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BOARDS: Neuromuscular > SCI > Flashcards

SCI Flashcards

1
Q

What spinal levels have the greatest frequency of injury?

A

C5
C7
T12
L1

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2
Q

Describe the pathophysiology of a spinal cord injury, either traumatic or non.

A

primary injury: interruption of blood supply

secondary injury: ischemia, edema, demyelination, necrosis of axons, progressing to scar tissue formation

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3
Q

Provide some non-traumatic causes of SCI.

A

disc prolapse, cancer, vascular insult, infection

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4
Q

For a C7 lesion, what level would you expect to see motor deficits?

A

C8 and below

- lesion level indicates most distal segment with preserved motor function (3+5 and above)

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5
Q

Paraplegia results from SCI at what levels?

A

T1 to L1, involving BLEs and trunk at varying levels

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6
Q

Your patient is an ASIA C - what can you expect about motor/sensory function?

A

C = incomplete -> motor is preserved below neuro level, and most key muscles are < 3/5

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7
Q

Describe the ASIA scales of SCI.

A 
A = complete
B = sensory but not motor function is preserved below neuro level and includes the sacral segments S4-5
C = motor is preserved below neuro level, but most muscles are < 3/5
D = motor is preserved below neuro level, and most muscles are >3/5
E = motor and sensory is normal

remember, sensory BEFORE motor

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8
Q

Central cord syndrome is commonly caused by what mechanism? What areas of function are preserved?

A
  • caused by hyperext. injuries to c-spine
  • preservation of more peripherally located lumbar/sacral tracts/leg fxn
  • proprioception/sensory descrim preserved
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9
Q

Which areas are lost with central cord syndrome?

A

lost:
- bilat spinothalamic (medial tracts in cord)
- ventral horn with BUE loss

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10
Q

What is Brown-Sequard syndrome?

A

hemisection of spinal cord typically d/t penetration wounds (bullet, knife)

asymmetrical symptoms

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11
Q

Your patient has a R T11 Brown-Sequard SCI. Describe the motor and descrim touch changes he likely has.

A

R T11 lesion

DCML: ipsilateral
- R loss of descrim touch/proprioception at T11 and below (ispsilateral b/c info can’t get up past the lesion to cross in medulla)

CST: ipsilateral

  • LMN symptoms at R T11 (LMN cant get out to area)
  • UMN symptoms at R T12 and below (UMN can’t get down to synapse onto LMN at indiv. levels)
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12
Q

Describe the pain/temp changes that occur in a brown-sequard syndrome at R T11 lesion.

A

R T11 lesion

SPINOTHALAMIC: contralateral/ipsi

  • L loss of pain/temp from T12 and below (these tracts from the L have already crossed midline, so they’re on the R side now, and then they course up and hit the lesion.. so no more info)
  • R loss of pain temp at T11 (the T12 tract courses up and hits the roadblock at T11, hasn’t crossed midline yet so you get ipsilateral pain/temp loss at lesion level)
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13
Q

Anterior cord syndrome is primary caused by what mechanism? What functions are preserved, and what are lost?

A
  • caused by hyperflexion at C-spine
  • bilateral: lost motor function, pain/temp, spastic paralysis below level
  • preserved light touch/proprioception
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14
Q

In posterior cord syndrome, what is lost and what is preserved?

A

lost: DCML
preserved: CST/STT

VERY RARE

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15
Q

Describe bowel/bladder ability for cauda equina syndrome.

A

flaccid paralysis of bladder/bowel

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16
Q

What vertebral level does the injury occur in cauda equina syndrome? What results?

A

injury below L1

  • results in injury to lumbar/sacral roots of peripheral nerves with sensory loss and paralysis
  • flaccid motor paralysis with no spinal reflex activity
17
Q

If a patient has “sacral sparing”, what does this mean?

A

sparing of tracts to sacral segments, with preservation of perianal sensation, rectal sphincter tone, or active toe flexion

18
Q

T/F: Cauda requina is reversible.

A

true, nerve regeneration can occur but is often incomplete

- slows and stops after ~ 1yr

19
Q

In SCI lesions above C4, what is especially important to examine?

A

respiratory function

- phrenic nerve, C3-5, innervates the diaphragm

20
Q

Describe the scoring of the modified ashworth.

A

0 =
1 = slight catch and release, or resistance at end of ROM
1+ = catch, but followed by resistance in < half of ROM
2 = Resistance through > half ROM, but limb still easily moved
3 = considerable tone increase, PROM difficult
4 = limb completely rigid, no passive movement able

21
Q

How long does spinal shock last?

A

flaccidity/reflex depression = can last for several hours or up to 24 weeks (?? online says 6, book says 24)

22
Q

What is autonomic dysreflexia? Symptoms?

A

noxious stimulus (kinked catheter, tight clothes, ulcer, positioning) precipitates a pathological autonomic reflex with symptoms of:

  • paroxysmal hypertension (stress/event induced)
  • bradycardia
  • diaphoresis, flushing, headache
  • convulsions
23
Q

What are your first steps when treating autonomic dysreflexia?

A

elevate head, check and empty catheter first

24
Q

You suspect your patient of having heterotopic bone formation. How might you suspect this?

A

soft tissue swelling, pain, erythema - generally near a large joint

25
Q

When reorienting a patient to the vertical position, what tools should be used?

A

tilt table, abdominal binder (to increase BP when getting vertical), LE wraps to decrease venous pooling

26
Q

Review UE myotome levels.

A 
C4: shoulder shrug
C5: biceps
C6: wrist extensors
C7: tricepts
C8: finger flexion
27
Q

Review LE myotome levels.

A 
L2 = hip flexion
L3 = knee ext
L4 = DF
L5 = great toe ext
S1 = PF
S2 = hamstrings
28
Q

At what level can SCI’s propel a manual w/c?

A

C6 - wrist extensors (push with shoulder, retract with biceps)
- need friction surface hand rims

29
Q

Your L4 spinal cord patient wants to know his prognosis for walking. What would you tell him?

A

generally, low lumbar lesions (L4-5) can be independent with bilateral AFOs and crutches/canes. they’re typically independent in community with w/c for high-endurance requirements

30
Q

For patients with lesions between T6-9, what are you thinking about for mobility aids?

A
  • w/c for community distances
  • need at least KAFOs for standing/walking
  • likely a limited household ambulator
31
Q

When trying to increase cardiovascular ability in tetraplegics, what should you be watching for (system response, wise)?

A
  • blunted tachycardia
  • lack of BP response
  • very low VO2 max
  • variable physiological response to exercise
32
Q

What are contraindications for exercise testing/training for those with SCI? (7)

A

1) autonomic dysreflexia
2) severe/infected skin on weight bearing surface
3) symptomatic hypotension
4) UTI
5) unstable fracture
6) insufficient ROM for task
7) uncontrolled hot/humid enviro

BOARDS: Neuromuscular (16 decks)

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