Spinal Cord Injuries

Question 1

What is a spinal cord injury (SCI)?

Answer 1

A spinal cord injury (SCI) involves damage to the neural aspects of the spinal cord and often includes damage to the vertebral column and supporting ligaments.

Question 2

What are the common consequences of spinal cord injury (SCI)?

Answer 2

SCI commonly results in sensory and motor function deficits due to the disruption of tracts that connect sensory afferent neurons and lower motor neurons to higher brain centers.

Question 3

What types of injuries can occur to the vertebral column?

Answer 3

Injuries to the vertebral column include fractures, dislocations, and subluxations.

Question 4

What are the common causes of spinal cord injury (SCI)?

Answer 4

Common causes of SCI include trauma (falls, sports accidents, motor vehicle accidents (MVA), violence), infarctions, embolisms, decompression sickness, birth injuries, and diseases (e.g., polio, spinal meningitis, tumors).

Question 5

What percentage of SCI injuries are caused by trauma, and which types are the most common?

Answer 5

Trauma accounts for a significant portion of SCI injuries: falls (19%), sports (8%), motor vehicle accidents (35-50%), and violence (30%).

Question 6

What demographic is at the highest risk of sustaining a spinal cord injury (SCI)?

Answer 6

Young males, particularly those in the 16-30 age group, are at the highest risk, with this group responsible for over 50% of new SCI cases. Males are four times more likely than females to sustain SCI.

Question 7

What are the mortality rates for SCI?

Answer 7

The one-year mortality rate for paraplegia is 6-10%, while for quadriplegia, it is 30-40%.

Question 8

Which vertebral levels are most commonly affected by spinal cord injuries?

Answer 8

SCI most commonly occurs at vertebral levels with greater mobility, including:
• Cervical spine: C5 to C7 (C6/C7/C8 spinal cord levels)
• Thoracic spine: T10 to T12
• Lumbar spine: L1 to L2

Question 9

How does SCI occur at the cervical level?

Answer 9

If a cervical vertebra (e.g., C5) is fractured, the spinal cord at the corresponding level (e.g., C6) is affected. The spinal roots for the C5 level exit between the C4 and C5 vertebrae, so the C5 injury can impact these roots as well.

Question 10

What is the difference between primary and secondary injury in SCI?

Answer 10

• Primary Injury: Result of the initial trauma and is often permanent.
• Secondary Injury: Results from contusion/tearing injuries that cause swelling, ischemia, hypoxia, edema, and hemorrhage. It leads to myelin and axonal destruction but can be reversible within 4-6 hours after the injury.

Question 11

How does the CNS typically react to major events like head trauma?

Answer 11

The CNS enters a period of low-level function known as neurogenic shock, lasting an average of 7–10 days, characterized by generalized hypotonia, flaccid paralysis of skeletal muscle, and very low reflex responses below the level of injury.

Question 12

What are the symptoms of neurogenic shock below the level of injury?

Answer 12

• Generalized hypotonia (“flaccid” stage)
• Flaccid paralysis of skeletal muscle
• Very low reflex response patterns
• Loss of spinal reflexes

Question 13

Is massage therapy recommended during neurogenic shock?

Answer 13

The value of massage therapy is questionable during neurogenic shock. It is better to wait until the shock is over, though short, adapted light treatments may be beneficial in some cases, with physician approval.

Question 14

What considerations must be addressed before providing massage therapy during neurogenic shock?

Answer 14

• Stability of CNS damage (e.g., absence of hemorrhage)
• Stability of cardiovascular and respiratory functions
• Whether massage would be beneficial for the client (physically and emotionally)
• Impact of medications
• Consent issues

Question 15

What functional losses are associated with neurogenic shock?

Answer 15

• Loss of pain perception
• Loss of proprioception
• Loss of thermoregulation
• Loss of bladder and bowel control

Question 16

What other symptoms might a client in neurogenic shock exhibit?

Answer 16

• Generalized decreased sensation
• Fluctuations in cardiac and respiratory control
• Tendency to slip in and out of consciousness
• Low cognitive responsiveness to external stimuli

Question 17

What condition occurs exclusively after spinal cord injuries and can last from several days to much longer?

Answer 17

Spinal shock.

Question 18

What factors determine the severity and duration of spinal shock?

Answer 18

The extent of spinal cord swelling and the level of injury.

Question 19

What is the average duration of spinal shock?

Answer 19

7–10 days, but it can last much longer in some cases.

Question 20

What is the purpose of surgery following a spinal cord injury?

Answer 20

To stabilize vertebral fractures and/or dislocations using bony fusion, pins, plates, rods, wires, or implanted devices.

Question 21

What is the HALO device, and when is it used?

Answer 21

A metal apparatus screwed into the skull and connected to shoulder pads to stabilize the upper spine after trauma, preventing neck and upper back movement.

Question 22

What percentage of spinal cord injury (SCI) patients survive 10 years after the first 24 hours?

Answer 22

85%

Question 23

What is the most common cause of death for SCI patients after surviving the initial trauma?

Answer 23

Pneumonia

Question 24

What are the second and third leading causes of death in SCI patients?

Answer 24

• Second: Non-ischemic heart disease (unexplained MIs despite no CV history).
• Third: External causes (unintentional injury, suicide, homicide).

Question 25

How long do SCI patients typically stay in acute care hospitals and rehabilitation facilities?

Answer 25

• Hospital: 16 days on average.
• Rehabilitation: 44 days on average.

Question 26

What is the primary goal of rehabilitation for SCI patients?

Answer 26

To maximize physical function, independence, quality of life, and self-esteem, preparing them to return home and integrate into the community.

Question 27

What types of therapy are included in SCI rehabilitation programs?

Answer 27

Physical therapy (PT), occupational therapy (OT), and massage therapy (MT).

Question 28

What factors influence the extent of disability following a spinal cord injury (SCI)?

Answer 28

The number of recovering neurons, the extent of spasticity, rehabilitation and adaptation efforts, and associated complications such as pain, spasticity, contractures, cardiac disease, MSK injury, overall health, and family support.

Question 29

How long does it usually take to clarify the disability picture after an SCI?

Answer 29

6–12 months post-injury.

Question 30

List common symptoms of acute SCI.

Answer 30

• Muscle weakness or paralysis in the trunk, arms, or legs.
• Loss of sensation in the trunk, arms, or legs.
• Muscle spasticity.
• Breathing problems.
• Heart rate/blood pressure problems.
• Digestive dysfunction.
• Loss of bladder and bowel function.
• Sexual dysfunction.

Question 31

What is spasticity, and what causes it?

Answer 31

• Spasticity: A condition where muscles stiffen or tighten, preventing fluid movement and causing contractions that resist stretching.
• Cause: Damage to areas of the brain or spinal cord responsible for muscle and stretch reflex control, disrupting normal signal flow.

Question 32

How does spasticity occur after an SCI?

Answer 32

• Signals from the brain cannot reach the spinal cord, and vice versa.
• Messages are sent back to the motor rootlet in the spinal cord, creating an easily triggered spinal reflex loop.

Question 33

What are common triggers for spasticity?

Answer 33

• Stretching muscles.
• Skin irritation (e.g., chafing, rashes, burns).
• Pressure injuries.
• UTIs or full bladder.
• Injuries to muscles, tendons, or bones below the SCI level.
• Tight clothing or wraps.
• Emotional distress.
• Pain from recent surgery.
• Menstruation.
• Extreme temperatures.

Question 34

How are spinal cord injuries structurally classified?

Answer 34

As “Complete” or “Incomplete.”

Question 35

How does the location of the SCI lesion affect deficits?

Answer 35

The higher the lesion site, the more extensive the deficits.

Question 36

What is a complete spinal cord injury (SCI)?

Answer 36

A complete SCI means the spinal cord level is completely damaged, preventing any transmission ascending or descending past the injury level/scar tissue.

Features:
• Bilateral presentation.
• No voluntary motor or conscious sensory function below the injury level.

Question 37

What is an incomplete spinal cord injury (SCI)?

Answer 37

An incomplete SCI means the spinal cord level is partially damaged, resulting in partial transmission and partial function below the injury level.
Features:
• Highly variable presentation.
• Some voluntary motor and/or sensory function remains below the lesion site.

Question 38

How are SCI levels functionally classified?

Answer 38

• By the last functioning level (neurologic level of injury, NLOI).
• Example: A total cord injury at C6 is classified as a “complete C5.”
• Functional classification uses the last fully functioning level, while medical professionals may classify by the injured vertebral level.

Question 39

What is the difference between quadriplegia/tetraplegia and paraplegia?

Answer 39

• Quadriplegia/Tetraplegia: Loss of movement and sensation in all four limbs, usually from an injury between C1 and T1.
• Paraplegia: Loss of movement and sensation in the lower half of the body, typically from an injury at T1 or below.

Question 40

What are common motor abilities/disabilities at the C1/C2/C3 SCI level?

Answer 40

• Limited head/neck or facial movement only.
• Complete paralysis of body, arms, and legs.
• No diaphragm function (requires ventilator).
• Total assistance for transfers, eating, drinking, and hygiene.

Question 41

What is autonomic dysreflexia (AD), and why is it significant?

Answer 41

• AD: A sudden, exaggerated reflexive increase in blood pressure in response to stimuli below the neurological injury level, common with injuries at or above T6.
• Symptoms: Severe headache, bradycardia, facial flushing, sweating, and pallor.
• Significance: It is potentially lethal but can usually be alleviated with prompt and simple interventions.

Question 42

What are motor abilities/disabilities at the C4 SCI level?

Answer 42

• Full head and neck movement depending on muscle strength.
• Paralysis of the body and legs.
• Sympathetic nervous system compromised; risk of AD.
• Breathing without a ventilator possible, but assisted coughing may be needed.

Question 43

What are motor abilities/disabilities at the C5 SCI level?

Answer 43

• Full head/neck movement and good shoulder movement.
• Paralysis of the body and legs.
• Good elbow flexion and supination; no finger, wrist, or elbow extension.
• Can use manual or power wheelchairs.

Question 44

What are the common triggers for spasticity after an SCI?

Answer 44

• Muscle stretching or positioning.
• Skin irritation (e.g., rashes, burns).
• Pressure injuries.
• UTIs or full bladder.
• Tight clothing.
• Emotional distress, surgery pain, or extreme temperatures.

Question 45

What is a complete spinal cord injury (SCI)?

Answer 45

Complete SCI means the affected spinal cord level is completely damaged, preventing any transmission past the injury level.

Features:
• Bilateral presentation.
• No voluntary motor or sensory function below the injury level.

Question 46

What is an incomplete spinal cord injury (SCI)?

Answer 46

Incomplete SCI means the spinal cord is partially damaged, leaving partial transmission and function below the injury level.

Features:
• Highly variable presentation.
• Some motor and/or sensory function remains below the lesion site.

Question 47

How are SCIs functionally classified?

Answer 47

By the last fully functioning level (neurologic level of injury or NLOI). For example, a total damage at C6 is classified as a “complete C5.”

Question 48

What is Brown-Séquard Syndrome?

Answer 48

Damage to one side of the spinal cord causing:

Ipsilateral:
• Motor paralysis or paresis (corticospinal tract).
• Loss of proprioception, vibration, pressure, and touch (dorsal columns).

Contralateral:
• Loss of pain and temperature (lateral spinothalamic tract).
• Prognosis: 90% regain ability to walk, recovery takes ~2 years.

Question 49

What is Central Cord Syndrome?

Answer 49

The most common cervical incomplete injury, often associated with hyperextension or stenosis.

Presentation:
• Weakness in upper extremities > lower extremities.
• Variable sensory loss below injury.
• Possible bladder, bowel, and sexual dysfunction.

Prognosis: Favorable; residual upper extremity weakness may persist.

Question 50

What is Anterior Cord Syndrome?

Answer 50

Damage to the anterior 2/3 of the cord, usually due to infarction of the anterior spinal artery.
• Loss: Motor function and pain/temperature sensation (corticospinal & lateral spinothalamic tracts).
• Preservation: Proprioception and vibration (dorsal columns).
• Prognosis: Worse than other syndromes, depends on injury level.

Question 51

What are key features of cauda equina syndrome?

Answer 51

• Damage to nerves fanning out from L1/L2, causing:
• Motor/Sensory Loss: Partial or complete.
• Cause: PNS lesion; regeneration is theoretically possible.

Question 52

What are the motor abilities/disabilities at the C6 level?

Answer 52

• Good head, neck, and shoulder movement.
• No finger movement, elbow extension, or wrist flexion.
• Can assist with daily tasks and self-transfer using assistive devices.
• Independent pressure releases and skin checks.

Question 53

What are motor abilities/disabilities at the C7/C8 level?

Answer 53

• Full head, neck, and shoulder movement.
• Partial finger movement, full elbow extension.
• Can self-transfer, drive with adaptations, and perform wheelchair push-ups.

Question 54

What are motor abilities/disabilities at the T6-T10 level?

Answer 54

• Good abdominal muscle control, partial trunk balance.
• Loss of function below the waist.
• Good sitting balance, better wheelchair operation, athletic activities possible.

Question 55

What is spasticity, and what triggers it after SCI?

Answer 55

• Definition: Muscles tighten or stiffen, preventing normal movement due to disrupted spinal reflex loops.
• Triggers: Stretching, skin irritation, pressure injuries, UTIs, tight clothing, emotional distress, and extreme temperatures.

Question 56

What are the features of motor and sensory loss in SCIs?

Answer 56

• Motor Loss: Myotomal flaccidity at the level and below.
• Sensory Loss: Dermatomal and scleratomal anesthesia at and below the level of injury.