spinal cord injury

Question 1

what are some causes of spinal cord injury?

Answer 1

• accidents
• falls
• violence
• neoplasm
• disease ( e.g transverse myelitis an autoimmune disease of long fiber tracts usu. in the thoracic spine –> paralysis in the legs)
• degenerative spine ( myelopathy: slow motion spinal cord injury over yrs.)

Question 2

if you have a fracture dislocation at c3/ c4 what will happen w/o immediate medical attention

Answer 2

death w/in 5 minutes because of suffocation due to phrenic nerve not being able to work.

Question 3

what are some acute consequences of spinal cord injury?

Answer 3

weakness: ( qudriparesis/plegia, neck injury, paraparesis/plegia, injury to caudal T1)

sensory loss: (touch, proprioception, pain, temperature)

sensory abnormalities: (parasthesia, pain ( neuropathic)

hypotension ( spinal cord ischemia)

urinary retention ( can’t relay info so you can ‘t release the pee)

orthopedic pain ( broken neck/back, multiple fractures)

Question 4

why is it BAD to give pain meds when someone has a spinal cord injury?

Answer 4

because they will likely have low BP due to spinal ischemia and meds like OPIOIDS will further lower BP causing their breathing to decrease even further

Question 5

what are some chronic consequences of spinal cord injury?

Answer 5

• involuntary movements ( spasticity i.e. hyperreflexia, and myocolonus:recurrent stretch reflex in gastrocnemus
• bladder problems : either spastic( can’t relax external sphincter ) or flaccid ( external sphincter is completely relaxed)
• decreased bowel motility
• male sexual dysfunction ( women don’t get infertility)
• increased risk for: blood clot, pressure ulcer, cutaneous ischemia- ( repositioning is vital to prevent this), autonomic dysfunction
• mostly absent thermoregulation ( no sweating( overly over heat,), limited vasoconstriction ( conserving heat)
• autonomic dysreflexia

-metabolic disorders ( diabetes, heart disease)
-psychosocial issues
musculoskeletal breakdown

Question 6

a spinal injury at what level would cause spastic ( can’t relax sphincter) bladder injury?

Answer 6

at or above t10

Question 7

a spinal injury at what level would cause flaccid (relaxed sphincter) bladder injury?

Answer 7

below t12

Question 8

what is the thing that people with spinal cord injury would like to regain?

Answer 8

control of their urination

Question 9

in spastic bladder problem due to Spinal cord injury what happens to the external sphincter as the detrussor muscle contracts with continued filling?

Answer 9

the external sphincter contracts stronger as well

Question 10

*** ( prob on test) overly full bladder is the most common cause of _______ ________?

Answer 10

autoimmune dysreflexia

Question 11

what symptoms would be exhibited with autonomic dysreflexia?

Answer 11

episodes of crazy high BP

HR drop to 40 beats per/min ( these two are paradoxical b/c usu increase BP is accompanied by increase heart rate)

Question 12

what can trigger autonomic hypereflexia?

Answer 12

• overly full bladder** ( biggest cause)
• bladder emptying ( if neurogenic bladder)
• strong cutaneous inputs

Question 13

what demographic does spinal cord injury affect most?

Answer 13

males and people over 40

Question 14

at what level do more than 50% of spinal cord injuries occur

Answer 14

cervical spine

Question 15

are more than 50% of the spinal cord injuries neurologically complete or incomplete and what does this mean?

Answer 15

neuroogically incomplete ( i.e. the patient has either sensory or motor function at s4 or s5)

Question 16

what is the american spinal injury association (ASIA) scale?

Answer 16

a scale for classification of a spinal cord: A is COMPLETE i.e no motor or sensory fnc below the injury.

E is normal ( sensory and motor fnc is normal ) B-C are varying degrees of incomplete injury

Question 17

what is a B on the ASIA scale?

Answer 17

sensory ( only) below injury, including S4- S5 segment ( anal segment)

Question 18

what is a C on the ASIA scale?

Answer 18

sensation and LIMITED motor fnc below the injury level

Question 19

What is a D on the ASIA scale?

Answer 19

sensation and significant motor fnc below the injury level

Question 20

can nerve cell bodies crushed in the traumatic injury be healed?

Answer 20

no they are permanently gone and so are the connections they made.

Question 21

what are the 3 broad approaches to spinal cord injury treatment?

Answer 21

NEUROPROTECTION: of surviving cells/axons from toxic environ. caused by injury

NEURORESTORATION:replace cells, provide neurotrophinc, reestablish a growth permissive environment

NEUROREHABILITATION ( strengthen existing systems, retain circuits, develop alternative strategies to accomplish desired tasks)

Question 22

what did the pt who had been quadraplegic for 17 years start spontaneous stepping while sleeping 3 days after he started intense lower limb training 5 hours per day?

Answer 22

because although he couldn’t feel it his right hip was subluxed and that afferent stimulus that we would normally feel as pain triggered the spinal cord and especially when he was laying down the stimulus had a greater effect.

Question 23

what improved for the pt who had been quadraplegic for 17 years start spontaneous stepping while sleeping 3 days after he started intense lower limb training 5 hours per day?

Answer 23

he was able to voluntarily walk better.

Question 24

what muscle shows a double burst in the EMG contractions?

Answer 24

tibialis anterior

Question 25

what evidence is there for Central pattern generators in humans?

Answer 25

increased involuntary double bursts in tibialis anterior

Question 26

can the central pattern generator in humans be trained to improve voluntary walking in persons with incomplete spinal cord injury?

Answer 26

NO, there is no evidence. the involuntary improvement is neuroplasticity. it’s due to the increase in balance and increase in leg muscles

Question 27

what is interlimb reflex?

Answer 27

when stimulate the knee for example and the contralateral hand innervated

Question 28

what are characteristics of the interlimb reflex?

Answer 28

most common in distal upper limb muscles, rare in proximal upper limb muscles, response is almost always excitatory in nature, minimum latency suggests (near) direct pathway btw sensory afferent and cervical motorneuron

*** not evident in able-bodied pts.

Question 29

what is the basis for the interlimb reflex?

Answer 29

regenerative sprouting: new connections in the spinal cord are made caudal to the jury post- injury

Question 30

when do interlimb reflexes appear after a spinal cord injury?

Answer 30

days to weeks ( they are established but not functional)

months to years later novel connections develop or existing connections strengthen dramatically

Question 31

once internal lomb reflexes what happens to them do the get stronger, weaken, disappear?

Answer 31

they get stronger for 1-2 years and never disappear

Question 32

interlimb reflexes are probably the basis for ________ _________?

Answer 32

autonomic dsyreflexia but decrease at the presynaptic sympathetic interneurons at the thoracic level not the motor neurons on the cervical enlargement.