SCI Flashcards
Most/least common areas of injury
Cs: mc / ts: lc
1 injury and 2 injury
1-injury 2-vasoconst, edema, ischema
Methylprednisone
8 Hrs of injury; 24-48hrs
Deep vein thrombosis
1st 12wks: 49-100%
Highest rate in 2wks
Umn Injury
Signs below the injury
No atrophy, deep tendon reflexes increased, patho reflexes present, fasciculations absent
Lmn injury
Signs at injury level, flaccid, atrophy, no deep tendon or patho reflexes, tremors present
AD
Increase in bp, decrease in hr, goosebumps and diaphoresis is at the level above the injury
Bradycardia
Occurs at T6 and above, similar to AD - common in cervical injuries
Bladder innervation: P/S/S
P - pelvic nerve, S2-4
Symp - hypogastric nerve, T11-L2
Som - pudendal nerve, S1-S4
Reflexive and areflexive bladder
R - S2-4 intact and bladder reflexively empties once it’s full
A - S2-4 compromised and bladder leaks, overflow continence
Bowel innervation: P/S/S
P - pelvic nerve, S2-4, vagus nerve
Symp - hypogastric nerve, T11-L2, superior and inferior mesenteric
Som - pudendal nerve, S1-S4
Reflexive and areflexive bowel
R - S2-4 intact and bowel reflexively empties once it’s full
A - S2-4 compromised, peristalsis intact due to intact sup/inf mesenteric but not enough for BM
Thermoregulation
T1 to L1/L2
May be unable to sweat below the level of injury = hyperthermia
ASIA A
ASIA B
A - intact
B - sensory but not motor below the neurological level (S4-5 sacral segments) AND no motor 3 levels below the motor level on either side
ASIA C
ASIA D
C - motor incomplete, more then half muscles below neuro level graded <3
D - motor incomplete, more then half muscles below neuro level graded >3
ZPP
Only determined for complete injuries
Complete SCI motor recovery time frame
Most recover first 3 months (3-6 months)
- can continue up to 2 yrs if str >0/5
Strength at 1 month with recovery at a year if 1-2/5 str
95% improve to 3/5
Strength at 1 month with recovery at a year if first level 0/5
50% improve to 1/5; 25% improve to 3/5
C1-C4 functional level
Transfers - Total A
Power WC with ind power tilt/recline
C5 functional level
Transfers - Total A
Power WC with ind power tilt/recliners
C6 functional level
Transfers - level: some assist to ind; unlevel: total A
Power WC with ind power tilt/recliners
*Manual WC ind within home but not community
C7-8 functional level
Transfers - level: ind; unlevel: ind
Manual WC with ind in home and community; some assist with unlevel terrain
T1-9 functional level
Manual wheelchair ind on home/community/unlevel terrains
Able to amb in // bars
T10-L1
Manual wheelchair ind on home/community/unlevel terrains
T11-12: limited household
L1: household , possible limited community
L2-S3 functional level
Manual wheelchair ind on home/community/unlevel terrains
L2: household, limited community
L3: household limited to ind community
L4 - ind with all
Brown-Sequard
IPSI proprioception, vibratory sense, deep/disc touch, and voluntary motor control
CONTRA pain/temp, crude touch
**Most likely to have highest functional gain
Ant Cord
Variable loss of motor function, pain, and temp with intact proprioception
Common with any spinal artery damage and hyperflexion injuries (teardrop/wedge)
**Most likely to have longest LOS
Central Cord
UEs>LEs with sparing of sensation to sacral region
Common with hyper extension injuries
**Most likely to have worst FIM at admission
Posterior Cord
Loss of proprioception, vibratory sense, and discriminative touch
Common with post spinal artery injury
Cause Equina Syndrome
More LMS
Asymmetrical weakness with areflexive bladder
Conus Medullaris Syndrome
Mix of UMS and LMS
Bilateral weakness with central s/s
Endurance and resistance training recommendations
E - 20-60 minutes, 3-5x week, 60-80% VO2 peak
R - 3x 8-12 reps, 2x week at mod to high intensity
Isokinetic strengthening can increase:
6MWT, BBS, and isometric strength
Guidelines (4) for locomotor training
- Maximize load through LEs
- Optimize sensory curing but avoid inappropriate sensory input like bracing or facilitation of antagonist musculature
- Promote normal kinematics
- Correct posture with AD (walking stick)
Protocol for managing shoulder pain with exercise:
Strengthening posterior shoulder musculature
Strengthening ERs of shoulder
Stretching anterior structures
Electrical stimulation for management of spasticity (types and how long):
Reciprocal inhibition
Tetanic contraction of agonist
FES
TENs
**Benefits last 10 mins to 3 hrs
Epidural spinal cord stimulation for 1.) mild/incomplete lesions and 2.) severe spasticity
- ) Stim below the level of lesion
2. ) Stim of dors roots of upper lumbar cord segments
