Spinal Cord Injury

Question 1

Level that spinal cord ends

Answer 1

T12-L1

Question 2

Dorsal column medial lemniscus tract

Answer 2

DCML - sensory, ascending
Located posterior of spinal cord

Proprioception
Vibration
Graphesthesia
Barognosis
Stereognosis
2 pt discrimination
Kinesthesia
Fine touch

“Poor Val Found GBS Twice”

Question 3

Corticospinal tract

Answer 3

CST - motor, descending

all movement

Question 4

Spinothalamic tract

Answer 4

STT - sensory, ascending

Anterior: crude touch
Lateral: pain, temperature*

*to contralateral side

Question 5

Posterior cord syndrome

Answer 5

Bilateral DCML affected
Bilat sensation loss

function: all DCML functions (proprioception, vibration, fine touch, graphesthesia, barognosis, stereognosis, 2 pt discrimination)

Cause: iatrogenic (medical error; rare)

Question 6

Anterior cord syndrome

Answer 6

Bilateral CST and STT affected

Function: pain/temp and motor

Cause: hyperflexion injury

Question 7

Central cord syndrome

Answer 7

Small lesion: bilat STT affected (pain and temp; interrupts where STT crosses)

Large lesion: all tracts affected bilaterally (center lesion touching all tracts)
- “walking SCI”
- “MUD-E”
> motor > sensory
> UE > LE
> Distal
> hyperEXTENSION MOI

Question 8

Brown sequard syndrome

Answer 8

Hemi-cord

DCML and CST same side lesion
STT opposite lesion

Cause: stab injury, gunshot wound

Question 9

Conus medullaris

Answer 9

Location: bilat and symmetrical in perineum and thighs

sensory: saddle distribution, bilat, symmetric

motor: symmetric

type: UMN & LMN (b/t spinal cord and cauda equina)

EMERGENT CALL 911

Question 10

Cauda equina

Answer 10

Location: unilateral and asymmetrical in perineum, thighs, leg, back

Sensory: saddle distribution, unilateral, asymmetric

motor: asymmetric

type: LMN

EMERGENT CALL 911

Question 11

Complete vs incomplete SCI

Answer 11

complete: no sensory or motor function in the lowest sacral segments (S4-5)

incomplete: motor AND/OR sensory function below neurological level including sensory and/or motor function at S4-5 (sacral sparing)

All cord syndromes are classified incomplete

Question 12

Standardized ASIA UE myotomes
C5-T1

Answer 12

C5 - elbow flexors
C6 - wrist extensors
C7 - elbow extensors
C8 - finger flexors
T1 - fifth finger abductors

Question 13

Standardized ASIS LE myotomes
L2-S1

Answer 13

L2 - hip flexors
L3 - knee extensors
L4 - ankle DF
L5 - great toe extensors
S1 - ankle PF

Question 14

ASIA motor level

Answer 14

BOTH sides

1. lowest level at which strength is at least 3/5 (this is the named level if step 2 is true)
2. all levels above being 5/5

Scored for each side, overall score is last normal for both

Question 15

ASIA sensory level

Answer 15

The level where sensory function is normal on both sides of body

1. lowest level where you have “2s”
2. All levels above also “2s”

Question 16

ASIA neurological level

Answer 16

Most CEPHALIC level with NORMAL sensory and motor function on BOTH sides of body

1. find motor and sensory level
2. Pick anatomically higher level < this is NLI

Question 17

ASIA A

Answer 17

Complete

No motor or sensory at S4-5

Question 18

ASIA B

Answer 18

Sensory incomplete

Sensory but no motor function present below NLII and S4-5

Question 19

ASIA C

Answer 19

Motor incomplete

Majority of key muscles below NLI have grade <3/5

Question 20

ASIA D

Answer 20

Motor incomplete

Majority of key muscles below NLI have grade >3/5

Question 21

ASIA E

Answer 21

Motor and sensory function normal

Question 22

Systemic complications of SCI

Answer 22

Cardiac: OH, autonomic dysreflexia
Pulmonary: respiratory dysfunction
GU: urinary and bowel retention +/- incontinence
Integumentary: pressure ulcers
MSK: contracture, weakness, tone

Question 23

Autonomic dysreflexia/hyperreflexia

Answer 23

At or above T6
Noxious stimuli below level of lesion
Inc systolic BP of 20-30 mmHg is diagnostic
More common in chronic stage (3-6 mo post injury) however can be seen acute
More common with complete SCI

Question 24

Causes of AD

Answer 24

bladder/bowel irritation
noxious stimuli below level of injury
GI irritation
sexual activity
labor
fracture below level of lesion

Question 25

S/S of AD

Answer 25

Inc BP (systolic rise 20-30 mmHg)* Dec HR* Severe headache, anxiety* Constricted pupils, blurred vision* Flushing, goose bumps (piloerection) above level of injury Dry ,pale skin below level of lesion Inc spasticity* *most notable

Question 26

AD intervention

Answer 26

SIT UP and LOWER LEGS (dec BP) Remove painful stimulus (loosen clothing/abdominal binder, check bladder, unclamp catheter, drain bag) Monitor vitals throughout > if no change req medical/nursing assistance; if OP call 911

Question 27

Respiratory function at C1-2 SCI

Answer 27

Intact muscles: SCM Upper trap Intervention: Phrenic n. stimulator Artificial ventilator

Question 28

Respiratory function at C3-4 SCI

Answer 28

Intact muscles: Partial diaphragm Scalene Levator scapulae Intervention: Mechanical ventilator C4- With recovery they can breathe on their own, part-time w/o vent > glossopharyngeal breathing (gulping air)

Question 29

Respiratory function at C5-8 SCI

Answer 29

Intact muscles: Diaphragm Pec major/minor Serratus ant. Rhomboid Lat dorsi Intervention: Weak cough (no abs) Must teach assistive coughing to people w/ respiratory compromise

Question 30

Respiratory function at T1-5 SCI

Answer 30

Intact: Some intercostals Erector spinae

Question 31

Respiratory function at T6-10 SCI

Answer 31

Intact: Intercostal and abdominals Respiratory function fully intact below T10

Question 32

Spastic bladder

Answer 32

UMN Reflexic bladder Seen in SCI above S2 spinal Tx: Intermittent catheterization every 3-6 hours Suprapubic tapping

Question 33

Flaccid bladder

Answer 33

LMN Areflexic bladder Seen in SCI below S2 spinal Tx: Intermittent catheterization every 3-6 hours Valsalva or Crede's (external pressure on bladder) maneuver

Question 34

General recommendations on assist and activities per spinal region affected: C1-4

Answer 34

Dependent w/ ADLs, breathing, transfers, mobility

Question 35

General recommendations on assist and activities per spinal region affected: C5-6

Answer 35

Modified independent with ADLs, breathing, mobility, transfers C5 mm. spared: "3BIRDS" biceps brachioradialis brachialis infraspinatus rhomboids deltoid supinators C6 mm. spared: "PET SLIP" pec major ECR Teres minor Serratus ant. lat dorsi infraspinatus pronator

Question 36

General recommendations on assist and activities per spinal region affected: C7 and below

Answer 36

Independent with ADLs, transfers, mobility, breathing. C7 mm. spared: "FEET" flexor carpi radialis extensor pollicis brevis extensor pollicis longus extrinsic finger ext. triceps

Question 37

C1-4 functional level

Answer 37

mechanical lift transfers power wheelchair - head/chin/mouth control

Question 38

C5 functional level

Answer 38

Dependent slide board transfer Manual WC - plastic coated hand rims

Question 39

C6 functional level

Answer 39

Independent slide board transfer Manual WC - plastic coated hand rims

Question 40

C7-8 functional level

Answer 40

Even: indep w/o slide board uneven: dependent on slide board C8 may be able to do floor to WC transfer Manual WC plastic coated hand rimis C7 - indep on even surfaces C8 - indep on ramps, curbs

Question 41

T1 functional level

Answer 41

floor to wheelchair transfer independent WC

Question 42

T4 functional level

Answer 42

sitting pivot transfer independent WC

Question 43

L3 functional level

Answer 43

stand pivot transfer (quads intact) independent WC