SCI basics 2 - SCI Flashcards
hwta is central cord syndrome
when the center of the cord is injuried sparing the the peri portion of the SC
when does central cord syndrome normally occur
the cervical region
when does central cord syndrome normal occur
may result from hemorhage and necrosis does not process peri
descruction of the sucal arties the supply this section of the cord
what kidn in juries normally lead to central cord syndrome
hyperext/flex syndrome
ext - oder adults
1 - falls
2 - MVA
what is the most common SCI syndrome
central cord syndrome
clinical presentation of central cord syndrome
more weakness in the UE compared to LE
sparing sensation and motor to the sacral region
may have neuro bowl bladder
may have somasensory deficits, paralysis in the hands are common
what is neurological bowel and bladder
A spinal cord injury sometimes interrupts communication between the brain and the nerves in the spinal cord that control bladder and bowel function.
This can cause bladder and bowel dysfunction known as neurogenic bladder or neurogenic bowel.
neuro return and central cord
neuro return is likely
functional mobility and central cord
likely to achieve functional independence during rehab
spv to modI
ADL vs mobility central cord
harder time with ADLs then mobility
hand recovery ceentral cord
hands have increased recovery time
there are a high number of sensory and motor connections in the hands
older patient and central cord syndrome
older patient have worse outcome for amb then younger patients
what are good prognosis factors for central cord syndrome
good hand function
evidence of early mob
young age
absence of spasticy
pre-injury employment
what does brown squared syndrome look like in the cord
hemi section of the cord is effected and the other side is preserved
brown squared syndrome seen more with incomplete or complete
incomplete
brown squared syndrome is a result of what most likely
stab wound or tumor
brown squared syndrome clinical presentation
isp motor and proprioceptive defects
contra: pain and temp or hypersensity
spascity may be present below the level of the lesion
brown squared syndrome prognosis - neuro return
likely to experience neuro return
brown squared syndrome prognosis - functional independence
likely to experience functional indp
brown squared syndrome prognosis - amb
75% - 90% amb indpendently
posterior cord syndrome cause
neck hyperext
post spinal art occlusion
tumor
disc compression
it B12 deficit
what is the least common SCI syndrome
posterior cord syndrome
posterior cord syndrome clinical presentations
loss/impaired: proprioception, vibration, JPS below the level of the lesion
perserved: muscle strength, temp and pain sensation
sensory ataxia
may have weakness depending on the amount damage
what is sensory ataxia
a form of ataxia caused by the impairment of the somatosensory nerves, leading to the interruption of sensory feedback signals.
It is characterized by postural instability and lack of coordination that worsen when visual input is removed.
prognosis of posterior cord syndrome - amb
poor
need to take in account other neuro factors
what is anterior cord syndrome impacting in the SC
the anterior 2/3 of the cord
trauma that causes anterior cord syndrome
2ndary spinal injuries
flexion -flexionteardrop fractures
direct damage to bone fragments
disc compression
and/or
anterior spinal art occlusion
clincal presenation of anterior cord syndrome
complete paralysis and hypoalgesia below the level of the lesion
preservation: touch, position sense, vibration, 2 point below the lesion
what is Hypoalgesia
diminished pain in response to stimulation that typically produces pain
prognosis of ant cord syndrome
poor for functional improvement
10-20% have a chance of muscle recovery, poor muscle power and coordincation
what is colonus medullaris syndrome due to
damage to the sacral cord and lumbar nerve roots
what is colonus medullaris due to traumawise
traumas and tumors
Clinical presentation of what is colonus medullaris
UMN and LMN signs
flaccid or spastic
varied about of LE weakness
areflexic bladder and bowel
saddle anesthsia
may retain sacral reflexes
is what is colonus medullaris complete or incomplete
could be both
what is an areflexic bladder
has lost its ability to contract and can be easily stretched, allowing large amounts of urine to accumulate
urnine spill over
prognosis of colonus medullaris syndrome - spinal shock
ecreases 2 weeks following injury
prognosis of colonus medullaris syndrome - is based on
severity
age
comorbities
previous level of function
what is CES due to
injury to the CE of the spine
MOI of CES
trauma
disc compression
tumor
spinal stenosis
s/p epidural hemotoma
lumbar fracture
is CES acute or chronic
either
CES clinical presentation- complete or imcomplete
either
CES clinical presentation - relfexia
hyporeflexia
CES clinical presentation - sensation
varied
saddle parathesia
CES clinical presentation - weakness where
DF/PF
hip ext
hip abd
CES clinical prognosis - spinal shock
~2 weeks
CES clinical prognosis - general
depends when the patient received treatment
what is Hyperesthesia
neurological condition that causes a person extreme sensitivity to touch, pain, pressure, and thermal sensations
what is Hypoalgesia
diminished pain in response to stimulation that typically produces pain
is voluntary motor control an issue that we can see with SCI
yes
you have LMN and UMN paralysis
what is UMN paralysis sue to
damage to the descending motor tracts
what is LMN paralysis due to
damage to the spinal nerve and the cauda equina
(peri nerves as well)
what do we see with UMN issues
dirsuption of the cortical spinal connection
hyper-reflex/tone
discoordination
+bab, clonus, other UMN
what do we see with LMN issues
hypo-reflex
hypotonicity
flaccidity
no UMN signs
what happen to the motor system with SCI
this leads to a inablity to contract of ineffieceent contraction of the muscles with innervation below the level of the lesion
with motor system issue and SCI what does regaining strength depend on
increasing strength depends on the completeness of the injury
preservation of motor units connections
propriospinal connections
what is happening with we increase strength following a SCI
recovery of existing connections
making new connections through other intact propriospinal connections
voluntary motor control is interrupted with SCI due to
UMN and LMN
is the sensory system normally impacted with SCI
yes
what does sensory impairment lead to
incoordination of body movements and impaired awareness
what does Light touch represent
DCML and SPT
what does pain and temp represent
spinothalamic tract
what does vibration, JPS, and proprioception mean
DCML
where does the DCML tract cross
brainstem
they travel up the cord
where does the spinothalamic tract cross
the cord
what does sensory loss depend on
the location and the severity of the damage
what does sensory recovery depend on
repeated sensory input
restoration of connections
or new connection throught intact pathways
is autonomic dysreflexia of version of hypo or hyper-reflexia
hyper-reflexia
at what level does autonomic dsyreflexia occur
after a spinal cord injury at or above the sixth thoracic vertebrae (T6)
what occurs in autonomic dysreflexia
a massive reflex sym surge from the thoracolumbar sym nerves that causes widespread vasocontriction
peri art HTN occurs
sympathetic NS
fight or flight
parasympathetic NS
rest and digest
what are the two components of the autonomic NS
sym and para
what can dysreflexia lead to
stroke or death
what are the sym of AD
HTN
brady
pounding headache
sweating above the level of the lesion (face neck and shoulders)
goosebump above the level of the lesion
flushing/blochy skin
blurred vision
what is the normal systolic BP for SCI above T6
90-110
a sudden rise in BP with AD is normally associate
brady
how much of a BP jump do we expect with AD
20 to 40
what are you thinking it could be is not AD
HTN
pheochromoytoma
what do you if you think someone has AD
act quick
sit them up (not down)
remove abdominal binder and compression socks
search for the source of the stimuli
what are some causes of AD
Ingrown toenail, kink/clogged in the catheter, full bladder, UTI, pressure injury
what is postural hypotension
when there is a decrease in BP when assuming an upright position
what is postural hypotension due to
reduced cerebral flow and decreased venous return to the heart
as a PT what do you do for postural hypotension
allow the cardiovascular system to gradually adapt by a graded progression to vertical
elevate the head of the bed
reclining wheelchair with elevating leg rests
tilt table
use of compression socks and abdominal binder
when does thermoregulation get thrown off - anatomy
interruption between the spinal cord the hypothalamus
what do we see if thermoregulation is off
absence of thermoreg sweating below the level of the lesion
shiver absesnt below the LOL
what is the primary muscle of inspiration
the diaphragm
what level is the diaphragm innevervating
C3-C4 (C4)
a lesion at BLANK level results in the inability to breath
C4
therefore is you have lesion at C$ you need a mechanical ventilator
intercostal innervation level
T1-12
involved in quiet insirpation
what muscles do expiration
abdominal and intercostals
loss of these muscles decrease expirtory efficency
abd are innervated at what level
T5 - T12
what are arefelxic muscles
complete absence of reflexes.
seen during spinal shock
as time passes following a SCI what happens to the muscles
reflexes return and tone increases
spascity
clonus
increase DTR
with SCI when spascity most noticed
higher lesions with incomplete lesions
what are the advatages of muscle tone
circulation aided by muscles
functional assist
may reduce OP
what are the disadvantages of muscle tone
decreased safetly for ADLs
mask the return of volitional movement
contractures
skin breakdown
bowel/bladder dys
what are some treatment we can do for muscle tone
stretch
positioning
cryotherapy
E-stim
aquatic therapy
EMG biofeedback
are more caudal lesions more UMN or LMN
LMN
what is needed for volunatary control of bowel and bladder
intact sacral cord communication with the brain
what is a neuro bladder
detrusor muscle stays relfexed and the bladder continues to fill
sphinter stays tight - cannot contract or relax
when a person lack bladder control because of the lack of SC and brain communication
how can a neuro bladder be delt with
can manage with a foley catheter
what is a LMN bladder
when the bladder has loss its ability to contract and can be easily stretched
spills over into the urinary tract
what do you do with a LMN bladder
brief or a condom catheter
SCI pt and knowing when to go to the bathroom
they will not know when they need to go no communication between the bladder/bowels and the brain
UMN injury bowel vs LMN bowel
UMN - reflexive, when the bowel is full it will empty by reflex
LMN - the anal muscl remain relaxed
sexual function is controlled by
sacral nerves
is preg possible in those with SCI
yes
