Spinal Cord Injury Flashcards
What is the incidence of SCI?
54 cases/million per year
What is the prevalence of SCI
299,000 in US about 4,400 in CO
Who has the highest incidence of SCI and why?
males out-weight females 4:1
due to risk taking behaviors
Occupational Risk
What season has the highest incidence of SCI
Summer due to travel and outdoor activities
What are the two highest categories for is the etiology of SCI
- Vehicle crashes- 37%
- Falls 31%
What is the most common level of injury for SCI?
incomplete tetraplegia
followed by incomplete paraplegia
What is the average age for SCI?
39 craig hospital statistic
What does the ISNCSCI include and what position is the patient in?
Sensory: 28 dermatomes with pinprick and light touch
0-3
Motor: 10 muscles each representing a nerve root innervation
0-5: 5 is intact
supine: pt is in the most stable position if they fractured their spine and this is completed within 72 hours of the injury
What is the difference between a complete and incomplete SCI? what does AIS stand for?
complete- no sensation or motor function at S4-5 level (rectal)
incomplete- some sensation and or motor function at S4-5 level (rectal)
AIS: ASIA impairment scale
AIS A
Complete
No sensory or motor function is preserved in the sacral segments S4-5
No anal sensory or contraction
Tick: NOOOON sign on ISNCSCI
AIS B
Incomplete
Sensory but not motor function is preserved below the neurological level
Must include the sacral segments S4-S5
AIS C
Incomplete
Must be at least a B (sensory or motor function is preserved in the S4/5 segments)
and you must have either
1. voluntary anal sphincter contraction or
2. sacral sensation plus sparing of motor function more than 3 levels below the motor level
more than half of the muscles grades below the single neurological level are <3
AIS D
Incomplete
Must be at least a C (sensory or motor function is preserved in the S4-S5 segments and have either sparing of motor function more than 3 levels below the motor level OR voluntary anal sphincter contraction)
and
at least half of the muscles grades below the single neurological level are > or equal to 3
think 3D
should be walking with bracing or assistive device
How do you classify an ISNCSCI Level?
Last level with both intact motor and sensory that is how you name the spinal cord injury
What level is the cauda equina?
L1-L2
What can you expect the presentation of an Upper Motor Neuron Injury?
Central nervous system affected: brain and spinal cord
-hyper-reflexia
-spasticity (velocity dependent)
-neurogenic bowel and bladder- spastic sphincters
-preserved reflexive penile erections in males `
What can you expect the presentation of a lower motor neuron injury?
damage to the peripheral nervous system
-hypo reflexive
-flaccidity (muscle weakness)
-flaccid bowel/bladder- incontinence
-no reflexive penile erection in males
How often do we need to turn someone in bed to relieve pressure preventing skin breakdown?
turn in bed: every 2 hours “side- back- side”
How often do pt with a SCI need to weight shift in their wheelchair?
every 20 min for 2 minutes
What ares of the body need to be off loaded to relieve pressure and prevent skin breakdown?
Check sacrum, ischial, heels, shoulder blades and back of head
What 4 things are include in Autonomic Dysfunction for individuals with SCI?
- Neurogenic shock
- Cardiovascular Complications
- Temperature Regulation
- Altered Sweat Secretion
Orhostatic hypotension, loss of spinal reflexes in UMN
Neurogenic Shock
Bradycardia, bradyarthymias, orthostatic hypotension, increased vasovagal reflex, vasodilation and stasis
Cardiovascular Complications
reduced sensory input to thermoregulating centers and loss of sympathetic control of temperature and sweat regulation below the level of injury
temperature regulation
Sweat can be excessive, absent or simply diminished, reflexive sweating- exclusively occurs below the LOI
Altered Sweat Secretion
What is the definition of Orthostatic Hypotension?
decreased BP >20 mmhg systolic or decrease BP >10 mmhg diastolic
What are the causes of Orthostatic Hypotension
decreased vasoconstriction
decreased venous return
dehydration
How will the patient present if they are experiencing Orthostatic Hypotension
Palor, diaphoresis, dizziness, nausea, light-headedness, blurry vision, shortness of breath, loss of conciousness
What are 3 things to rule out that present like Orthostatic hypotension?
vestibular dysfunction
low oxygen saturation
stress/anxiety
What are some treatments for orthostatic hypotension?
abdominal binder (to keep blood from pooling), medication, caffeine, hydrate (increase blood volume)
What is autonomic Dysreflexia?
Increase in BP >20-40 mmhg above baseline usually with bradycardia (low HR)
What are the causes of Autonomic Dysreflexia?
occurs in SCI of T6 and above
noxious stimulus below the level of injury
-full bladder, impacted/irritated bowel, pain
Vasodilation above level of injury only
Vasoconstriction below level of injury
What to do if a patient is experiencing autonomic dyreflexia?
Sit the patient upright and find the noxious stimulus
Dorsal column carries what info
localized fine touch, pressure, vibration and proprioception
Dorsal column
Cell body
synapse
info carried
cell body: dorsal root ganglion
synapse: medula
info: thalamus integrated at the primary sensory cortex
spinothalamic tract carries what info
pain temp crude touch
Descending motor tracts path
from R internal capsule
medula
left side of body
motor tract right side moves the left side
corticospinal tract
providing voluntary motor function. This tract connects the cortex to the spinal cord to enable movement of the distal extremities
Blood supply of the spinal cord
1/3 posterior spinal blood supply
2/3 anterior spinal blood supply
Anterior Cord Syndrome
MOI:
Affects:
Tract involved:
anterior cord syndrome
MOI: anterior spinal artery compressed by bone fragments
can be due to AAA
affect: motor paralysis
tract: corticospinal tract
Anterior Cord Presentation
Loss of: motor function (corticospinal tract)
Loss of pain, temp, crude touch (spinothalamic tract)
Preservation of: position, vibration, and touch sense (dorsal tract)
Posterior Cord Presentation
Posterior Cord
Loss of: pressure, light touch, proprioception, vibration (dorsal tract)
intact: muscle power, pain, temp, proprioception
-good power, pain temp sensation
-difficulty in coordinating movements of limb
rarest form
Central Cord Presentation
MOI:
Tracts involved:
Presentaion
Prognosis:
Central Cord
MOI: due to hyperextension of C-spine
older adult falling down
Tracts: Dorsal column half impaired STT okay
Presentation: Greater UL weakness
some control over bowel and bladder
sensory loss is minimal
Prognosis: recovery possible
Central cord presentation affects UL or LL more
UL
Is there recovery possible for central cord
yes
In central cord do you have sensory and bowel and bladder function
yes sensory
some bowel and bladder
Brown- sequard syndrome
ipsilateral impaired or loss of movement
preserved pain and temperature sensation
contralateral normal movement
impaired pain and temp sensation
Conus medullary syndrome
bladder dysfunction
bowel dysfunction
sexual dysfunction
low back pain
unilateral or bilateral leg pain
diminished rectal tone
Cauda equina syndrome
Below vertebral level L2
LMN Injury peripheral nerves
injury to nerve roots
muscle weakness
decreased sensation
decreased bowel and bladder control
Presentation of Autonomic dysreflexia
flushing/blotchy red rash
sudden headaches
diaphoresis
chills
blurred vision
nausea
Are we worried about DVT in individuals with a spinal cord injury
yes 40-100% of new injuries need to be on heparin coumadin
______ is the leading cause of death in acute SCI
PE
Spastic spincters—>
High blood pressure—>
incomplete bladder drainage—>
spastic spincters—> retention of urine
high blood pressure—> autonomic dysreflexia
incomplete bladder drainage–> UTI
What is intermittent catherization used for
maintain low urine volumes and pressure to avoid urinary tract damage
every 4-6 hours
digital stimulation
suppository
regular schedule
diet considerations
all parts of a bowel management program
Ideal bowel management program
less than 90 min
everday or everyother day
no routine use of suppositories
less than 3 incontinence episodes per year
low incidence of constipation
HO what is it
bone growth in or near a joint after SCI and traumatic brain injury
most common areas for HO
hips
knees
elbows
% of individuals with SCI who have HO
20-50%
Signs and symptoms of HO
- decreased ROM
- edema
- warmth
- low grade fever especially at night
Diagnosis of HO
- asymmentrical PROM
- bone scan- 2-4 weeks
- Xray- progresive HO chronic
- Serum alkaline phosphate- 2-3 weeks
management of HO
NSAIDs
AROM
What is the primary cause of death after SCI
respiratory dysfunction
Treatment to prevent respiratory dysfunction
- clear secretions
- maximize inspirations
- maximize cough/expiration
Diaphragmatic pacer system
allows partial or full time weaning from the ventilator
