Spinal Cord Injury Flashcards
Spinal Cord Injury
A complex condition that presents very differently depending on the level and severity of the injury.
Complete SCI
Produces a total loss of motor and sensory function
Incomplete SCI
Some function, either sensory or motor remains below the level of the injury.
American Spinal Injury Association (ASIA)
- Grading scale that describes the severity of the injury using the lettering system A-E
- .When utilizing, a medical professional tests specific motor functions of different muscles innervated by different nerve roots along the spinal cord and sensory dermatomes.
- Completing the ASIA scale will provide the level of injury (based on motor and sensory responses) and also the severity of the damage done to the cord.
Dermatomes (ASIA Scale)
The specific location of the body associated with sensory info of a particular nerve root
(ex. if you provide tactile stimulus to client’s right thumb and they can feel it, that is an indication their C6 spinal cord sensory pathway is in-tact. If that same client has bicep flexion within normal limits, that would indicate the spinal cord is intact at the C6 level and the injury is likely lower on the spinal column)
ASIA A
- Complete
- No remaining sensory or motor function below the level of the injury.
ASIA B
- Sensory Incomplete
- Complete motor function loss but some sensory function intact below the level of the injury.
ASIA C
- Motor Incomplete
- Some motor movement remains below the level of the injury, but less than half of the muscle groups can move against gravity through a full range of motion (<2/5)
ASIA D
- Motor Incomplete
- Some motor movement remains below the level of the injury, with more than half of the muscle groups below the level of the injury able to move against gravity (>3/5)
ASIA E
- Normal
- No motor or sensory function impairment
- If the motor and sensory function is tested in an individual who had previous deficits and now with retesting motor and sensory function is found to be normal.
Central Nervous System
Made up of the brain and spinal cord
The spinal cord assists with…
Communicating sensory and motor info to and from the brain and the PNS
The spinal cord is protected by…
The Vertebral Column
Vertebral Column
Composed of 33 vertebrae
- 7 Cervical
- 12 Thoracic
- 5 Lumbar
- 5 Sacral
Spinal Cord Nerves
31 pairs that exit the spinal cord at various levels and branch out to form the PNS
-Spinal nerves begin at C1 and the actual spinal cord ends at L1 with the cauda equina extending past the L1 level
Cervical Nerves carry impulses to and from the…
Head, neck, diaphragm, arms, and hands
Thoracic Spinal Nerves carry information to and from the…
Chest and upper abdominal musculature
Lumbar Spinal Nerves carry information to and from…
The legs and part of the foot
Sacral Nerves innervate…
The remainder of the foot, bowel, bladder, and muscles involved with sexual function
The level of spinal cord injury is strongly related to…
Function and Prognosis
Tetraplegia
(aka Quadriplegia)
-Injuries in the cervical area
-Functional impairment in the arms, trunk, legs, and pelvic organs
(typically have difficulty using their arms and legs)
Paraplegia
- Injuries in the thoracic and lumbar region
- Motor and sensory impairments at the thoracic, lumbar, or sacral segments of the cord
- Typically have full function of arms but limitations with LE
What happens if the spinal cord is completely severed at the level of the 6th cervical nerve root?
Motor and sensory information below that level can no longer travel between the brain to the peripheral nervous system.
Therefore, there would be complete motor and sensory paralysis below the level of injury.
Example: C5 SCI
Elbow flexors will be intact because the biceps are innervated at the C4 level and not impacted by the injury.
Example: C6 SCI
- Individual should have wrist extensors.
- Finger flexion and fine motor activity may not be present
- May be able to use a tenodesis grasp to hold items and engage in functional activities.
Tenodesis grasp
- May be able to be used with C6 SCI
- involves the passive opening of the fingers when the wrist is flexed and the closing of the fingers when the wrist is extended.
- Individuals with no innervation of finger flexors can utilize this grasp for functional tasks.
Example: C7 SCI
- Have innervation of the triceps allowing for elbow extension.
- Helpful for functional transfers because they will be able to lift themselves up and off of the sitting surface.
Example C8 SCI
Have the long finger flexors which can facilitate a stronger grasp
Example: At the Thoracic Levels T4-T12 (SCI)
Typically see stronger abdominal and erector spinae muscles which allow for improved respiratory function and sitting balance
The lower the thoracic injury the more…
Abdominal muscles are innervated, leading to increased stability in the core and improved sitting balance.
Example: L2, L3 & L4 SCI
We can expect…
- L2: Hip flexion
- L3 Knee Extensors
- L4: Ankle Dorsiflexors
Anterior Cord Syndrome
- Results from damage to the anterior spinal cord tissue
- Clinically this presents as loss of motor function below the level of injury and los of thermal, pain, and tactile sensation below the level of the injury.
.Brown-Sequard’s Syndrome
- Occurs when only one side of the spinal cord is damaged, or one side is damaged more than the other.
- Typically results in ipsilateral loss of motor function and reduction of deep touch and proprioceptive awareness below the level of injury as well as contralateral loss of pain, temperature and touch sensation.
Central cervical cord syndrome
- Results in an individual losing function of their upper extremities while the lower extremities are in-tact.
(ex. one of the biggest challenges some experience is avoiding falls because, legs work normally, but was unable to catch himself if he fell or tripped over something)
Spinal Shock
Experienced by clients directly after traumatic SCI
- Often presents itself as complete flaccidity or paralysis of the muscles below the level of the injury and an absence of reflexes
- May also impact the muscles above the level of injury.
- Typically lasts 1 to 3 months and afterwards muscle and sensory function above the injury typically returns to normal and in the next year of recovery muscle, sensory, and reflex function should stabilize to a new normal
Respiratory Complications
May be experienced by people with spinal cord injuries above the T12 level
- The abdominal musculature is innervated at T7, the intercostal muscles are innervated from T1 through T12, and the diaphragm is innervated by C4.
- Injuries at any of these levels can result in difficulty breathing
- Individuals with higher level cervical injuries may require a ventilator to assist with their respiration.
Autonomic Dysreflexia
- An exaggerated response by the autonomic nervous system
- Essentially, when the nerves below the level of injury become irritated the autonomic nervous system responds with a “fight or flight” physiological response such as diaphoresis, headache, or tachycardia.
- These symptoms tend to come on fast.
Noxious stimuli (Autonomic Dysreflexia)
- Could be anything that would be bothersome to an individual without a spinal cord injury but, because of impaired motor and sensory functions, this individual can’t tell that something is bothering them.
- Essentially autonomic dysreflexia is the body’s way of warning someone that something is not right.
- Common sources of irritation may be overfill of the bowel and bladder, a urinary tract infection, pressure wounds, or even a small irritation such as an ingrown toenail or a wheelchair rubbing on someone’s heal.
- As a clinician, it is important to be aware of the signs and symptoms of autonomic dysreflexia, find the cause of the irritation, and try to fix the problem.
- This may mean repositioning the client or emptying the bowel and bladder.
People with spinal cord injuries are at a higher risk for…
Urinary tract infections and impacted bowels.
- May also experience postural hypotension, deep vein thrombosis due to reduced circulation, trauma to the lower extremities, and prolonged bed rest, pressure wounds (aka decubitus ulcers), thermal regulation issues; and they are at risk for heterotopic ossification (abnormal formation of bond deposits on muscle, joints and tendons and can be exacerbated by lack of limb movement)
- Aa OTs we need to be aware of common complications in order to take measures to prevent them or take action when they occur.
Occupational therapists work in a variety of settings with individuals with spinal cord injuries to regain their independence with a focus on…
ADL, IADL engagement, bowel/bladder management, sexual intimacy, work, leisure, and engagement in a variety of other occupations and roles.
-Depending on the level and completeness of an injury, different functional limitations will occur
