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Neuro Eval II > Spinal Cord I > Flashcards

Spinal Cord I Flashcards

1
Q

4 Aspects of SCI Body Structure Function Exam and Eval

A
  • Sensation
  • Strength
  • Muscle spasticity/ tone
  • Range of motion
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2
Q

What are the 3 components of the International Standards for Neurological Classification of Spinal Cord Injury?

A

Sensory Testing
Motor Testing
Anorectal Exam

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3
Q

What does the ISNSCI determine?

A
  • Sensory level
  • Motor level
  • Neurologic level
  • Severity (complete vs. incomplete)
  • ASIA Classification
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4
Q

What must you do in order to get an accurate classification?

A

Test ALL aspects of the exam

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5
Q

Two parts of sensory testing

A
  • Light touch (DCML)
  • Pin Prick (ALS)
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6
Q

How to do light touch sensory testing

A

 Identify reference point on cheek
 Use key sensory points at each dermatome from ISNSCI worksheet (move C2→S4, single side)  Each key point assessed with single small swipe with wisp of Q tip

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7
Q

Grading for light touch

A

2: Intact
1: Impaired - can feel touch by feels different that reference
0: Absent

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8
Q

Instruction for light touch sensory testing

A

“Tell me when you feel me touch you, and if it feels the same or different than your cheek”

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9
Q

How to perform pin prick sensory testing

A
  • Each key point is assessed with 4-6 touches in random order of sharp/dull with safety pin
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10
Q

Instruction for pin prick sensory testing

A

“tell me if you feel sharp or dull after each touch”
*after series of touches at each sensory point…
“Did that feel the same or different than your cheek?”

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11
Q

Pin prick grading

A

2: Intact
1: Impaired - can distinguish between sharp/dull but feels different than reference
0: cannot distinguish between sharp/dull

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12
Q

What position should the patient be in for sensory exam?

A

Supine
It is standardized and reproducible

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13
Q

Sensory exam considerations

A

 Eyes open for instruction & demonstration (on own hand), eyes closed for exam
 Differentiate between patient lacking sensation vs not understanding task
 No leading questions – “did you feel that?”
 MUST ask for comparison to reference to be able to distinguish between 1 or 2 grading
 Pause exam if repositioning limb to access sensory point and explain to patient

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14
Q

What is the sensory level?

A

The most caudal level on each side with intact sensation for BOTH light touch and pinprick with all 2s above

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15
Q

ASIA Key Muscle Groups

A
  • C5: Elbow Flexors
  • C6: Wrist Extensors
  • C7: Elbow Extensors
  • C8: Long Finger Flexors
  • T1: Small Finger Abductor
  • L2: Hip Flexors
  • L3: Knee Extensors
  • L4: Ankle Dorsiflexors
  • L5: Great Toe Extensors
  • S1: Ankle Plantarflexors
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16
Q

ASIA Motor Grading

A
  • 5 - Anti-gravity, full resistance
  • 4 - Anti-gravity, partial resistance
  • 3 - Anti-gravity, no resistance
  • 2 - Gravity-eliminated, full ROM
  • 1 - Gravity-eliminated, partial ROM or trace muscle contraction
  • 0 - no trace muscle contraction
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17
Q

5 ISNSCI Motor Testing Considerations

A

 Demonstrate task by moving patient through PROM first OR demo on self in patient’s line of vision – remember, they are supine!
 Ask patient to move through AROM in anti gravity position first and then move to gravity eliminated if needed
 Palpate over muscle belly of muscle being assessed in case you don’t see AROM
 Support or “float” limb to eliminate effects of friction when moving in gravity eliminated position
 Starting position accounts for restrictive antagonist muscles or extensor spasm/tone (see motor exam guide)

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18
Q

What if they have a motor grade of 0?

A
  • Cue for muscle contraction regardless of whether it is happening or not
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19
Q

How do you determine the motor level?

A
  • Most caudal level on each side with intact motor function with all 5s above
  • Intact motor function = at least 3/5
20
Q

How to determine Neurologic Level of Injury

A

Most caudal level with intact sensation and motor function bilaterally

21
Q

How do you determine the neurologic level of injury if it is a thoracic level injury?

A

Go based on the sensory level

22
Q

2 Parts of anorectal exam:

A

 SENSORY: Includes S4-5 sensory point + Deep Anal Pressure (DAP)
 MOTOR: Includes Voluntary Anal Contraction (VAC)

23
Q

Why is the anorectal exam important?

A

 Represents the most caudal segments of the spinal cord
 Determines patient’s bowel/bladder function
 Key determinant of severity of SCI – complete vs incomplete

24
Q

What defines a complete vs incomplete spinal cord injury?

A

Absence or presence of sacral sparing
- Complete: No VAC, DAP, or S4-S5 sensation on either side
- Incomplete: If VAC, DAP, or or any S4-S5 sensory scores are >0 on either side

25
Q

AIS A

A

No Sacral sparing in sacral segments
Complete SCI

26
Q

AIS B

A

Sacral Sparing Present
Neither VAC present NOR motor function more than 3 levels below motor level on a given side
(Sensory incomplete/motor complete SCI)

27
Q

AIS C

A

Sacral Sparing Present
There is VAC present OR there is motor function more than 3 levels below the motor level on a given side
Half of the key muscles below the NLI are NOT a grade 3 or better

28
Q

AIS D

A

Sacral Sparing Present
There is VAC present OR there is motor function more than 3 levels below the motor level on a given side
Half of the key muscles below the NLI ARE a grade 3 or better

29
Q

C5

A

Elbow flexors

30
Q

C6

A

Wrist Extensors

31
Q

C7

A

Elbow extensors

32
Q

C8

A

Finger Flexors

33
Q

T1

A

Finger abductors (little finger)

34
Q

L2

A

Hip Flexors

35
Q

L3

A

Knee extensors

36
Q

L4

A

Ankle DFs

37
Q

L5

A

Big Toe Extensors

38
Q

S1

A

Ankle PFs

39
Q

What are zones of partial preservation?

A

 Most caudal innervation below sensory/motor levels in a sensory or motor complete injury (any innervation)
 Sensory ZPP –in absence ofDAP (can be on one side only if S4-5 present unilaterally)
 Motor ZPP – in absence of VAC

40
Q

Central Cord Syndrome

A

 Most common form of incomplete SCI
 Commonly occurs from hyperextension injury or a fall by an older adult with underlying cervical disease
 Greater motor deficits due to medial aspect of
corticospinal tract involvement (hands and forearms)
 Pain and temperature sensation lost mainly in UE and trunk due to spinothalamic somatotopic organization
 Bladder dysfunction but sacral sensation usually
preserved

41
Q

Anterior cord syndrome

A

 Sometimes referred to as anterior spinal artery syndrome or ventral cord syndrome
 Caused by hyperflexion injuries of cervical spine resulting in infarction of anterior 2/3 of spinal cord or its vascular supply from ASA
 Characteristic of motor paralysis below level of lesion
 Loss of pain and temperature below level of lesion
 Light touch, vibration and proprioception is typically preserved due to sparing of DCML

42
Q

Brown-Sequard Syndrome

A

 Characterized by a hemisection of the spinal cord
 Presents as ipsilateral motor deficits and light touch, proprioception and vibration
 Contralateral pain and temperature sensation loss
 Most often caused by a trauma (GSW or stabbing to neck or back), and less commonly non- traumatic from a spinal tumor, inflammatory
disease process (MS, infectious disease process (TB, Meningitis) or blocked blood flow to spine

43
Q

Posterior Cord Syndrome

A
  • Uncommon
  • Bilateral loss of proprioception and vibration sense DCML affected)
44
Q

Cauda Equina Syndrome

A

nerve root compression/damage after
exiting spinal cord often leading to incontinence and LE weakness (LMN presentation)

45
Q

Conus Medullaris Syndrome

A

similar presentation to Cauda Equina Syndrome w/ UMN signs as well

Neuro Eval II (16 decks)

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