Spinal Cord Injury

Question 1

Tetraplegia

Answer 1

• Impairment or loss of motor and/or sensory function
• Damage to the cervical segments
• Upper, lower extremities and trunk affected

Question 1

Paraplegia

Answer 1

• Impairment or loss of motor or sensory function
• Damage to the thoracic, lumbar or sacral segments
• Lower extremities and/or trunk affected

Question 2

SC lesions - Complete

Answer 2

• Sensory and motor function in the lowest sacral segments (S4/S5) absent post-injury

> ASIA scale: AIS A (cf assessment)

Question 3

SC lesions - Incomplete

Answer 3

• Detectable residual sensory or motor function below the neurological level and specifically in the lowest sacral segment

> ASIA scale: AIS B, C, D, E

Question 4

Types of SCI - Pathophysiology

Answer 4

• Contusion: bruising, usually from trauma
• Laceration: severing or tearing, usually from fire weapons and knife wounds
• Solid: Axonal damage, through injury or demyelination

Question 5

Spinal vs neurogenic shock

Answer 5

Spinal shock corresponds to a loss of neurological activity below the injury level. While neurogenic shock corresponds to hemodynamic consequence of SCI.

Spinal shock corresponds to a loss of neurological activity below the injury level (due to a sudden loss of conduction in the spinal cord).

While neurogenic shock corresponds to hemodynamic consequence of SCI (characterised by vasodilation and increased perfusion of the lower extremities)

Question 6

Cervical tetraplegia: C1-C4 (high cervical nerves)

Answer 6

Most severe of the spinal cord injury levels

• Paralysis in arms, hands, trunk and legs
• Patient may not be able to breathe on his or her own, cough, or control
  bowel or bladder movements
• Ability to speak is sometimes impaired or reduced

Question 7

Cervical tetraplegia: C5-C7 (Low-cervical nerves)

Answer 7

• Corresponding nerves control arms and hands
• Usually able to breathe on their own and speak normally

Question 8

Thoracic paraplegia (T1-T5)

Answer 8

Abilities:
- Head control and upper limb
- Respiratory control
- Most likely use a manual wheelchair

Disabilities:
- Lower limb control
- Autonomic dysreflexia
- Respiratory endurance might be compromised
- Assistance on transfers might be necessary

Question 9

Thoracic paraplegia (T5-T9)

Answer 9

Abilities:
- Head control and UL
- Transfer from bed to chair and back
- Car driving (adapted)

Disabilities:
- LL control
- Autonomic dysreflexia
- Respiratory endurance

Question 10

Thoracic paraplegia (T10-L1)

Answer 10

Abilities:
- Normal respiratory function
- Good trunk control
- Car driving
- Transfers

Disabilities:
- Partial paresis of LL
- Spasticity might be present
- Gait

Question 11

Lumbar (L1- L5) and Sacral nerves (S1- S5)

Answer 11

• Some loss of function in the hips and legs
• Little or no voluntary control of bowel or bladder

Depending on strength in the legs, may need a wheelchair and may also walk with assistive devices and special equipment (LUMBAR)

Most likely able to walk (SACRAL)

Question 12

Spinal spasticity

Answer 12

Results of neural mechanisms vs altered muscle contractile properties in cortical

• Pain, Spasm, contractures
• Hyperreflexia, clonus, clap-knifes responses, long-lasting cutaneous reflexes

Question 13

Behaviour and awareness deficits (caused by spinal cord injury)

Answer 13

• Depression
• Aggression
• Anxiety
• Knowledge deficit about condition and prognosis
• Impaired cognitive function due to CSF reduction, leading to LOC (acute only)