Spinal Cord Injury

Question 1

General Stats

Answer 1

Incidence 25 025/ millionAverage age 31.782% male

Question 2

Etiology

Answer 2

MVC 37%Violence 27%Falls 21%Sports 7.1%Other 8%

Question 3

Tetraplegia

Answer 3

Due to injury to cervical segments of spinal cordSensory +/- motor function in arms, trunk, legs

Question 4

Paraplegia

Answer 4

Due to injury to thoracic, lumbar, or sacral segments of spinal cordSensory +/- motor function in trunk, legsBoth loss of bowel, bladder, sexual function

Question 5

Functional Outcome C1-C4

Answer 5

Supported ventilationDependent for transfers, self-careEnvironmental controlPower chair with tilt/recline for pressure and hypotension relief

Question 6

Functional Outcome C5

Answer 6

Elbow flexion plus orthoses can allow self-care and mobilityFeeding, oral-facial hygiene, table top communicationOther ADL dependentManual chiar indoors, power wheelchair

Question 7

Functional Outcome C6

Answer 7

Radial wrist extensionTenodesis orthosisFeed, facial hygiene, dressingSliding board transfersManual wheelchairDriving adapted van

Question 8

Functional Outcome C7-C8

Answer 8

Triceps, finger extension, wrist flexion at C7Improves transfers and mobilityIndependent bed mobility, dressing facial hygiene, transfersFinger flexion at C8Total independence with wheelchairCan drive car

Question 9

Thoracic

Answer 9

Total independence at wheelchair levelBelow T1 hand function is normalIntercostals and abdominals present the lower the lesionMay do some standing and walking with KAFOs or RGOs

Question 10

Lumbar

Answer 10

Independent at wheelchair levelCommunity ambulators have control of pelvis, hip flexors, 1 quadriceps, proprioception in hips and ankles, usually T12 or belowRequire KAFOs, AFOs plus canes or crutches

Question 11

Spasticity

Answer 11

CommonDevelops in first few months, initially flexor then extensorTreat if interfering with function, positioning, transfers, sleep, or causes pain or deformityPhysical Pharmacologic: oral, injected, intrathecal

Question 12

Heterotropic Ossification

Answer 12

Abnormal bone formation in soft tissues around hips, knees, shoulders, and elbowsOccurs in 16-53% of SCI patients, but only 18-37% have a significant ROM limitationUsually occurs within 1st 6 months after injury, rare after 1 yearTreatment: ROM, drugs, surgery

Question 13

Autonomic Dyreflexia

Answer 13

Acute syndrome of massive sympathetic discharge, occurs as a result of noxious stimuli, with spinal cord lesions above T6Hypertension, headache, sweating, nasal congestion, flushing, reflex bradycardiaOccurs in 48-83% of tetraplegic and high paraplegic patientsTreatment: sit up, remove noxious stimulus, drugs

Question 14

Syringomyelia

Answer 14

Post-traumatic cystic myelopathyOccurs in 0.3-3.2%, as early as 2 monthsPain and numbness, weakness, cranial nerve findingsTreatment: surgical

Question 15

Osteoporosis

Answer 15

Occurs below the level of the injurySpine relatively sparedAt risk for fracturesNo good treatment

Question 16

Pain

Answer 16

CommonPeripheral nerve painCentral spinal cord painVisceral painMuscle and mechanical painPsychogenic pain

Question 17

Tendon Transfers

Answer 17

Can be useful for C5 and C6 levelsAllow wrist flexion and elbow extension

Question 18

FNS

Answer 18

Implantable neuroprosthesesWalker systems