SCI basics - SCI Flashcards
what is the spinothalamic tract for
pain
temp
what is the DCML for
JPS
pressure touch
vibration
what is global sensory loss normally due to
the cortex and peri nerves
what is the lateral corticospinal tratct
To control the voluntary movement of contralateral limbs
ventromedial pathway function
innervate axial and antigravity muscles to help keep the head positioned during antigravity activities
complete SC vs one-sdie of the SC
complete: loss of motion bilaterally and have global sensory loss below the lesion
one-sided:
o vibration and proprioceptive sense isp
o pain and temp from the contra
what is the anterior spinal art
look at slide
is supplies 2/3 of the spinal cord
- most grey matter
- descending tracts
- both lateral and anterior
- spinothalamic
- spinocere
what is sacral sparing
the patient maintains sensation around that anal region
where does the posterior spinal artery supply
the dorsal column and part of the dorsal horn
what are things that can lead to spinal cord damage
trauma
disease
cog defects
what is the most common cause of SCI in the adult population
trauma
was are the two type of SCI injury
direct
indirect
direct damage to the spinal cord example
bullet
indirect spinal cord injury example
impingment of bony/soft structures
does the spinal cord injury have to be complete for deficits to appear
no
brusied tissue can cause neuro damage that is just as sig as if the SCI was severed
what is are of the spine is most vulnerable to injury
cervical
most injury is seen in the lower SC areas
what kind of injuries have the highest incidence of neuro injury
flexion force injury
seen with whip lash
what are the forces that lead to vert injury
flexion
compression
extension (hyper)
how do compression injuries occur
axial blow to the head
how to hyperextension injuries occur
when the head and chin strike in a fall or a MVA
what kind of causes of SCI is mostly seen in the elderly population
hyperextension injury
think falls
how large is the thoracic region
1-12
in the lumbar region of the spine - where does injury omstly occur at
thoraco lumbar section
t12- L1
how long is the lumbar segment of the spine
5 segments
how long is the scaral segment of the spine
5 segments
how long is the cervical segment of the spine
8 segments
in neuro damage in thelumbar region normally complete or imcomplete and why
incomplete
they have good vascular supply - large vertebral canal in that section
the cord is not present at L1- L2
what are some examples of non-traumatic lesions
tumors
vascular syndromes
MS
ALS
tumors in the spinal cord
they normally have a compressive effect
what is the most common type of tumor in the spinal cord
extradural
what could lead to weakness, sensory loss, pain with an extradural tumor
located near the nerve root
intramedullary what kind of pain do we expect
back pain is common
radicular pain is not common
what vascular syndromes common in the spinal cord
no
when it is present I can be hard to diagnose
what is an infraction
tissue death or necrosis due to inadequate blood supply to the affected area
what are the vascular syndromes that we see with SCI
infraction of the anterior spinal cord
and
hemmorage from vascular malformations and trauma
what is anterior spinal art syndrome
occlusion in the ant spinal cord that produces damage to most of the cord except for the dorsal horns and the dorsal aspect of the dorsal horn
what do patients present if they have anterior spinal art syndrome
paralysis below the level below the level of injury
deficits in pain and temp below that level
perservation of vibration and propioeption
is posterior spinal art occlusion common
less common
what do patient present with if they have posterior spinal art occlusion
loss of propioception and vibration below the level of injury
what is arteriovenous malformations
tangle and art and veins that represent the persistance of embroyotic pattern of blood vessels
hemo of these thin vessels occur in 20-30 yo
what can arteriovenous malformations be preceeded by
headaches and seizures
are aneurysms common with SCI
uncommon
what is a complication of aortic aneurysm
spinal cord ischemia
this can also be a complication of vascular surgery
what were the two degenerative disease that we where introduced to
MS
ALS
how to we treat SCI
surgical and non-surgical
what are examples of SCI surgical interventions
fusion
decompression
what are examples of non-surgical intervention for spinal cord
miami J
TLSO
LSO
stablization and bracing
steriod infusion
what are the cervical precautions
no excessive movements
Miami J, aspen collar at all times
no active shoulder abd or flexion above 90
no lifting over 5 lbs
no pillow under your head
pillow under head cervical precautions
sometime 1 thin pillow is allowed
the goal is avoid putting the head into extra flexion
what are TLS precautions
no BLT
no lifting greater then 10 lbs
log rolling only
no HOB > 30 -deg
OOB with TLSO
no hip felxion past 90-deg
what does TLS stand for
thoracic and lumbar spine precasutions
what does BLT stand for
bending lifting and twisting
what does TLSO stand for
Thoracic-Lumbar-Sacral Orthosis (TLSO)
what is spinal shock
occurs after there is trauma to the cord
temp ceases function below the level of the lesion
spinal reflexes, voluntary motor and sensory function, and automnomic control are absent below the level of the lesion
the spinal cord is knock out like when you are knock out for a fight - takes a little to regain function
how long does spinal shock last
clears within the first 24 hrs and usually resolves in a few weeks
what is the cause for spinal shock other then the trauma that is experienced
unknown
what is neurological return
the resumption of voluntary movement and sensory function that has been lost as a result of the injury
not the return of reflexive functioning below the lesion
what is neuro return evidence of
evidence of a connection between the brain and the muscles or dermatones have resumed function
does neuro return occur quickly or slowly
slow
when does most neuro recovery occur
in the first 6 months and platues after the first 2 years
what are the mech of neuro return
nerve root recovery
remyleination of f surving neurons
resolution of patho processes
injuring induced platisity
making new connection
what leads to fast recovery of neuro return
resolution of patho process that were causing neruo deficits
edema
hemorrhage
as these are clearing out we will see a return
does spinal shock occur acutely or chronically
acutely
what does neuro return depend on
completeness of the injury and degree
what does inadequate inspiration result in
reduced ventilation of the lungs
what does inadequate coughing lead to
allows for secretions to build up in the lungs
with SCI why do we often see complications with respiration
because of weakness in the accessory muscles
breathing and higher leveel of injury
the pt may need a ventilator
why do we often see pressure ulcers with complete lesion and tetra
lack of sensation and lack of mobility
what are some options that can lead to pressure relief
push up forward
lateral weight shifts
power chair seat functions
cushion options
patient education about pressure relief
how often should the pt move to prevent pressure sores
2 min every 20-30 mins
what are some factors that lead to DVTs
absent or reduced LE muscular activity
immobilty
how is DVT related to muscles
the venous system relies on the musculature to pump the blood back up to the heart
what are contractures
deformity is likely to form when there are muscle strength imbalances, spasicty, gravity, and postural causes 1 or more joint to remain in one position for extended periods
how do we treat contracture
periodic ROM
where is heterotrophic ossification normally located
hip, shoulder, knees
how do we treat heterotrophic ossification
moderate intensive stretching to maintain ROM
where do we mostly see osteoporosis (OP)
LE
female
low BMI
older
OP and SCI
after SCI there is a net loss of bone mass becasue the rate of resportion is greater then new bone formation
