Spinal Cord Injuries

Question 1

Central cord

Answer 1

Most common in cervical region
Central part of cord is damaged
Result from hyperextension
Greater weakness in UE than LE

Question 2

Brown-Sequard (hemi-section of cord)

Answer 2

Half of the cord is damaged
Ipsilateral proprioceptive and motor loss
Contralateral loss of pain and temp
Extremity with greatest strength and poorest sensation

Question 3

Anterior cord

Answer 3

Caused by flexion injury
Variable motor and sensory loss
Pain and temp impaired
Proprioception and light touch are preserved

Question 4

Posterior cord

Answer 4

Least frequent

Proprioceptive loss

Question 5

Conus medullaris

Answer 5

Injury to sacral cord and lumbar nerve roots
Lower extremity motor and sensory loss
Areflexic (absence of reflexes) bowel and bladder

Question 6

Cauda Equina syndrome

Answer 6

Inury at L1 level or below
LMN lesion, therefore flaccid paralysis with no spinal reflex activity
Loss of motor function and sensation
Areflexic bowel and bladder

Question 7

Spinal shock

Answer 7

Transient suppression/depression and gradual return of spinal reflexes
Phase 1 (0-1 day): areflexic/hyporeflexic
Phase 2 (1-3 days): initial reflex return
Phase 3 (1-4 wks): initial hypereflexia
Phase 4 (1-12 months): final hypereflexia

Question 8

Orthostatic hypotension

Answer 8

Blood pooling in LE compromising venous return
Typically occurs in SC above T6
An excessive fall in blood pressure upon assuming the upright position
symptoms: dizziness, vision changes, syncope

Question 9

Response to orthostatic hypotension

Answer 9

1. Check blood pressure
2. If the person is in bed, lower the head of the bed
3. If the person is in a w/c, lift legs and observe signs of relief (if symptoms persist, recline w/c to place head at or below level of heart)
4. Put person to bed
5. Continue to monitor BP, seek med assistance, do not leave person

Question 10

Autonomic dysreflexia

Answer 10

Abnormal response to noxious stimulus that results in extreme rise in blood pressure, pounding headache, and profuse sweating
*Medical emergency if stimulant isn’t removed quickly
*Typically occurs in SC above T6
most often a result of overfull bladder, UTI, fecal impaction, pressure ulcers, ingrown toenails

Question 11

Prevention of Autonomic dysreflexia

Answer 11

Teach frequent pressure relief principles
Ensure compliant with intermittent catherization
Practice well-balance diet habits
Ensure medication compliance
Educate how to recognize signs and initiate first aid procedure

Question 12

Response to Autonomic dyreflexia

Answer 12

1. Ask person to stop activity
2. Check blood pressure, IF high:
3. Have person sit up with head elevated
4. Loosen clothing and other constrictive devices
5. Check urinary catheter
6. Continue to monitor blood pressure and seek medical assistance

Question 13

Neurological level

Answer 13

Denotes lowest level which key muscles grade >3/5, normal strength and intact sensation

Question 14

Complete injury

Answer 14

Absence of sensory and motor function in lowest sacral segments (S4-S5)

Question 15

Incomplete injury

Answer 15

Partial preservation of sensory and/or motor function below neurological level

Question 16

Zone of partial preservation

Answer 16

Complete injuries with partial innervation in dermatomes below neurological level

Question 17

ASIA Impairment Scale

Answer 17

A=complete
No sensory or more function preserved is S4-S5
B=incomplete
Sensory but no motor function below neurological level
C=incomplete
Sensory and motor below neurological level, muscles 3/5
E=normal
Motor and sensory functions are normal

Question 18

Prognosis

Answer 18

Inverse relationship with time
Greatest motor/sensory return within 6 months
Rate of recovery after 1 year slows

Question 19

Intervention: C1-C4

Answer 19

Manually ventilating
Managing ventilator
Assist in selection of equipment
Train to use mouth sticks

Question 20

Intervention: C5

Answer 20

Mobile arm support (weak deltoid and biceps)
Wrist support
Universal cuff
Trunk support

Question 21

Intervention C6-C7

Answer 21

Tenodesis grasp
Reach and grasp (C7) (triceps)
Great proximal innervation
Transfers, bed mobility, wheelchair

Question 22

Intervention: C8

Answer 22

Hand function
Extrinsic finger muscles and thumb flexors
Intrinsic minus hands
Used for grasp, decreased/ limited intrinsic hand muscles (lumbricals)

Question 23

Intervention: paraplegia

Answer 23

higher-level compared to high cervical injuries
Independent with ADLs
Better recovery of skills
Fewer medical complications
Truck control
Community outings