Spinal Cord Injury Flashcards
cervical injury and involves any degree of paralysis of the
four limbs and trunk musculature
Quadriplegia
paralysis caused by a thoracic, lumbar or sacral injury and
involves any degree of paralysis of the lower extremity with involvement of
the trunk, legs, feet and toes, depending on the level of the lesion
Paraplegia
most caudal level of the spinal cord with normal motor
and sensory function on both the left and right sides of the body
Neurological Level
all segments above must be 5/5
Motor Level
all segments above must be 2/2
Sensory Level
No motor or sensory function is preserved in S4-S5 (Asia Scale)
A - Complete
SENSORY BUT NOT MOTOR fxn is preserved below the neurological level and includes S4-S5 (ASIA Scale)
B - Incomplete
Motor function is preserved below the neurological elevel and MORE THAN HALF of key muscles below the neuro level have a muscle grade less than 3
C - Incomplete
Motor function is preserved below neuro level, and AT LEAST HALF OF KEY MUSCLES have a muscle grade of 3 or more (ASIA Scale)
D - Incomplete
Motor and sensory function is normal (ASIA Scale)
E - Normal
describe the areas of intact motor and/or sensory
function below the neurological level if an individual has motor and/or sensory function below the neurological level but does not have
function at S4 and S5
Zone of Partial Preservation
complete transection of the spinal cord; no motor or sensory
preserved at S4-S5; may have preservation of strength or sensation below the neurological level
COMPLETE
injury to the spinal cord that does not cause a total transection with some degree of voluntary movement or sensation preserved
at S4-S5
INCOMPLETE
Incomplete Injury CLINICAL SYNDROMES
- Anterior cord
- Brown-Sequard
- Central cord
- Posterior cord
- Cauda equina Injuries
- Conus medullaris injuries
- damage to the anterior portion of the cord and/or its vascular supply from the ASA
- d/t FLEXION INJURIES
- proprioception is preserved
Anterior Cord Syndrome
- HEMISECTION of the spinal cord
- d/t PENETRATING WOUNDS, GSW, STAB WOUNDS
Brown-Sequard Syndrome
- MC
- d/t HYPEREXTENSION/WHIPLASH INJURIES to the cervical region, congenital or degenerative narrowing of the spinal canal
- Most prevalent in aging populations due to arthritic changes
- UE > LE, potential flaccid paralysis
Central Cord Syndrome
- damage to the DCML
- d/t STDs such as syphilis
- involvement: gait dev
Posterior Cord Syndrome
- do not involve damage to the spinal cord itself but rather to the spinal
nerves that extend below the end of the spinal cord - anatomically incomplete d/t the great number of nerve roots involved
- considered as peripheral nerve injuries
- usually occurs with fractures below the L2
- areflexic bowel and bladder; LMN motor paralysis
Cauda Equina Injuries
- injury of the sacral cord and lumbar nerve roots
- bowel and bladder incontinence and sexual dysfunction are typically
more severe than cauda equina injuries* - Involvement: loss of motor and sensory function below the level of injury
(not severe); absence of reflex arc, LMN motor paralysis
Conus Medullaris Injuries
- immediately after SCI
- period of AREFLEXIA and flaccid paralysis below level of injur
- 1 week to 3 months
Spinal Shock
- MC cause of death
- T12 and below - normal respiratory status
Respiratory Complications
- occurs in lesions above T6
- Sx: pounding headache,
diaphoresis, flushing,
goosebumps, tachycardia
followed by bradycardia - Mx: find the cause and alleviate
(e.g. emptying the bladder)
Autonomic Dysreflexia
- blood tends to POOL DISTALLY in the LE as a result of reduced
muscle tone in the trunks and legs - Sx: light-headedness, dizziness, pallor, sudden weakness,
unresponsiveness - Mx: antiembolism socks, abdominal binders, assuming an
upright position slowly
Postural Hypotension
➢ a serious complication after SCI
caused by the following main
reasons:
a. reduced circulation due to
decreased tone
b. frequency of direct trauma
to legs causing vascular
damage
c. prolonged bed rest
➢ Signs: LE swelling, localized redness,
low-grade fever
Deep Vein Thrombosis
- maintaining appropriate body temperature is often a problem
for SCI patients above T6.
➢ poikilothermia - during the 1st year after injury
➢ cold weather causes discomfort
➢ excessive sweating may occur above the level of injury in
warmer weather
Thermal Regulation
➢ appears after spinal shock subsides
➢ increase in spasticity can be triggered by:
a. infections
b. positioning
c. pressure sores
d. UTIs
e. heightened emotional states
➢ beneficial
Spasticity
➢ abnormal formation of bone deposits on muscles, joints, and tendons
➢ MC areas: hip and knee
➢ happens in 20% of SCI patients
➢ Signs: heat, pain, swelling, decrease in AROM/PROM
Heterotopic Ossification
➢ kidney failure as a result of chronic UTI - one of the MC
causes of death
➢ Warning signs: cloudy urine or has excessive particles, dark or foul-smelling urine, fever, chills, increase in
spasticity
➢ Tx: PREVENTION
Genitourinary Complications
➢ can become either spastic or flaccid
➢ usually flaccid during the state of spinal shock
Complications Associated with the Bowel
major reason for hospital admission in SCI patients
Decubitus Ulcer
availability of a caregiver 24hrs is the most appropriate safety option
C4 and above
may use a phone independently with possible adaptations but may be limited in other emergency responses
C5 and below
rely on wheelchair for household and
community mobility
Thoracic level and above
able to ambulate in short distances with an AD (e.g. lofstrand crutches) and orthosis but practicality during
household and communitysettings must be considered.
Lower level thoracic injury
requires assistance and some personal attendance care
C6 and above
can often live independently; but may require
assistance with heavier maintenance tasks
C7 and below
Wheelchair Prescriptions
C4 and above - power wheelchair
C5 - highest level - power wheelchair (community mobility)
manual wheelchair with handrim projections
C6 - manual wheelchair with handrim projections
C7 - manual wheelchair with handrim projects (friction)
C8 - standard handrims; wheelie for community ambulation
Orthosis
C4/C5 - balance forearm orthosis
C6 - tenodesis splint
T1-T8 - KAFO + // bars or walker
T9-T12 - KAFO + walker
T12-L3 - KAFO + loftstrand crutches
L4 - L5 - AFO + loftstrand
L5-S1 - rocker bar
Transfers
C3 (obese) - hydraulic lift
C5 - dependent sliding transfer
C6 - independent sliding board transfer
C7 - independent transfer s̅ sliding board on all level surfaces
T1 - floor to wheelchair
T4 - sitting pivot
L3 - standing pivot
