Spinal Cord Injuries

Question 1

Afferent motor sensors

Answer 1

Ascending, received by spinal cord from PNS and information is transmitted to higher structures in the CNS

Question 2

Efferent motor sensors

Answer 2

Descending, transmitted by spinal cord back to the PNS

Question 3

Pairs of spinal nerves

Answer 3

31

Cauda equina- bundle of nerves past spinal cord’s ending

Question 4

Dermatome map

Answer 4

Shows a more detailed outline of muscles innervated by each level of the spinal cord and a sensory map of the body

Question 5

Reflex arc

Answer 5

A built-in reflex that does not need conscious thought for certain muscle functions or responses to occur

Question 6

Leading cause of SCI

Answer 6

MVA followed by falls and acts of violence

Question 7

Gender and mean age

Answer 7

80% of cases are male, present mean age is 34.7

Question 8

Compared to composition of general pop., SCI’s have a higher incidence among non-Caucasian

Answer 8

Blacks = 12% of general population but account for 24% of SCI

Question 9

Complete SCI

Answer 9

complete transection of the cord, all ascending and descending pathways are interrupted, total loss of motor and sensory function below the level of injury

Question 10

UMN injury

Answer 10

If reflex arc are intact below the level of injury but are no longer mediated by the brain

Loss of voluntary movement below injury, spastic paralysis, no muscle atrophy, hyperactive reflexes

Question 11

LMD injuries

Answer 11

A loss of voluntary function below the level of injury, flaccid paralysis, muscle atrophy, absence of reflexes

Question 12

Incomplete injuries

Answer 12

Occur when damage to the spinal cord does not cause a total transection, some degree of voluntary movement or sensation below the level of injury, UMN AND LMN can be complete or incomplete

Question 13

ASIA

Answer 13

American spinal injury associated impairment scale

Question 14

Post-traumatic complications

Answer 14

Spinal shock

Question 15

Spinal shock

Answer 15

Period of altered reflex activity immediately after a traumatic SCI, spinal cord below lesion are deprived of excitatory input from higher CNS center, flaccid paralysis, absence of reflexes, bladder flaccid

Question 16

How long spinal shock lasts

Answer 16

1 week to 3 months, once subsides- the areas above lesion operate as they one did, below lesion will resume if the reflex arc is intact

Question 17

Respiratory complications

Answer 17

SCI above T12,
Abdominal musculature T7-T12,
Intercostal muscles T1-T12,
Diaphragm is inverted @ C4, complete injuries above= respirator, below=shallow breathing, cough may be compromised

Most common cause of death following a SCI

Question 18

Autonomic Dysreflexia (Hyperreflexia)

Answer 18

Involves exaggerated response of the ANS, flight or fight, T6 or above,
Signs- headache, flushing, goosebumps, tachycardia followed by bradycardia
Cause- irritation of nerves below level of injury, bladder, bowel, UTI, decubitus ulcers

Question 19

Management of hyperreflexia

Answer 19

Finding the cause and alleviating it and maintaining person in upright position

Prevalent on initial months following injury

Question 20

Postural hypotension

Answer 20

BP decreases, cervical or thoracic SCIs, orthostatic hypotension, if does not subside quickly assume semireclined or reclined position

Question 21

DVT

Answer 21

Reduced circulation caused by decreased tone, frequency of direct trauma to less causing vascular damage, prolonged bed rest

Swelling in LE’s, redness low grade fever

2 weeks post injuries greatest risk

Question 22

Thermal regulation

Answer 22

Function of ANS, maintaining body temp problem above T6, takes on temp. Of external environment

Question 23

Musculoskeletal complications

Answer 23

Spasticity- UMN lesions, results in contractures

Heterotopic ossification

Question 24

Genitourinary Complications

Answer 24

UTI

Question 25

Dermal complications

Answer 25

SCI injury involves loss of sensation in affected areas, will not be able to feel pain, heat, lesions, pressure

Question 26

Tips to minimize dermal injury

Answer 26

Sources of injury, heat and cold cautions, check the skin at least twice a day to check for injury

Question 27

Pressure ulcers

Answer 27

Stage 1- redness or darkened skin, epidermis and dermis
Stage 2- open lesion with blister or scab, dead and dying adipose tissue
Stage 3- wound is draining, ulcer is developing in dead tissue, muscle, surgery
Stage 4- down to bone, infection and bone decay, surgery, no pressure for weeks

Question 28

Spastic bowel

Answer 28

Can use touch to encourage bowel to relax and let out stool, suppository may be needed

Question 29

Flaccid bowel

Answer 29

Cannot be stimulated to relax father, will not push out stool on its own, manual removal of the bowel

Question 30

Surgical interventions

Answer 30

Laminectomy- the removal of bony fragment or bullet to relieve pressure on cord

Spinal fusion- fusion of two or more vertebrae to achieve stability

Question 31

C1-C3

Answer 31

Ventilator

Question 32

C5

Answer 32

Power wheelchair

Question 33

T1-T3

Answer 33

Independent- living, transfers, self-care, assistance still required for high, low, heavy tasks