Spinal Cord Injuries Flashcards
Afferent motor sensors
Ascending, received by spinal cord from PNS and information is transmitted to higher structures in the CNS
Efferent motor sensors
Descending, transmitted by spinal cord back to the PNS
Pairs of spinal nerves
31
Cauda equina- bundle of nerves past spinal cord’s ending
Dermatome map
Shows a more detailed outline of muscles innervated by each level of the spinal cord and a sensory map of the body
Reflex arc
A built-in reflex that does not need conscious thought for certain muscle functions or responses to occur
Leading cause of SCI
MVA followed by falls and acts of violence
Gender and mean age
80% of cases are male, present mean age is 34.7
Compared to composition of general pop., SCI’s have a higher incidence among non-Caucasian
Blacks = 12% of general population but account for 24% of SCI
Complete SCI
complete transection of the cord, all ascending and descending pathways are interrupted, total loss of motor and sensory function below the level of injury
UMN injury
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
LMD injuries
A loss of voluntary function below the level of injury, flaccid paralysis, muscle atrophy, absence of reflexes
Incomplete injuries
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
ASIA
American spinal injury associated impairment scale
Post-traumatic complications
Spinal shock
Spinal shock
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
How long spinal shock lasts
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
Respiratory complications
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
Autonomic Dysreflexia (Hyperreflexia)
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
Management of hyperreflexia
Finding the cause and alleviating it and maintaining person in upright position
Prevalent on initial months following injury
Postural hypotension
BP decreases, cervical or thoracic SCIs, orthostatic hypotension, if does not subside quickly assume semireclined or reclined position
DVT
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
Thermal regulation
Function of ANS, maintaining body temp problem above T6, takes on temp. Of external environment
Musculoskeletal complications
Spasticity- UMN lesions, results in contractures
Heterotopic ossification
Genitourinary Complications
UTI
Dermal complications
SCI injury involves loss of sensation in affected areas, will not be able to feel pain, heat, lesions, pressure
Tips to minimize dermal injury
Sources of injury, heat and cold cautions, check the skin at least twice a day to check for injury
Pressure ulcers
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
Spastic bowel
Can use touch to encourage bowel to relax and let out stool, suppository may be needed
Flaccid bowel
Cannot be stimulated to relax father, will not push out stool on its own, manual removal of the bowel
Surgical interventions
Laminectomy- the removal of bony fragment or bullet to relieve pressure on cord
Spinal fusion- fusion of two or more vertebrae to achieve stability
C1-C3
Ventilator
C5
Power wheelchair
T1-T3
Independent- living, transfers, self-care, assistance still required for high, low, heavy tasks
