Spinal Cord Injury Flashcards
Describe the 2 functional categories of SCI
Tetraplegia
* Motor and/or sensory impairment of upper and lower extremities, including trunk
* Lesions of cervical spinal cord
* Accounts for ~56% of SCI
Paraplegia
* Motor and/or sensory impairment of lower extremities, including trunk
* Lesions of thoracic or lumbar spinal cord and cauda equina
* Cauda Equina
→ Damage to conus or spinal roots of cord
→ LMN injury
What are some outcome measures for SCI?
- ASIA - ISNCSCI
- Stages of motor recovery
- BBS
- mTUG
- ABC
- M6MWT
- 10MWT
- SWAT
How do you ddetermine the neurological level of injury? (NLI)
ASIA - ISNCSCI
most caudal level of the spinal cord with antigravity muscle strength (grade 3) and normal sensory function on both the left and right sides of the body
how do you determine the motor level?
ASIA - ISNCSCI
- lowest myotome with key muscle strength grade of at least 3 AND strength of key muscles above this level are normal (i.e. MMT grade of 5)
how do you determine the sensory level?
ASIA-ISNCSCI
- determined through assessment of light touch and pinprick on left and right sides of body at key dermatomes
- based on ordinal scale: 0=absent, 1=impaired, 2=normal
- sensory level = most caudal level with normal light touch and pinprick sensation
What are the zones of partial preservation?
ASIA-ISNCSCI
area of intact motor &/or sensory function below neurological level of injury in someone with a complete SCI (i.e. no function at S4 & S5)
What is central cord syndrome?
Hyperextension injuries to cervical region
- damage to the most central aspects of the cord -> more severe neurological involvement of the UE (cervical tracts are more centrally located)
- distal UE weakness
- loss of fine motor control
- able to recover ability to ambulate
What is anterior cord syndrome?
Flexion injuries of cervical region
- damage to anterior portion of cord and/or vascular supply
- loss of motor function (corticospinal tract damage)
- loss of the sense of pain & temperature (spinothalamic tract damage) below the level of the lesion
- proprioception, light touch, vibratory sense preserved (mediated by dorsal columns with separate vascular supply)
What is Brown-Séquard syndrome?
Penetration wounds (gunshot/stab)
- hemisection (damage to one side) of spinal cord
- partial lesions more common than true hemeisections
- asymmetrical features -> ipsilateral side as lesion = paralysis (damage to lateral corticospinal tract) & sensory loss, ipsilateral loss of proprioception light touch & vibratory sense (damage to dorsal column)
- contralateral to lesion -> damage to spinothalamic tracts = loss of sense of pain & temp (loss begins several dermatone segments below level of injury
- presents like a stroke
What is the clinical presentation of SCI?
- Spinal shock (immediately post-injury)
- spasticity
- orthostatic hypotension
- autonomic dysreflexia
- paralysis & paresis
- cardiovascular impairment
- impaired temp control
- pulmonary impairment
- bladder/sexual/bowel dysfunction
What occurs during Spinal Shock?
- period of areflexia (absence of reflexes)
- impaired autonomic regulation
- hypotension
- loss of control of sweating
- hyperreflexia follows areflexia
What is the leading cause of death in acute, subt-acute & chronic stages pts with high cervical SCI?
Pulmonary impairments
- C1-C2 lesion → no phrenic nerve innervation → no spontaneous respiration (accessory muscles intact) → artificial ventilator or phrenic nerve stimulator
- If abdominal & intercostal muscles weak → impaired airway clearance
What are major causes of mortality & morbidity in SCI pts?
bladder dysfunction
What are common secondary medical complications that can occur?
- Pressure injuries (one of the most common)
- DVT
- pain
- contractures
- heterotopic ossification
- osteoporosis & skeletal fracture
What is the PT treatment for acute care?
Goals:
* Prevent secondary complications
* Education
* Early mobilization when medical clearance given
* Be aware of precautions – spinal instability, fractures, concomitant injuries, etc. may preclude some movements or positions
- ROM exercise
- respiratory care
- skin care
- education
