Spinal Cord Injuries and Diseases

Question 1

Horns of the spinal cord

Answer 1

Anterior horn: motor, efferent, ventral
Posterior horn: sensory, afferent, dorsal

Question 2

Levels of injury

Answer 2

Neurological level: what muscles can still function
Functional level: what can client still do?
Osteological level: where the damage is

Question 3

Types of spinal cord injury

Answer 3

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

Question 4

Forces that cause spinal cord injury

Answer 4

Acceleration-deceleration: hyperflexion, hyperextension
Rotation: snapping neck
Axial loading: crushing
Penetrating: bullet

Question 5

C1-C3 spinal cord injury

Answer 5

Full time ventilation
Needs help clearing secretions
Total assist for ADLs
Chin switch 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

Question 6

C4 SCI

Answer 6

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 puff, or chin switch to operate chair
Risk of autonomic dysreflexia
Dependent for ADLs

Question 7

C5 SCI

Answer 7

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

Question 8

C6 SCI

Answer 8

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 fix light meals, feed, shave, brush teeth, with adaptive cuff
May dress UE
Need help with LE
May be able to empty catheter bag

Question 9

C7-C8 SCI

Answer 9

Full wrist and elbow flexion and extension
- partial digit
Electric or manual wheelchair
Risk 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

Question 10

T1-T4 SCI

Answer 10

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

Question 11

T5-T9 SCI

Answer 11

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

Question 12

T10-L1 SCI

Answer 12

Intact respiratory function
Good trunk balance
Many use a standing frame or hip braces
Most use manual chair
Independent with ADLs

Question 13

L2-S5 SCI

Answer 13

Full UE and trunk with some hip, knee, and foot depending on level
Independent with ADLs
Normal respiration
Walking with braces or crutches
May use wheelchair for energy conservation
Hand controls on car
Bladder, bowel, and sexual function impacted

Question 14

General rules for SCI

Answer 14

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

Question 15

Autonomic hyperreflexia or dysreflexia

Answer 15

T6 and above
Emergent
ANS misinterprets noxious stimuli
Only occurs with neurological defect
Can cause coma or death

Question 16

Orthostatic hypotension

Answer 16

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

Question 17

SCI increase risk of

Answer 17

DVT
Postural hypotension (orthostatic hypotension)
Heterotrophic ossification
Thermal regulation issues (T6 and above)

Question 18

Central cord

Answer 18

Incomplete - center of spinal cord usually damaged from tumor
Weak upper body, stronger lower body
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

Question 19

Brown-Sequard

Answer 19

1/2 is damaged
Ipsilateral proprioceptive and motor loss
Contralateral pain and temperature loss below damaged level
Usually a penetrating injury

a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side

Question 20

Anterior cord syndrome

Answer 20

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

Question 21

Posterior cord syndrome

Answer 21

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

Question 22

Conus medullaris syndrome

Answer 22

Lesion to sacral cord (T12)
- compression of fx of T12 - kicked in butt
Flaccid legs
Flaccid anal sphincter
- atonic bowel

Question 23

Cauda equina syndrome

Answer 23

Compression of nerve roots below L1, usually by fx or disc herniation
LE motor deficit
Variable bladder, bowel, and sexual dysfunction
Variable sensory loss

Question 24

Neural tube defects

Answer 24

Spina bifida occulta
Spina bifids cystica
- Meningocele
- Myelomeningocele
Function is based on level of defect

Question 25

IICP

Answer 25

Increased intracranial pressure
Hydrocephalus
- shunt