SCI

Question 1

traumatic injuries

Answer 1

result from an external force acting on the body

MVA 40.4%
Falls 27.9%

Question 2

Non-traumatic injuries

Answer 2

disease or pathological influence causing SCI

39% of all SCI

Causes: neoplasms, vascular dysfunction (SC stroke), RA, OA, infection, ALS (LMN & UMN), and MS (UMN)

Question 3

spastic hypertonia

Answer 3

65% of individuals with SCI

more common in complete injuries

up to 50% of individuals report spasticity to be a problem for daily life

tx- stretch does not work well, meds, botox, surgical approaches

Question 4

Cardiovascular impairments

Answer 4

imbalance between parasym and sympa systems

higher level injury than more significant

orthostatis hypotenion tx- abdominal binder and ted hose

DVT tx- ted hose, SCDs, meds, IVC filters. Holmans sign, painful to touch.

Question 5

Pulmonary impairments

Answer 5

below T10 have near normal pulmonary function

important! 3,4,5 kees diaphragm alive

interventions- phrenic nerve stimulators, assisted coughing, trach with vent

need pressure in abdominals for diaphragm to function properly

Question 6

Blood supply to the spinal cord

Answer 6

anything with vascular supply can stroke

anterior spinal artery supplies more to spinal cord.. more likely to have stroke ant.

Question 7

Causes of spinal cord injuries (%)

Answer 7

MVA 24%

Accident working 28%

Fall.unknown 9%

Question 8

Levels of spinal cord injury-neurological level

Answer 8

most caudal level of the spinal cord with normal motor and sensory function bilaterally.

Question 9

Levels of spinal cord injury- motor level

Answer 9

the most caudal segment of the spinal cord with normal motor function bilateraly

test: MMT 6 point scale

Question 10

Levels of spinal cord injury-sensory level

Answer 10

the most caudal segment of the spinal cord with normal sensory function bilaterally

test: pin prick and fine touch at key dermatomes
3 point scale (0 absent, 1 impaired, 2 normal)

Question 11

Complete injury

Answer 11

no sensory of motor function is preserved in the lowest sacral segments, S4 and S5

Question 12

Incomplete injury

Answer 12

motor and/or sensory function is preserved below the neurological level including sens and/or motor function at S4 and S5. Has to include sy/sx

Question 13

Zones of partial preservation

Answer 13

areas of intact motor and/or sensory function that is preserved below the neurologic level but no motor or sensory function at S4 ad S5. S4/S5 very important. Ajah score.

Question 14

Tracts: ascending

Answer 14

dorsal column- proprioception, vibratory sensation, deep touch, discriminating touch

spinothalamic, spinoreticular, spinotectal- pain, temp, crude touch

spinocerebellar-

Question 15

Tracts: descending

Answer 15

lateral corticospinal-voluntary movement

anterior corticospinal- voluntary movement of axial muscles

Medial and lateral vestibulospinal- positioning of head and neck, posture, balance

medial and lateral reticulospinal- posture, balance, automatic gait related movements

rubrospinal-movement of limbs

Question 16

spinal cord syndromes

Answer 16

brown sequard

anterior cord

posterior cord

central cord

cauda equina

Question 17

Brown sequard syndrome

Answer 17

violence, shootings

injured one level lower

caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion

tracts- spinothalamic (both sides), corticospnal(ipsiateral), medial lemniscus (ipsilateral)

impairments:
pain, temp, coarse touch (both sides),
motor function (ipsilateral), fine touch, proprioception (ipsilateral)

Question 18

Anterior cord syndrome

Answer 18

more common

below C spine, might need w/c but some can use KAFO or HKAFO

Hard forced flexion injury Wear seat belt correctly.

tracts: spinothalamic, descending motor tracts

impairment- pain, temp, motor control

Patient present with following features:

complete motor paralysis below the level of the lesion due to involvement of corticospinal tracts

loss of pain and temperature at and below the level of injury due to involvement of lateral

spinothalamic tract
intact 2-point discrimination, proprioception and vibratory senses due to intact posterior column

autonomic dysfunction: orthostatic hypotension

bladder and bowel dysfunction and sexual dysfunction may arise depending on the level of the lesion

Question 19

posterior cord syndrome

Answer 19

very rare, best to have of all

extension injury

sensation impaired

posterior column damage- vibration and proprioception loss below the level of the lesion

clinical presentation:
Loss of proprioception + loss of vibration sensation + loss of two point discrimination +loss of light touch

Question 20

central cord syndrome

Answer 20

cervical spine EXT

tracts-ascending spinothalamic, lateral cortical spinal (ipsilateral)

impairment- pain, temperature, motor control (ipsilateral)

Patients are typically left with more profound motor weakness of the upper extremities and less severe weakness of the lower extremities. A varying degree of sensory loss below the level of the lesion and bladder symptoms (urinary retention) may also occur.

Question 21

Cauda equina syndrome

Answer 21

Cauda equina syndrome (CES) is a rare but serious condition that describes extreme pressure and swelling of the nerves at the end of the spinal cord.

potential impact for all nerve roots below L2

saddle anesthesia

impairments- loss of sensation mild to severe

loss of motor control mild to severe

associated with loss of bowel and bladder control

cauda equina dermatomes- L4/L5

rememeber L2 or lower can be affected