SCI- Spinal Cord Injury Flashcards
True or false
SC receives afferent (sensory) info
Motor cortex transmits descending info- efferent (motor) in back to the peripheral NS
Vertebral column protects SC
True
How many vertebrae’s do we have?
33
How many pairs of spinal nerves exit SC to form PNS?
31
Spinal nerves C1-C7 exit above or below vertebrae?
Above
Spinal nerves C8-S5 exit above or below vertebrae?
Below
What is SC gray matter?
Located centrally
Cell bodies
Synapses
What is SC white matter?
Contains ascending and descending pathways
Periphery of SC
What is the leading cause of SCI in the US?
Motor vehicle accidents
What are other causes of SCI?
Falls/ acts of violence (gunshot wounds)
Sports related- diving (most common)
Spina bifida (nontraumatic cause) - congenital neural tube dysfunction
Bacterial/ viral infections can damage SC tissue
What are the 2 major classifications of SCI?
Complete
Incomplete
What is complete SCI?
Cord completely transected
All ascending and descending pathways interrupted
Total loss of motor and sensory function below the level of injury
What is incomplete SCI?
Cord NOT completely transected
Some degree of voluntary movement or sensation below level of injury
Can upper motor neuron (UMN) and lower motor neuron (LMN) injuries be either complete or incomplete?
Yes
True or false
Anterior horn to muscle = LMN (lower motor neuron)
True
True or false
Brain to spinal cold to anterior horn = UMN (upper motor neuron)
True
What is anterior cord syndrome?
Loss of motor function below level of injury
Loss of thermal, pain, and tactile sensation below level of injury
Retain light touch and proprioception
Incomplete injury
What is Brown-Sequard’s Syndrome?
One side of SC damage
Often results from a penetrating wound (gunshot or stab wound)
Incomplete Injury
What are clinical signs of Brown-Sequard’s Syndrome?
Ipsilateral of motor function below level of injury
Ipsilateral reduction of deep touch and proprioceptive awareness
Contralateral loss of pain, temp and touch
incomplete injury
What is a central cervical cord syndrome?
More impairment in neural fibers serving UEs (compared to LEs)
Often occurs with structural changes to the vertebrae
Arthiritic changes can lead to spinal canal narrowing
Syndrome prevalent in aging pop
incomplete injury
What are clinical signs of central cervical cord syndrome?
Motor and sensory functions in the lower extremities less involved than in upper extremities
Improvement in intrinsic hand function are generally evidenced last, if at all
A potential for flaccid paralysis of the upper extremities, as the anterior horn cells in the cervical spinal cord may be damaged b/c synapses for motor pathways, an LMN injury may result
What is a cauda equina injury?
Without injury to SC
Injury to nerve roots/ spinal nerves
Direct trauma most common use
incomplete injury
What are clinical signs of cauda equina injury?
Loss of motor function and sensation below the level of injury
Absence of a reflex arc, as the transmission of impulses through the spinal nerves to their synapse point is interrupted
Motor paralysis is of the LMN type, with flaccidity and muscle atrophy seen below the level of injury. Bowel and bladder function are also a-reflexic
some chance for nerve regeneration and recovery of function if the roots are not too severely damaged or divided
What is a conus medullaries injury?
Similar to cauda equina injury
incomplete injury
What are clinical signs for conus medullaries injury?
Loss of motor function and sensation below the level of injury, although typically not severe
Absence of a reflex arc, as the transmission of impulses through the spinal nerves to their synapse point is interrupted
Motor paralysis is of the LMN type, with flaccidity and muscle atrophy seen below the level of injury
Bowel and bladder incontinence and sexual dysfunction are typically more severe than cauda equina injuries
Complete and incomplete is quadriplegia, tetraplegia or paraplegia?
All
How long is the average length of stay in acute care for SCI?
12 days
After the average length of stay in acute care what is next?
Transfer to inpatient rehab
Depending on other complications
What is the therapists primary role in acute care?
Preserving ROM
Vital sign stability during functional mobility
Acute care addresses life threatening issues by stabilizing medical status
What are some post traumatic complications?
Spinal shock (altered reflex activity)
Catherization
Foley (indwelling catheter)
Increase in spasticity (flexor) after spinal shock subsides- reflex arc fires
6-12 months after jury, increased spasticity may occur in the extensors
1 yr post tone fluctuations cease
What is Spinal shock (altered reflex activity)?
Spinal cord segments below level of injury deprived of excitatory input from higher CNS centers
Flaccid paralysis below level of injury
Absence of reflexes
Foley (indwelling catheter)?
Bladder may be flaccid
How long does spinal shock generally last?
1-3 months post injury
What are some respiratory conditions?
Injuries below T12 usually have normal respiratory status
Above T12 can have some level of compromise
Complete injuries above C4 require a respirator- may be candidate for a phrenic nerve stimulator (diaphragm pacing)
C4 and below:
- breathing may be shallow
- productive cough may be compromised
- MOST COMMON CAUSE OF DEATH AFTER SCI
What is autonomic dysreflexia (hyperreflexia)?
Exaggerated response of the autonomic nervous system (flight or fight)
Occurs in people with injury above T6
Signs include:
- intense headache
- diaphoresis
- flushing
- goosebumps
- tachycardia followed by bradycardia
- dramatic increase BP
What can trigger this response?
- full bladder/ bowl
- UTI
- decubitus ulcers
Upright position helps decrease BP
What is postural hypotension/ orthostatic hypotension?
Decrease BP
Often seen in people with cervical or thoracic SCI
Blood tends to pool in legs
Symptoms include:
- light headed
- dizziness
- pallor
- sudden weakness
- unresponsiveness
Prevention measures:
- antiembolism hosiery
- abdominal binders
- slow positional change to upright position
- maintain semi reclined position until symptoms subside
What are potential complications and signs of deep vein thrombosis (DVT)?
Potential complication in SCI due to:
- reduced circulation
- direct trauma to legs causing vascular damage
- prolonged bed rest
Signs include:
- swelling in legs
- localized redness
- low grade fever
Greatest risk period first 2 weeks post injury
What is thermal regulation?
Function of RNS
Difficulty maintaining body temp- injuries above T6
Body tends to assume temp of external environment (Poikilothermia)
Extreme temp difficult
- lack of blood vessel constriction below injury level to conserve heat
- excessive sweating above injury level, but not below
What is musculoskeletal issues of spasticity?
UMN lesions increased tone following spinal shock
Increased spasticity can be triggered by infections, pressure stores, UTI, emotional state
Spasms can be advantageous to maintain muscle bulk circulation, bowel and bladder transfers
Excessive spasticity can lead to contractures, pain and reduced function
What is musculoskeletal issues of heterotopic ossification (ectopic bone)?
Abnormal formation of bone deposits on muscles, joints and tendons
Most often occurs at the hip and knee (followed by shoulder and elbow)
Clinical signs of HO include:
- heat
- pain
- swelling
- decrease in active or passive ROM
What is a genitourinary complications?
UTI common and dangerous complication
Nature of bladder function dependent on injury causing LMN or UMN deficits
What is a UMN bladder in genitourinary complications?
Spastic bladder
Bladder can contract and void reflexively
May be able to trigger
Must have voiding schedule since cannot sense when bladder is full
What is a LMN bladder in genitourinary complications?
Flaccid bladder
May continue after spinal shock if injury to cauda equina
No reflex arc so no spontaneous emptying
Schedule catherization
External abdominal pressure with fist- Credé’s maneuver
Glottic closure and abdominal muscle contraction- Valsalva maneuver
What are UTI signs of genitourinary complications?
Cloudy urine
Particles in urine
Dark/ foul smelling urine
Fever
Chills
Increased spasticity
What are bowel complications?
May be spastic or flaccid
Spastic may use reflexive elimination techniques
Must follow bowel schedule
Flaccid bowel cannot be stimulated reflexively- may require manual removal of stool prevent impaction
Constipation or impaction may trigger autonomic dysreflexia in people with SCI above T6
Diarrhea is problematic
- avoid overuse of laxatives
- proper diet
- adequate hydration
- bowel schedule
What are dermal complications?
Pain and temp and potential skin damage not sensed below level of injury
Danger of pressure sores
- major reason for hospital admissions
- impaired circulation
Preventable
- visual inspection (2x a day)
- areas prone to breakdown sacrum, ischium, calcaneous, scapula
- proper nutrition
- attention to environment
What are some mental health challenges in SCI?
High rate of depression
Depression can lead to
- pressure ulcers
- decreased occupational performance
Signs include:
- disinterest
- feeling worthless
- fatigue
- changes in weight and appetite
- suicidal ideation
What are medical/ surgical management for SCI?
Immobilize with backboard/ neck brace
Decompress, realign and stabilize SC
Laminectomy
Spinal fusion
Throacolumbosacral orthosis (TLSO) “clamshell”
“Halo” orthosis (most restrictive cervical device)
Steroids
Therapeutic hypothermia
Stem cells
Epidural stimulation
Functional electric stimulation
Assisted movement/ enhanced (AMES) tech
What does SCI impact on occupational performance?
Grooming/ dressing
Driving
Employment/ work roles
Bladder/ bowl elimination
Feeding/ meal prep
Social relationships
Sexual expression
Home maintenance
Education
Leisure pursuits
Pet care
Family roles
