Spinal Cord Injury Flashcards
What are some acute/immediate responses to spinal cord injury? (There are 6)
Weakness, sensory loss, sensory abnormalities (neuropathic pain/parasthesia), hypotension, urinary retention, orthopedic pain
Why does a spinal cord injury immediately cause hypotension? Why is this a problem?
The body’s response is to vasoconstrict. This results in less blood flow going to the peripheral nerves and increases ischemia
What are some long term consequences of spinal cord injury? (there are 11)
Involuntary movement, effects on the bladder, sexual dysfunction, higher risk of blood clots, higher risk of pressure ulcers, autonomic dysfunction, loss of thermoregulation, increased risk of metabolic disorders, musculoskeletal breakdown, fractures, psychological issues
Myoclonus and spasticity may occur as a long term consequence of spinal cord injury. What are myoclonus and spasticity?
Myoclonus is a recurrent stretch reflex that is involuntary. For example sitting in a wheelchair and pumping your leg involuntarily. Another word for spasticity is hyperreflexia
A spinal cord injury above T10 has a different effect on the bladder than below T10. How are these injury locations different on the bladder?
Above T10: UMN
Have a spastic or neurogenic bladder- as the bladder fills the detruser muscle contracts and the harder the sphincter contracts. Urine only comes out when the detruser pressure is greater than the sphincter; the incomplete emptying of the bladder leads to chronic UTI
Below T10: LMN
Flaccid bladder where the urethral sphincter is lose and get constant leakage
Why do those with spinal cord injuries have a higher risk of pressure ulcers?
They can’t feel pressure (epicritc) and therefore aren’t prompted to shift their weight. So get cutaneous ischemia if they don’t shift enough
Why is autonomic dysreflexia? What causes autonomic dysreflexia?
Autonomic dysreflexia are episodes of incredibly high blood pressure and to compensate the body decreases the cardiac output (heart rate X stroke volume). Autonomic dysreflexia occurs when there’s a strong afferent stimulus like nociception from the overfilling bladder or from cutaneous input
What is the difference between a complete and incomplete spinal cord injury? What’s a B Incomplete vs. a C incomplete spinal cord injury?
Complete: no motor or sensory below the injury
Incomplete: Have sensory only below the site of the injury, but no motor
B incomplete: have sensory only below the site of injury including S4-S5
C incomplete: have sensory below the site of the injury as well as limited motor function
What are the three approaches to treat acute spinal cord injury?
- Neuroprotection- try and protect the surviving cells/axons; reduce the ischemia
- Neurorestoration- replace the neurons by providing neutrophins or promoting regeneration
- Neurorehabilitation- strengthen anything that’s left (any existing systems)
A patient who had a complete spinal cord injury 17 years ago started involuntarily stepping after starting a new training program. What caused this? What does it prove?
This patient had osteoarthritis but couldn’t feel the pain. However, the spinal cord can still respond to this afferent injury by stimulating his CPG (central pattern generator). This proves that humans have a CPG that requires a high threshold or high nociception input to stimulate. This CPG can’t be trained
When the legs are under control of the central pattern generator, one muscle is shown to be involuntarily controlled by showing a double burst on EEG. What muscle is this?
Tibialis anterior
What are interlimb reflexes? In what types of spinal cord injury are they seen? Why do they occur?
Interlimb reflexes: when touching ice to left foot and the right arm fires
Seen in all patients with chronic cervical spinal cord injury
Interlimb reflexes occur because the brain loses the afferent input below the spinal cord injury and so new growth occurs between the ascending pathways and the existing motor pathways- this shows new growth and regenerative sprouting
