Segmental Spinal Reflexes and Nociception

Question 1

What does proprioception refer to?

Answer 1

The awareness of the position and movement of the head, body and limbs.

Question 2

What tests can you think of which are useful to assess proprioception? (6)

Answer 2

paw positioning,
hopping,
placing and visual placing,
wheel barrowing,
extensor postural thrust,
hemi-walking and paper-sliding tests

Question 3

What is proprioception NOT specific for?

Answer 3

Neuro-anatomical location

Question 4

When testing propriocetpion - what must be supported?

Answer 4

Weight

Question 5

What are the 4 regions of the spine for neuro-anatomical localisation?

Answer 5

C1-C5 (cranial cervical),
C6-T2 (cervicothoracic intumescence),
T3-L3 (thoracolumbar),
L4-S1 (lumbosacral intumescence)

Question 6

Upper motor neuron (UMN) neurological deficits are seen when the reflexes are ? in the evaluated limb.

Answer 6

present or increased

Question 7

Lower motor neuron (LMN) neurological deficits are seen when the reflexes are in the evaluated limb.

Answer 7

absent or decreased

Question 8

Lesions affecting segments C1-C5 cause what deficits in:
A) Thoracic limb?
B) Pelvic limb?

Answer 8

A) UMN
B) UMN

Question 9

What segmental spinal reflexes are expected with Lesions of C1-C5?

Answer 9

Normal

Question 10

Lesions affecting segments C6-T2 cause what deficits in:
A) Thoracic limb?
B) Pelvic limb?

Answer 10

A) LMN (reduced spinal reflexes)
B) UMN

Question 11

Lesions affecting segments T3-L3 cause what deficits in:
A) Thoracic limb?
B) Pelvic limb?

Answer 11

A) Normal
B) UMN

Question 12

Lesions affecting segments L4-S3 cause what deficits in:
A) Thoracic limb?
B) Pelvic limb?

Answer 12

A) Normal
B) LMN

Question 13

It is important to remember that the spinal cord segments do not correspond to the surrounding vertebrae, as most spinal cord segments lie cranially to the vertebra of the same number, except which segments.

Answer 13

C1, C2, L1 and L2

Question 14

Most spinal nerves exit through ? cranially to the vertebra with the same name

Answer 14

intervertebral foramina

Question 15

Where does the spinal cord end?

Answer 15

L5-L6

Question 16

What forms the cauda equina?

Answer 16

The nerves of the caudal lumbar and sacral spinal cord

Question 17

What does the withdrawal reflex evaluate in the thoracic limb? (2)

Answer 17

Intumescence and brachial plexus nerves

Question 18

What does the Extensor carpi radialis reflex evaluate in the thoracic limb?

Answer 18

Caudal cervical intumescence (C7-T2 and radial nerve).

Question 19

What does the withdrawal reflex evaluate in the pelvic limb? (3)

Answer 19

lumbar intumescence, femoral and sciatic nerves.

Question 19

What does the patellar reflex evaluate in the pelvic limb? (2)

Answer 19

Evaluation of L4-L6 spinal cord segments and femoral nerve.

Question 20

Reliable reflexes of the thoracic limb? (2)

Answer 20

Withdrawal
Extensor carpi radialis reflex

Question 21

Reliable reflexes of pelvic limb? (2)

Answer 21

Withdrawal
Patellar

Question 22

Brain lesion; deficits in:
A) Thoracic limbs?
B) Pelvic limbs?

Answer 22

A) UMN
B) UMN

Question 23

Peripheral neuropathy, deficits in:
A) Thoracic limbs?
B) Pelvic limbs?

Answer 23

A) LMN
B) LMN

Question 24

What position must the HL be in for patellar reflex?

Answer 24

Relaxed

Question 25

How is the cutaneous trunci reflex performed?

Answer 25

forceps to pinch the skin cranial to the wings of the ilium,- both sides

Question 26

What should the cutaenous trunci reflex result in?

Answer 26

Contraction of the cutaneous trunci muscle on both sides

Question 27

Which nerve involved in the efferent pathway will trigger contraction of the cutaneous trunci muscle?

Answer 27

Lateral thoracic n.

Question 28

Cutaenous trunci reflex The A) pathway includes a sensory stimulation of the B) nerve root of at the level of the dermatome tested and bilateral stimulation of the nuclei of the lateral thoracic nerve located at the level of the C) spinal segment.

Answer 28

A) afferent B) dorsal C) C8

Question 29

The testing of the cutaneous trunci muscle is useful to localise a ?lesion

Answer 29

thoracolumbar

Question 30

Where will the lesion will be located in relation to the cut-off of the cutaneous trunci if present?

Answer 30

within the four spinal segments cranial

Question 31

The testing of the cutaneous trunci is also useful for cervicothoracic and brachial plexus lesions as it can be absent due to a lesion of the A) pathway (B) nerve).

Answer 31

A) afferent B) lateral thoracic

Question 32

When testing spinal palpation; which part should be tested last?

Answer 32

Suspected painful area

Question 33

Nociception is evaluated by?

Answer 33

conscious response of the patient to a painful stimulus.

Question 34

Why is it imperative to differentiate nociception from withdrawal reflexes?

Answer 34

Nociception is important in the assessment of the severity of a spinal lesion and its prognosis.

Question 35

Define nociception

Answer 35

Ability to feel pain

Question 36

What are the 4 steps of nociception?

Answer 36

transduction, transmission, modulation perception

Question 37

Nociception: The noxious stimulus is transduced by the receptor into an A) impulse that is then transmitted by the B) nerve to the spinal cord.

Answer 37

A) electrical B) peripheral sensory

Question 38

Nociception: The spinal cord modulates the impulse and sends it to the brain via the ? tract.

Answer 38

spinothalamic

Question 39

The final step of nociception - what perceives pain?

Answer 39

Brain

Question 40

In case of lumbo-sacral and sacrococcygeal injury testing of the nociception needs to be performed at the level of?

Answer 40

Tai and perineum

Question 41

What is the prognostic results with absent nociception with lumbo-sacral and sacrococcygeal injury ?

Answer 41

poor prognostic indicator for recovery of urinary and faecal continence.

Question 42

What is the important role of testing the presence or absence of nociception?

Answer 42

important prognostic value in case of spinal cord and peripheral nerve injury

Question 43

Is the nervous system able to regenerate with severe damage of the axon of the neuronal cell.

Answer 43

Yes

Question 44

How many degrees of axonal injury are there?

Answer 44

3

Question 45

What are the degrees of axonal injury? (3)

Answer 45

- Neurotmesis - Axonotmesis - Neurapraxia

Question 46

What Neurotmesis the result of?

Answer 46

the complete damage of the nerve, including axon, Schwann cells and surrounding connective tissue.

Question 47

Prognosis for neurotmesis?

Answer 47

VERY poor ; regeneration of the nerve is almost impossible

Question 48

What does Axonotmesis refers to?

Answer 48

the damage of the axon with preservation of the endoneurium and the surrounding myelin sheath produced by the Schwann cells.

Question 49

What are the specific and time for prognosis of axonotmesis

Answer 49

The axon can regenerate if the damaged area is not too extended, however, the regeneration is very slow.

Question 50

What does Neurapraxia refers to?

Answer 50

interruption of the nerve conduction with no damage to the nerve. It is normally due to demyelination with an undamaged axon, due to compression or transient lack of blood supply

Question 51

How long does recovery take with neurapraxia?

Answer 51

1-5 weeks

Question 52

Is it possible for the nerve to regenerate?

Answer 52

Almost impossible