)
Bladder:
Mod I for male in bed or w/c
Mod I for female in be; Mod A for female in w/c.
Bowel:
Min A to mod I with use of equipment
Bowe/bladder problems for paraplegia
Bladder:
Mod I for male and female
Bowel:
Mod I for male and female
Head-hip relationships
when transferring, head to move in opposite direction of hips
Myelotomy
severs certain tracts within spinal cord in order to decrease spasticity and improve function
Neurectomy
removal of segment of a nerve in order to decrease spasticity and improve function
Neurogenic nonreflexive bladder
bladder is flaccid as a result of cauda equina or conus medullaris lesion. sacral reflex arc in damaged
Neurogenic reflexive bladder
empties reflexively for a patient with injury above T12. Sacral reflex arc remains intact
Paradoxical breathing
abnormal breathing
common in tetraplegia
Inspiration: abdomen rises and chest pulled inward
Expiration: abdomen falls and chest expands
Rhizotomy
resection of sensory component of a spinal nerve to decrease spasticity
Spinal shock
occurs 30-60 minutes after trauma to spinal cord and can last several weeks. Presents with total flaccidity and loss of all reflexes below level.
Tenodesis
tetra
do not possess control for grip but utilize the flexed fingers for grip
Tenotomy
release of tendon
Tetraplegia
cervical spine
Paraplegia
thoracic, lumbar, sacral
Gait training can be done in those with injury at ___ or lower.
T9
