SCI- MED AND PT MANAGMENT Flashcards
What is the most common way to obtain a traumatic SCI?
motor vehicle accident
central cord syndrome- common with older adult falls
What is the mean age of SCI?
43 YEARS
-group of older adults and younger
78% male
What percent of SCI are in ppl > 60 years?
11.5%
What is the most common type of SCI?
incomplete tetraplegia
ISNCSCI testing (“ASIA Testing”)
COMPONENTS
-light touch sensation
-pin prick sensation
-anorectal exam —> allows us to determine incomplete or complete
-UE and LE motor testing
Light touch sensory testing-ISNCSCI
Dermatomes- C2-S4/5
0- Absent - patient does not correctly and reliably report being touched
1- Impaired - feels touch but diff from face
2- Normal - feels touch and feels same as face
NT- not testable - Key sensory point unavailable or patient unable to distinguish
accurate testing on face
pin prick sensation- ISNCSCI
Dermatomes- C2-S4/5
0- Absent - patient does not correctly and reliably report being touched by either end of pin OR does not reliably distinguish between sharp and dull ends of the pin
1- Impaired - distinguishes between sharp and dull but reports intensity is different from face (greater or lesser)
2- Normal - distinguishes sharp or dull sensation correctly and describes it as same as their face
NT- not testable - Key sensory point unavailable or patient unable to distinguish
accurate testing on face
Upper extremity myotomes
- C5: Elbow Flexors
- C6: Wrist Extensors
- C7: Elbow Extensors
- C8: Finger Flexors
- T1: 5th Finger Abductor
Lower extremity myotomes
- L2: Hip Flexors
- L3: Knee Extensors
- L4: Ankle Dorsiflexors
- L5: Great Toe Extensors
- S1: Ankle Plantar Flexors
When is an upper and lower extremity motor exam typically performed per ISNCSCI?
often 72 hours after injury
-performed in supine (gravity eliminated)
Anorectal Exam
Deep Anal Pressure (DAP)
*May be the only evidence of an INCOMPLETE SCI
- Insert gloved, lubricated finger into anus
- The patient is asked to describe any sensory awareness
including feeling of touch or pressure - Recorded as present or absent
Voluntary anal contraction- anorectal exam
- After testing DAP, ask the patient to attempt to contract around your finger as though preventing a bowel movement
- A circumferential tightening of the anal sphincter around your finger is positive
- Pressure at the tip of your finger is the result of “bearing down” with the diaphragm or abdominals and is recorded as negative.
AIS A on INSCSCI
COMPLETE
- No sensory or motor function is preserved in sacral segments S4-S5 –> no anal sensory or motor contraction
- No anal sensory or motor contraction
- Trick: NOOOON
—> N: no voluntary anal contraction
0- light touch R
0-pin prick R
0-light touch L
0-pin prick L
No- deep anal pressure
AIS B
INCOMPLETE
-sensory, but not motor function is preserved below the neurological level
-must include sacral segments S4-5
-NO NOOOON
B = Incomplete: Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
AIS C
INCOMPLETE
- Sensory or motor function is preserved in S4/5 segments
- Must have either voluntary anal contraction OR
Sacral sensation PLUS motor sparing of the
motor function 3 levels below the motor level - More than half the muscles grades below the single neurologic level are <3.
Explain sparing with spinal cord injury:
C4 AIS A
–> patient can still have biceps control and wrist extensor control despite C4 level of injury
AIS D
INCOMPLETE
- Everything for AIS C
- AND at least half of the muscle grades below the single neurologic level at >/= 3.
** muscles are stronger than AIS C
AIS E
INCOMPLETE
- Sensory and Motor function are normal
- Persistent hyperreflexia does not negate
this classification
-the patient had prior SCI-related deficits
*Individuals without a spinal cord injury do not receive an AIS Grade.
What factors have an impact on functional recovery following SCI?
age
timing of surgical decompression
penetrating injuries
What is the relationship between age and prognosis with SCI?
50-65 difficult to determine prognosis
under 50 - better prognosis
over 65- worse prognosis
What is the rate of SCI recovery?
-most rapid in the first 3 months
-majority of recovery first 6-9 months
-late recovery up to 2-5 years
-most plateau 12-18 months
-early improvement–> greater recovery
What type of SCI has the lowest conversion rate to an incomplete?
High thoracic AIS A
-due to innate bony stability of the thoracic spine
What type of SCI has the highest rate of conversion?
lumbar AIS A
-the highest rate of conversion likely due to cauda equina and possible peripheral nerve injury