Spinal Cord Injury

Question 1

How many spinal nerve pairs exist in the human body?

Answer 1

31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal.

Question 2

Which spinal levels are most susceptible to injury?

Answer 2

C5-C7 and T12-L2 due to increased mobility and mechanical stress.

Question 3

What is the difference in nerve root exit between cervical and other spinal levels?

Answer 3

C1-C7 nerves exit above their corresponding vertebrae, while C8 and below exit below their corresponding vertebrae.

Question 4

What is the functional loss pattern for a lateral corticospinal tract lesion?

Answer 4

Ipsilateral motor loss due to 80% of fibers decussating in the medulla.

Question 5

What happens when the DCML is damaged?

Answer 5

Ipsilateral loss of discriminative touch and proprioception.

Question 6

What symptoms occur with a spinothalamic tract lesion?

Answer 6

Contralateral loss of pain and temperature sensation.

Question 7

What is the ASIA Impairment Scale (AIS) used for?

Answer 7

To classify the severity of spinal cord injuries based on motor and sensory function loss.

Question 8

What defines a complete SCI (ASIA A)?

Answer 8

No sensory or motor function preserved in the sacral segments S4-S5.

Question 9

What is sacral sparing and why is it important?

Answer 9

Sacral sparing (DAP - deep anal pressure & VAC - voluntary anal contraction) indicates an incomplete SCI and potential for better recovery.

Question 10

What is the Zone of Partial Preservation (ZPP)?

Answer 10

Dermatomes and myotomes below the neurological level that retain some function in a complete SCI.

Question 11

How is sensory function tested in SCI patients?

Answer 11

Light touch and pinprick testing across 28 dermatomes bilaterally.

Question 12

How is motor function graded in SCI patients?

Answer 12

Using the ASIA scale, which grades key muscles from 0 (paralysis) to 5 (normal strength).

Question 13

Which key muscles correspond to C5, C6, and C7?

Answer 13

C5: Elbow flexors (biceps), C6: Wrist extensors (ECRL, ECRB), C7: Elbow extensors (triceps).

Question 14

Which key muscles correspond to L2, L3, and L4?

Answer 14

L2: Hip flexors (iliopsoas), L3: Knee extensors (quadriceps), L4: Ankle dorsiflexors (tibialis anterior).

Question 15

What is Central Cord Syndrome?

Answer 15

The most common incomplete SCI, affecting upper limbs more than lower limbs due to corticospinal tract somatotopy.

Question 16

What is Brown-Séquard Syndrome?

Answer 16

Hemisection of the spinal cord causing ipsilateral loss of motor/proprioception and contralateral loss of pain/temp.

Question 17

What is Anterior Cord Syndrome?

Answer 17

Bilateral loss of motor function, pain, and temperature sensation, but preserved light touch and proprioception.

Question 18

What differentiates Conus Medullaris from Cauda Equina Syndrome?

Answer 18

Conus Medullaris affects both UMN and LMN; Cauda Equina is purely LMN with areflexia, saddle anesthesia, and bowel/bladder dysfunction.

Question 19

What is Autonomic Dysreflexia?

Answer 19

A life-threatening hypertensive response to noxious stimuli in SCI patients above T6.

Question 20

What are common causes of Autonomic Dysreflexia?

Answer 20

Bladder distension, bowel impaction, pressure ulcers, ingrown toenails, tight clothing.

Question 21

What is the first step in managing Autonomic Dysreflexia?

Answer 21

Sit the patient upright, identify and remove the noxious stimulus, check blood pressure.

Question 22

What is Orthostatic Hypotension and why is it common in SCI?

Answer 22

A drop in BP >20 mmHg systolic or >10 mmHg diastolic due to impaired sympathetic vasoconstriction.

Question 23

Why is pulmonary function often impaired in SCI?

Answer 23

Loss of diaphragm, intercostal, and abdominal muscle function depending on injury level.

Question 24

What muscles are primary for inspiration and expiration?

Answer 24

Inspiration: Diaphragm, intercostals; Expiration: Abdominals, internal intercostals.

Question 25

What is Glossopharyngeal Breathing (GPB)?

Answer 25

A technique used by high cervical SCI patients to swallow air for breathing assistance.

Question 26

What are the primary PT interventions for pulmonary function in SCI?

Answer 26

Diaphragmatic breathing, incentive spirometry, assisted coughing, respiratory muscle training.

Question 27

What are the primary PT goals in acute SCI management?

Answer 27

Maintain neutral spine, prevent secondary complications, early mobilization, respiratory support.

Question 28

What is the role of a cervical orthosis (CO) in SCI?

Answer 28

To provide spinal stabilization post-injury or surgery (e.g., Miami J, Philadelphia collar, Halo).

Question 29

What is the role of a TLSO in SCI management?

Answer 29

Thoracolumbosacral orthoses stabilize lower spinal injuries and prevent excessive motion.

Question 30

What is the expected functional outcome for a C5 complete SCI?

Answer 30

Requires dependent ADLs, power wheelchair with hand controls, limited functional hand use.

Question 31

What is the expected functional outcome for a T10 complete SCI?

Answer 31

Independent transfers, wheelchair mobility, potential for therapeutic ambulation with bracing.

Question 32

What are the most common secondary complications of SCI?

Answer 32

Pressure ulcers, DVT, contractures, osteoporosis, heterotopic ossification, chronic pain.

Question 33

How often should weight shifts be performed in SCI patients?

Answer 33

Every 15 minutes in a wheelchair, every 2 hours in bed to prevent pressure sores.

Question 34

What is the primary cause of heterotopic ossification in SCI?

Answer 34

Abnormal bone growth in soft tissues due to prolonged immobility and inflammation.

Question 35

What pharmacologic interventions help manage spasticity in SCI?

Answer 35

Baclofen, tizanidine, botulinum toxin, intrathecal baclofen pump.

Question 36

What is Tenodesis Grasp and why is it important?

Answer 36

A passive grasp mechanism used by C6-level SCI patients for functional hand use.

Question 37

What are positive prognostic factors for walking recovery post-SCI?

Answer 37

Preserved pinprick sensation in LEs, younger age, ASIA C/D classification.

Question 38

What percentage of ASIA C patients regain some walking function?

Answer 38

Approximately 65% regain some ability to walk.

Question 39

What is the plateau period for functional recovery post-SCI?

Answer 39

12-18 months post-injury.

Question 40

How does motivation and psychosocial support impact SCI recovery?

Answer 40

Higher motivation, strong social support, and access to rehab services improve outcomes.

Question 41

What are the major spinal cord syndromes?

Answer 41

Includes Central Cord Syndrome (UE > LE weakness) Brown-Séquard Syndrome (ipsilateral motor & proprioception loss, contralateral pain/temp loss) Anterior Cord Syndrome (loss of motor, pain/temp, preserved proprioception) Cauda Equina Syndrome (LMN signs, bowel/bladder dysfunction)

Question 42

What is the neurological level of injury (NLI) in SCI?

Answer 42

The most caudal segment of the spinal cord with normal motor and sensory function bilaterally.

Question 43

What are the functional outcomes based on lesion levels?

Answer 43

Higher cervical injuries (C1-C4) require ventilators; C5 has partial UE movement; C6 allows tenodesis grasp; T1 and below allow full UE function; L2 and below have potential for ambulation with bracing.

Question 44

What is spinal shock and its phases?

Answer 44

A temporary loss of reflexes, motor, and autonomic function below the injury level. Phases: 1 (areflexia) 2 (initial reflex return) 3 (hyperreflexia) 4 (spasticity/variable function).

Question 45

How do you differentiate between complete and incomplete SCI?

Answer 45

Complete SCI has no motor/sensory function at S4-S5 (no sacral sparing); incomplete SCI retains some function below the lesion, including sacral sparing.

Question 46

What are common bladder and bowel dysfunctions in SCI?

Answer 46

Above T12 = UMN bladder (spastic, reflexive emptying). Below T12 = LMN bladder (flaccid, requires catheterization). Bowel dysfunction requires bowel programs.

Question 47

What respiratory complications arise from SCI?

Answer 47

C1-C4 injuries may need ventilators; C5-T12 injuries impact cough function and breathing control. Patients benefit from assisted cough techniques and incentive spirometry.

Question 48

What are key wheelchair skills for SCI patients?

Answer 48

Includes propulsion, pressure relief techniques, curb negotiation, floor recovery, and maneuvering uneven surfaces.

Question 49

What are transfer techniques for SCI patients?

Answer 49

Includes slide board transfers, dependent lifts, anterior/posterior transfers, head-hips relationship for movement control.

Question 50

What are key bed mobility techniques for SCI patients?

Answer 50

Rolling, supine to sit, long sitting balance, and leg management techniques based on lesion level.

Question 51

What factors influence gait training potential in SCI patients?

Answer 51

Level of injury, presence of spasticity, bracing needs, assistive devices, and neuroplasticity training principles. ASIA C/D have better chances of walking.

Question 52

What are PT implications for SCI rehabilitation?

Answer 52

Includes preventing pressure ulcers, managing autonomic dysreflexia, respiratory training, mobility training, strength & endurance exercises, and patient education on long-term care needs.