SCI Flashcards
what are nontraumatic sources of SCI
RA, spina bifida, AVM, tumors, demyelination (MS), and infections (transverse myelitis)
how far down does the spinal cord travel
down to L2 vertebral level
where do spinal segments receive their vasculature
ASA and PSA from the VA
what does the SC dorsal column control
sensory ascending light touch and proprioception
how is the DCML organized
from medial to lateral
- fasciculus gracilis (S - L/T)
- fasciculus cuneatus (U/T to C)
what does the CST control
descending motor control
how is the CST organized
lateral column from deep to superficial C, T, L, S
how is the ALS controlled
anterolateral from deep to superficial C, T, L. S
what are the three components of SCI classification
vertebral level of lesion, tetra/paraplegia, and ASIA functional classification
how does ASIA determine the sensory level of injury
most caudal dermatome to have NORMAL senation for BOTH pinprick and light touch on BOTH sides
how does ASIA determine the motor level of injury
most caudal key muscle group (out of 10 myotomes) graded 3/5 or better with segments above 5/5
which segments are tested for ASIA sensation? motor?
sensation C2 - S4/5
motor: C5-T1 and L2-S1
what is the ASIA definition of complete?
absence of sensory and motor function at the lowest sacral level S4/5
what does ASIA definite as incomplete
sacral sparing
what is sacral sparing
voluntary external anal reflex OR light touch/pin prick at S4/5
what is the zone of partial preservation
segments below the neuro level of injury with some or both sensation and motor ONLY applying to complete injuries
what is the grading range for ASIA testing
0 = absent 1 = altered 2 = normal NT = not tested
define ASI-A
complete - no sensory or motor function preserved through S4/5
define ASI-B
sensory incomplete - sensory is preserved through S4/5 AND no motor more than three levels below level of injury on either side
define ASI-C
motor incomplete - motor function preserved below the level of injury AND more than half of mytomes below the level are graded 0-2
define ASI-D
motor incomplete - motor function preserved below the level of injury AND more than half of the myotomes below the level are graded 3-5
define ASI-E
normal - history of SCI, previously graded lower, but shows normalcy in all grades throughout
T/F: ASIA A-E can all be graded as complete OR incomplete
false: only ASI-A is complete and ASI-B-E are incomplete
what are four common incomplete syndromes
anterior cord, central cord, brown-sequard, and cauda equina
T/F: surgical decompression for SCIs must be performed early for best outcomes
false/trick question: the jury is out on the best timing for surgical decompression whether it be early or delayed
what are two PT considerations for cervical SCI
posterior approaches disrupt neck extensors and iliac bone grafts
what are vascular and inflammatory consequences of SCI
- ischemia/hypoxia
- hemorrhage
- toxins/oxidative stress
- swelling
- apoptosis
how does blood pressure relate to SCIs
SCI patients are vulnerable to systemic hypotension
what is typical blood pressure management parameters for SCI patients
maintain MAP above 85-90 for 5-7 days via volume resuscitation and vasopressors
what medication is typically administered for secondary effects of SCI
methylprednisolone (MPSS)
what is spinal shock
period of areflexia immediately following SCI usually resolving within 24 hours
what are the characteristics of spinal shock
areflexia, flaccidity, loss of bowel and bladder, autonomic dysreflexia
what is the first and major sign of resolving spinal shock
positive bulbocavernosus reflex
what do we expect with sympathetic trunk involvement in SCI patients
bradycardia, dilation of peripheral vasculature below lesion, decreased exercise tolerace, lower SV and CO
how to you condition patients to upright
apply TED hose, ace wraps, and abdominal binding prior to beginning upright activities followed by slow accommodation to upright
what causes orthostatic hypotension
imbalance between sympathetic and parasympathetic nervous systems, decrease in active muscle contraction, and prolonged bed rest
in which SCI population do you expect to see AD
T6 and above injuries and more commonly in complete injuries
what are the sxs of AD
- BP 20-30 mmHg above normal
- sweating
- headache
- flushed
- blurred vision
- tight chest and stuffy nose
what typically triggers AD
bladder, bowel, skin, and sexual organ noxious stimulus
what do you do if a patient experiences AD
sit up and lower the legs
what is spastic hypertonia
a long term complication of SCI characterized by hypertonicity, hyperactive stretch reflex, spasticity, spasms, and clonus
who gets spastic and flaccid bladders
spastic in UMN and flaccid in LMN
how do you prevent pressure ulcers in bed? in a chair?
bed rolling every 2 hours and chair pressure relief every 15-20 min
where can osteogenesis occur in SCI patients
soft tissues below the level of injury
what are the early sxs of HO
swelling, decreased ROM, erythema, local warmth
how do you manage HO
P/AAROM once signs of inflammation have subsided
when does the most dramatic return of movement and function occur in SCI patients
first several months
what happens to movement and function after the first few months of recovery
plateauing although not uncommon to see improvement
what are the general goals of acute care SCI PT
- prevent joint contracture
- improve muscles and breathing
- acclimate to upright
- prevent secondary complications
