Spinal Cord Injuries and Diseases Flashcards
Horns of the spinal cord
Anterior horn: motor, efferent, ventral
Posterior horn: sensory, afferent, dorsal
Levels of injury
Neurological level: what muscles can still function
Functional level: what can client still do?
Osteological level: where the damage is
Types of injury
Concussion - temporary, motor and sensory is impacted
Contusion - bruising with swelling, temporary
Laceration - tearing of SOME tissue, may be repaired if minor, but it permanent if tracts are disrupted
Transection - severing of spinal tissue that causes permanent damage
* complete - all tracts are disrupted and there is no function below level of injury
* incomplete - some tracts are disrupted, some may recover; preserved sensation below level of injury, preserved motor can be functional or nonfunctional
Forces that cause injury
Acceleration-deceleration: hyperflexion, hyperextension
Rotation: snapping neck
Axial loading: crushing
Penetrating: bullet
C1-C3 spinal cord injury
Full time ventilation
Needs help clearing secretions
Total assist for ADLs
Chun or puff chair (mainly with C3)
- chairs are slightly tilted to prevent autonomic dysreflexia cause by orthostatic hypotension
Risk of autonomic dysreflexia
Swelling above level of injury
C4 SCI
Have full head and neck movement
- ventilator to begin; will eventually be able to breathe without it, but won’t have full respiratory ability
- can breathe with diaphragm
Needs help to clear secretions and cough
Mouth stick, sip and puss, or chin switch to operate chair
Risk of autonomic dysreflexia
Dependent for ADLs
C5 SCI
No need for ventilator
Needs help clearing secretions and coughing due to low stamina
Risk of autonomic dysreflexia
Good shoulder and elbow flexion (no extension)
Independent with power wheelchair
Needs some assistance with manual wheelchair
- adjusted rims, short distances on even surfaces
Dependent for transfers
Can help with dressing, but still dependent
May be able to use a universal cuff for feeding
C6 SCI
Good shoulder and elbow flexion, wrist extension
- tenodysis action
Independent with power wheelchair
Some assistance with manual wheelchair
Dependent for transfers
May need help clearing secretions or may be able to perform a manual cough
Risk of autonomic dysreflexia
May be able to fist light meals, feed, shave, brush teeth, with adaptive cuff
May dress UE
Need help with LE
May be able to empty catheter bag
C7-C8 SCI
Full wrist and elbow flexion and extension
- partial digit
Electric or manual wheelchair
Rish of autonomic dysreflexia
Able to drive with adaptations
Can usually transfer independently
Dress, groom, and bathe independently
Independent with bowel and bladder care
Can do light household tasks
T1-T4 SCI
Full use of UE (paraplegic)
T4 has good chest muscles but not all
Manual or power chair
Transfer and dress independently
At risk for autonomic dysreflexia
Independent from chair with complex meals, house and childcare
Can drive with hand controls
T5-T9 SCI
Full UE strength
Better balance
Independent for all ADLs and household tasks, may need assistance for heavy activities
Endurance is decreased
Most use manual chairs
T10-L1 SCI
Intact respiratory function
Good trunk balance
Many use a standing frame or hip braces
Most use manual chair
Independent with ADLs
L2-S5 SCI
Full UE and trunk with some hip, knee, and foot depending on level
Independent with ATLs
Normal respiration
Walking with braces or crutches
May use wheelchair for energy conservation
Hand controls on car
Bladder, bowel, and sexual function impacted
General rules for SCI
C level - tetraplegic
T level - paraplegic
Complete - absence of sensory and motor function in the lowest sacral segment
Incomplete - partial preservation of sensory and.or motor function below the neurological level including the lowest sacral segment
- zone of partial preservation
Autonomic hyperreflexia or dysreflexia
T6 and above
Emergent
ANS misinterprets noxious stimuli
Only occurs with neurological defect
Can cause coma or death
Orthostatic hypotension
Can be seen with lots of patients
Move them slow - occurs when standing too fast
Not emergent
Fast drop in BP
Can cause autonomic dysreflexia
SCI increase risk of
DVT
Postural hypotension (orthostatic hypotension)
Heterotrophic ossification
Thermal regulation issues (T6 and above)
Central cord
Incomplete - center of spinal cord usually damaged from tumor
Weak upper, stronger lower
Varying degrees of bowel and bladder
Burning hand syndrome
- with some central cord clients (usually there is a fx or dislocation present)
- the patient complains of severe burning in hands and/or feet
Brown-Sequard
1/2 is damaged
Ipsilateral proprioceptive and motor loss
Contralateral pain and temperature loss below damaged level
Usually a penetrating injury
Anterior cord syndrom
Loss of voluntary motor, pain, and temperature perception below injury
Retains posterior column function (proprioception, light touch, pressure, position, and vibration)
Injury to anterior cord
Posterior cord syndrom
Very rare
Happens with hyperextension injuries with fx or tumor
Proprioception, vibration sense, 2 point discrimination, and light touch are lost below lesion
Most function is preserved
Compression by tumor or infarction of posterior spinal artery
Conus medullaris syndrome
Lesion to sacral cord (T12)
- compression of fx of T12 - kicked in butt
Flaccid legs
Flaccid anal sphincter
- atonic bowel
Cauda equina syndrome
Compression of nerve roots below L1, usually by fx or disc herniation
LE motor deficit
Variable bladder, bowel, and sexual dysfunction
Variable sensory loss
Neural tube defects
Spina bifida occulta
Spina bifids cystica
- Meningocele
- Myelomeningocele
Function is based on level of defect
IICP
Increased intracranial pressure
Hydrocephalus
- shunt
