Spinal Cord Injuries

Question 1

Cervical Precautions (3)

Answer 1

1. If spine is unstable, pt is on bed rest
2. if spine is pending clearance but no fx/dislocation, pt may be up w/ use of collar
3. If pt is post-fixation, pt may be up w/ use of collar

Question 2

Thoracic & Lumbar precautions (5)

Answer 2

1. if spine is unstable or any doubt, pt on bed rest
2. Limit extremity movement to limit spine mvt
3. do not elevate HOB
4. Pt should be at 30deg reverse Trendelenburg to prevent aspiration while eating
5. Log roll x 2 assist

Question 3

Level of Injury

• based on?
• motor vs. sensory level

Answer 3

Based on the last INTACT muscle group and dermatome - NOT by spinal fracture location

can describe sensory & motor levels separate
- neurological level is the HIGHEST level on either side, for either sensory & motor

Motor - muscle strength at least 3/5
Sensory - normal sensation (2)

Question 4

Key Cervical muscle groups

Answer 4

C1-C4 = diaphragm
C5 = biceps
C6 = wrist extensors
C7 = triceps
C8 = finger flexors
T1 = small finger abductors

Question 5

Key Lumbar muscle groups

Answer 5

L2 = hip flexors
L3 = quads - knee extensors
L4 = ant tib/dorsiflexors
L5 = long toe extensors (EHL)
S1 = ankle plantarflexors

Question 6

ASIA Scoring

Answer 6

“completeness” of injury

based on presence or absence of rectal tone

Question 7

ASIA A

Answer 7

Complete injury

no motor or sensory function in S4/5

Question 8

ASIA B

Answer 8

Sensory incomplete

sensation is preserved but NO motor function is intact below neurological level

Question 9

ASIA C

Answer 9

Motor incomplete

motor function is preserved below neurological level w/ more than half of the key muscles w/ a score of LESS than 3 (0-2)

Question 10

ASIA D

Answer 10

Motor incomplete

Motor function is preserved below neurological level w/ more than half of the key muscles w/ a score of 3 OR GREATER

Question 11

ASIA E

Answer 11

Normal

used in follow up patients w/ SCI who initially had deficits

Question 12

Anterior Cord Syndrome

• clinical presentation
• causes
• prognosis

Answer 12

loss of function of everything except the dorsal column

• intact conscious touch & proprioception
• absence of pain, temp and all motor function below level of injury

Causes: anterior spinal artery infarction, disc herniation or radiation myelopathy

Poor prognosis

Question 13

Central Cord Syndrome

• clinical presentation
• causes
• prognosis

Answer 13

central area of injury when affects the medially located motor fibers that control the distal UE function

• UE weakness > LE w/ sacral sparring
• LE spinothalamic & corticospinal tracts are usually sparred b/c more lateral

Causes: syringomyelia, intramedullary tumor, axial compression

Good prognosis for functional recovery

Question 14

Brown-Sequard Syndrome

• clinical presentation
• causes

Answer 14

damage that affects half of the spinal cord

• SAME side: spastic paresis (UMN lesion), loss of light touch & vibration
• OPP side: loss of pain & temp

Cause: bullet or knife injury, MS

Question 15

Cauda Equina Injury

• clinical presentation
• causes

Answer 15

LBP, radicular pain, LE paresis or paralysis, sensory deficit in perineal area, bowel or bladder dysfunction, diminished patellar and Achilles reflexes

Causes: disc herniation

MEDICAL EMERGENCY

Question 16

Autonomic Dysreflexia

• what is it
• most common cause
• symptoms
• what to do

Answer 16

MEDICAL EMERGENCY - increase in BP and risk for cerebral hemorrhage or possible heart failure
- pt’s w/ injury @ T6 or higher at risk

Most common cause = bladder distention

Symptoms: headache, sweating, nasal congestion, sustained penile erection, hyperhidrosis (goose bumps), paresthesias

What to do: check for source, get assistance, ELEVATE the head, activate EMS

Question 17

DVT

• what is it
• when is the highest risk

Answer 17

coagulation of blood resulting in thrombus in the venous system

HIGHEST RISK = 2 weeks after initial injury during acute flaccidity phase

Symptoms: rapid onset of swelling, increased temp in limb

Question 18

Heterotrophic Ossification

• what is it
• where does it occur
• most commonly seen at…

Answer 18

ectopic bone formation in the soft tissue surrounding a joint due to inflammatory process –> sudden limitation of ROM
- occurs BELOW level of injury

most commonly seen at hip, can occur in knee, shoulder and elbow

Question 19

Syrinogmyelia

• what is it
• symptom

Answer 19

a syrinx is a tapered, fluid filled cavity w/n the SC that may extend for multiple spinal levels

Can cause considerable functional limitations and pain
- a new change in level of function such as sudden decrease in motor function is a sigh of a new pathology

“a chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord. This characteristically results in wasting of the muscles in the hands and a loss of sensation”

Question 20

SCI and Pain

- normal vs. abnormal

Answer 20

Nociceptive pain - normal

Neuropathic pain - pain or sensory disturbance due to abnormal processing of afferent input
- relentless burning