SCI Flashcards
The rate of recovery for SCI patients is greatest during the ___ year because of the impact of ____ ___ ____
1st. spontaneous neural recovery
During the chronic timeframe (one year post-injury), recovery is more related to ____ __ ____ ____
rehabilitation and lifestyle choices
Severity o SCI is determined based on the classification category using the ____ _____ ____ ____ ____ ____
American Spinal Injury Association Impairment Scale
Individuals classified as an AIS ___ have the best prognosis for recovery of sensorimotor function below the level of injury; whereas individuals classified as AIS ___ have the worst prognosis for recovery of sensorimotor function below the level of injury
D, A
Neurological level of injury is the most ___ level where both sensory and motor systems are intact
rostral
more common at cervical levels resulting from a small fall in the forward direction
hyperextension injury
hyperextension injuries are frequently ____ injuries, and often associated with ___ ____ ___
incomplete, central cord syndrome
prognosis for recovery of below the level of hyperextension injury
good
these types of injures are common in high velocity injuries such as MVAs
Flexion
flexion injuries are associated with _____ SCI, suggesting the prognosis for recovery below the level of injury is ____
complete, poor
injuries are associated with diving accidents or large falls with force through the head or the pelvis
compression
compression injuries are associated with ____ SCI, suggesting the prognosis for recovery below the level of injury is ____
complete, usually poor
MRI classification: neuro findings are apparent, but no atypical findings are observed via imaging. Frequently associated with incomplete SCI. most frequently observed with children
Spinal Cord Injury without Radiographic Abnormality (SCIWORA)
MRI classification: frequently associated with MVAs or a fall forward. Most likely to be incomplete (AIS:C,D,E) and therefore have a good prognosis for recovery. Usually subclassified as having an incomplete spinal cord syndrome
Edematous
Prognosis for edematous mri classification
good
MRI classification: the most common cause of SCI. Usually caused by vertebral fx or subluxation, such that there is physical impact on the spinal cord causing both tissue damage and hemorrhage.
Contusion
prognosis for contusion mri classification
not good
MRI classification: intraspinal bleeding into the epidural, subdural, subarachnoid or intramedullary space. It is frequently related to unstable vertebral fx, which will require internal stabilization.
Hemorrhagic
The presence of _____ within the spinal cord (intramedullary space) is a poor indicator of recovery of ____
hemorrhage; function below the level of injury
MRI classification: occurs following a morphological change to the spinal cord. it is usually associated with sever vertebral dislocation, which requires surgical reduction and internal fixation.
Compression
compression injuries prognosis
poor
MRI classification: penetrating injuries frequently related to acts of violence.
Transection
transection injurys tend to be ____, and therefore have a poor prognosis for recovery below the injury
complete
associated with penetrating injury where the individual exhibits ipsilateral spastic hemiparesis and loss of light touch with contralateral loss of pain and temp
brown-sequard syndrome
regarding non-traumatic injuries, which spinal artery infarction has a better prognosis (ANT or POST)
posterior spinal artery infarction has a better prognosis than anterior
refers to the damage to axons, glial cells and support cells in the spinal cord
primary SCI
refers to the subsequent spinal cord edema and decrease in spinal perfusion
secondary
management of the ____ injury frequently determines the ultimate prognosis of the individual
secondary
_______ _____ are used to reduce the implication of secondary injury
pharmacological agents
Severity is based on the integrity of the
final sacral segment (ability to detect sensory stimuli and perform a motor contraction)
Complete SCI
AIS A
sensorimotor function of the final sacral segment (S4-5) is disrupted
AIS A
Usually have limited sensorimotor function below the level of injury except for the possibility of zone(s) of partial preservation
AIS A
Incomplete SCI in which sensory function is preserved
AIS B
The motor function of the final sacral segment has been disrupted
AIS B
Usually have sensory but not motor function below the level of injury
AIS B
Incomplete SCI in which limited sensorimotor function is preserved
AIS C
Both sensor and motor function is preserved at the final sacral segment
AIS C D E
most of the muscles below the level of injury are “weak” (MMT: 2/5 or 1/5)
AIS C
Incomplete SCI in which sensorimotor function is preserved
AIS D
Most of the muscle below the level of injury are strong (MMT:3,4,5/5)
AIS D
Risk for SCI but no neurological findings are identified
AIS E
most likely have LMN signs and sensorimotor impairment in the legs
Lumbar
most likely have UMN and LMN signs and have sensorimotor impairment in the trunk and legs
Thoracic
Most likely have UMN signs and have sensorimotor impairment in arms, trunk, and legs
Low cervical
Most likely have UMN signs and difficulty activating respiratory muscle
High cervical
SC levels with inability to grasp
C1-C5
Ability to grasp with tenodesis
C6 C7
Ability to grasp
C8 and down
Ability to walk household distance
L2-L4
Ability to walk community distance
S1 S2
Cervical SCI that has preferentially damaged the gray matter in the middle of the cervical spinal cord
central cord injury
symptoms of central cord injury
LE sensorimotor function> UE sensorimotor function
prognosis of central cord injury
good for recovery below the level of injury
Brown-Sequard syndrome is damage to half of the spinal cord that interferes with ipsilateral _____ and _____ tracts and contralateral ____ tract
coricospinal, dorsal column medial lemniscus, spinothalamic
symptoms of brown sequard syndrom
ipsilateral spastic hemiparesis and loss of light touch, contralateral loss of pain and temp
prognosis for brown sequard
good for recovery below level of injury
damage to anterior half of the cord that disrupts the coricospinal tract as well as the spinothalamic tract (presereved proprioception below the level of injury
Anterior cord syndrome
symptoms of anterior cord syndrome
motor function loss, and loss of pain and temp
prognosis for anterior cord syndrome
poor for recovery below level of injury
These two conditions cause areflexive bowel and bladder (loss of function) and areflexive lower limb
conus medullaris and cauda equina
pharmaceutical management within ___ hours of injury to manage secondary injury are more likely to be classified as incomplete
6
Injury below ___ have good prognosis for recovery of walking ability
L2
Injury below ___ have a good prognosis for recovery of grasping ability
C7
Direction of injury, best to worst prognosis
Extension, flexion, compression
T/F level of injury is much less important than the severity of injury
T
AIS A
complete: no motor or sensory fxn is preserved at the sacral segments
AIS B
incomplete: sensory but not motor function is preserved below the neurological level and includes the sacral segments
AIS C
incomplete: motor function is preserved below the neurological level and more than half of the key mm below the level have a mm grade less than 3
AIS D
incomplete: motor function is preserved below the neurological level and at least half of key mm below the neurological level have mm grade of 3 or more
CV system gone haywire caused by noxious stimulus
Autonomic dysreflexia
T/F autonomic dysreflexia is a level problem, not severity problem
T, impacts individuals T6 and above
Important ROS integumentary
ask about skin integrity
Important ROS cardiopulmonary
if injury is T6 or above, ask if they have had autonomic dysreflexia (what was the irritant)
Important ROS MSK
heterotopic ossification (ask about joint motion)
Important ROS neuromuscular
consider undiagnosed change in neurological status (Syrinx or Tethered Cord), ask about a CHANGE in sensation, strength, coordination or stiffness (refer to neurologist if any changes present)
only teach compensation when prognosis for recovery for typical movement pattern is
NOT realistic
2 keys for skilled rolling
prepostion to reduce friction
use head and arms for momentum with tight back
