SCI Flashcards
DCML Tract controls…
-Fine touch
-Proprio
-Vibration
2-pt Discrimination assesses what? Explain the procedure
DCML
Ability to discern whether 2 separate objects versus just one touching the skin
Sterognosis assesses what? Explain the procedure
DCML
Identify objects with eyes closed
Barognosis assesses what? Explain the procedure
DCML (pressure)
Put 2 objects in each hand, identify which is heavier
Graphesthesia assesses what? Explain the procedure
DCML
Like drawing on the back & have them guess
Anterior Spinothalamic Tract controls…
Crude touch
Crude touch vs fine touch
Crude = just yes or no
Fine = localizing where the touch is
Lateral Spinothalamic Tract controls…
Pain & temp
Corticospinal Tract controls…
Motor function
Posterior SCI Syndrome: MOI
Iatrogenic (medical error)
Posterior SCI Syndrome: tract(s) involved
DCML (usually bilateral)
Posterior SCI Syndrome: what is impaired
-Proprio
-Fine touch
-Vibration
Sxs on the same side (if unilateral)
Anterior SCI Syndrome: MOI
Hyperflexion
Anterior SCI Syndrome: tract(s) involved
Spinothalamic & Corticospinal (usually bilateral)
Anterior SCI Syndrome: what is impaired?
-Pain & temp (opp side if unilateral)
-Motor (same side if unilateral)
Brown Sequard Syndrome: MOI
Hemi-section (gunshot, stab)
Brown Sequard Syndrome: tract(s) involved
DCML
Spinothalamic
Corticospinal
Brown Sequard Syndrome: what is impaired?
Same side: sensory & motor
Opp side: pain & temp
Central SCI Syndrome: MOI
Hyperextension
Central SCI Syndrome (small lesion): tract(s) involved
Lateral spinothalamic
Central SCI Syndrome (large lesion): tract(s) involved
DCML
Lateral Spinothalamic
Anterior Spinothalamic
Corticospinal
Central SCI Syndrome (small lesion): what is impaired?
Pain & temp (bilateral)
Central SCI Syndrome (large lesion): what is impaired?
Partial loss of everything (bilateral).
UE motor more affected bc central part of corticospinal = UE.
Conus Medullaris vs Cauda Equina: location
Conus Medullaris: end of spinal cord (~L1)
Cauda Equina: horse tail, nerves extending down
Conus Medullaris vs Cauda Equina: presents like
Conus Medullaris: UMN + LMN
Cauda Equina: LMN
Conus Medullaris vs Cauda Equina: symmetry of sxs
Conus Medullaris: bilateral symmetric
Cauda Equina: unilateral asymmetric
Conus Medullaris vs Cauda Equina: key symptoms
Both: saddle anesthesia, bowel/bladder
Conus Medullaris vs Cauda Equina: medical emergency?
Both = YES
Key differentiation between Complete vs Incomplete SCI
Complete: NO sensory or motor function at S4-S5 (perineal).
Incomplete: “sacral sparing” - sensory and/or motor intact at S4-S5
ASIA Motor Level
Lowest level that has at least 3/5 bilaterally.
Everything above is 5/5.
ASIA Sensory Level
Lowest level where both light touch & pinprick are 2/2 bilaterally.
Everything above is 2/2.
How to determine NLI
Between motor & sensory levels, pick the one that is most superior.
E.g., if sensory is C7 and motor is C8, NLI is C7.
ASIA motor grading scale
Same as MMT
ASIA sensory grading scale
0 = absent
1 = impaired
2 = normal
ASIA A definition
Complete SCI
No motor/sensory at S4-S5
ASIA B definition
Incomplete SCI
Sensory present below NLI
ASIA C definition
Incomplete SCI
< half mm below NLI are >/=3
ASIA D definition
Incomplete SCI
> half mm below NLI are >/=3
ASIA E definition
No SCI
Normal
Common cardiac complications
Orthostatic hypotension
Autonomic dysreflexia
Respiratory dysfunction
Common non-cardiac complications
Urinary/bowel retention or incontinence
Pressure ulcers
Contractures
Mm weakness
Mm tone
Autonomic Dysreflexia: most often occurs under what circumstances
Injuries at/above T6
Typically Complete (ASIA A)
Typically 3-6mo after injury
Autonomic Dysreflexia: cause
Noxious stimuli below level of lesion
Autonomic Dysreflexia: key dx criteria
SBP increase by 20-30mmHg
Autonomic Dysreflexia: common sxs
-Decreased HR
-Severe HA
-Constricted pupils, blurred vision
-Increased spasticity
-Confusion, anxiety
-Flushing & piloerection above level of lesion
-Dry, pale skin below level of lesion
Autonomic Dysreflexia: intervention
MED EMERGENCY!
-Sit them up, lower the legs.
-Remove painful stimuli (unclamp & drain catheter, loosen clothing, remove abdominal binder).
-Monitor vitals (if no improvement, Rx management needed).
At what level of injury is respiratory function near-normal?
T11 and below
Bowel & bladder function is controlled by…
S2-S4
Reflexic Bladder: definition & where is the injury located?
AKA spastic or UMN bladder
Injury above S2
Areflexic Bladder: definition & where is the injury located?
AKA Flaccid or LMN bladder
Injury at/below S2
Reflexic Bladder: treatments
-Intermittent catheter
-Suprapubic tapping
Areflexic Bladder: treatments
-Intermittent catheter
-Valsalva maneuver
-Crede’s maneuver
CTSIB Conditions
1: EO, stable
2: EC, stable
3: Conflict, stable
4: EO, unstable
5: EC, unstable
6: Conflict, unstable
If a pt falls in CTSIB Condition 1, which systems are affected & which systems are they dependent on?
Affected: all 3
Dependent: none
If a pt falls in CTSIB Condition 2, which systems are affected & which systems are they dependent on?
Affected: somatosensory
Dependent: vision
If a pt falls in CTSIB Condition 3, which systems are affected & which systems are they dependent on?
Affected: somatosensory
Dependent: vision
If a pt falls in CTSIB Condition 4, which systems are affected & which systems are they dependent on?
Affected: vision
Dependent: somatosensory
If a pt falls in CTSIB Condition 5, which systems are affected & which systems are they dependent on?
Affected: vestib
Dependent: somatosensory & vision
If a pt falls in CTSIB Condition 6, which systems are affected & which systems are they dependent on?
Affected: vestib
Dependent: somatosensory & vision
If a pt is dependent on VISION, which CTSIB conditions will be most unstable?
2, 3, 5, 6
If a pt is dependent on SOMATOSENSORY, which CTSIB conditions will be most unstable?
4, 5, 6
If a pt is dependent on VESTIBULAR, which CTSIB conditions will be most unstable?
5, 6
