Spinal Cord Injury Flashcards
Spinal Cord Injury
Injury to the spinal cord resulting in a change, either temporary or permanent, in its normal sensory, motor or autonomic function
SCI Causes
Hyperflexion/extension Axial loading Bruising Severing With or without spinal fracture or dislocation
SCI Causes - Atraumatic
Vascular
Neoplastic
Degenerative
Traumatic SCI %
MVC - 39% Falls - 28% Gun-related - 15% Sports - 8% Other trauma - 10%
Common SCI Co-morbidities
Brain injury
Fractures
Pneumothorax
Peripheral nerve injury
Who’s more likely to get SCI?
Males
Tetraplegia
Between C2 and T1
Paraplegia
T1 down
Spinal Cord Injury Manifestation
Traumatic blow to spine Changes in blood flow cause damage Excessive release of neurotransmitters kills nerve cells Immune system cells create inflammation Free radicals attack nerve cells Nerve cells self-destruct
Aspen Collar
Most common cervical
Miami J Collar
Prevents head from developing wound
Philadelphia Collar
Preventative if not sure about injury
Can be intubated
SCI Evaluation
MOI Co-morbidities Past history Precautions ASIA level Level of injury
Cervical Precautions
Unstable, on bed rest
Pending clearance, and no fracture/dislocation identified, may use a collar
Post fixation, to be up, will use a collar
Thoracic and Lumbar Precautions
Bedrest Limit extremity movement Don't elevate HOB Place in reverse trendelenburg (30 deg) to prevent aspiration Log roll x 2 assist
Level of Injury
Determined by last intact muscle group and dermatome, not by fracture
ASIA Sensory Grading
0 - absent
1 - altered
2 - normal
ASIA Motor Grading
Same as MMT
“Completeness” of Injury
Relates to presence or absence of rectal tone or sensation
Takes into consideration if any sensation or motor function is present below level of injury
ASIA “A” Classification
Complete - no motor or sensory function is preserved
ASIA “B” Classification
Sensory Incomplete - sensory, but not motor function is preserved below neurological level
ASIA “C” Classification
Motor Incomplete - motor function preserved below neurological level and more than half of key muscle functions below NLI have grade less than 3
ASIA “D” Classification
Motor Incomplete - motor function preserved belos neurological level and at least half of key muscle functions below NLI have grade more than 3
ASIA “E” Classification
Normal - follow up of patients who initially had deficits
Incomplete Lesions
Pattern of clinical presentations directly related to cross-sectional anatomy of spinal cord
Anterior Cord Syndrome
Loss of function of the ventral pathway and the conservation of the dorsal column
Not good prognosis
Anterior Cord Syndrome Result
Preservation of light touch, proprioception and deep pressure with absences of pain and motor function
Anterior Cord Syndrome Causes
Anterior spinal artery infarction
Disc herniation
Radiation myelopathy
Central Cord Syndrome
Central area of injury which affects the medially located motor fibers that control distal upper extremity function
Favorable functional recovery
Central Cord Syndrome Result
UE weakness greater than LE weakness
Sacral sensory spared
Central Cord Syndrome Causes
Syringomyelia
Tumor
Spondylotic myelopathy
Brown-Sequard Syndrome
Damage that affects one-half of the spinal cord significantly greater than the other half
Brown-Sequard Syndrome Result
Spastic paresis
Loss of light touch and vibration
Sensation on the damaged side
Loss of pain and temperature on the contralateral side
Cauda Equina Results
Low back pain Radicular pain Lower extremity paresis or paralysis Sensory deficit in the perineal area Bowel or bladder dysfunction Diminished or absent patellar and Achilles reflexes
Factors with Improved Outcomes
Completeness of injury
Age
So-so early surgical intervention
Zones of partial preservation
Secondary Conditions from SCI
Autonomic dysreflexia DVT Pressure ulcers UTI/Renal problems Fractures Pain Spasticity
Autonomic Dysreflexia
Risk at T6 and higher
Inc blood pressure which increases risk for cerebral hemorrhage or heart failure
AD Symptoms
Headache Sweating Nasal congestion Hyperhidrosis Paresthesias
AD Causes
Bowel/bladder distension Rectal stimulation Cutaneous lesions Fractures Body-positioning *BLOCKED URINARY CATHETER*
DVT
Result of coagulation of blood
Highest incidence in first 2 weeks
DVT signs
Rapid onset of swelling
Increased temperature in limb
Pressure Ulcers
Due to immobilization or poor handling
Prolonged compression between bony prominence against support surface
Decrease tissue perfusion
Heterotrophic Ossification
Ectopic bone formation in soft tissue surround joint
Usually caudal to injury
Sudden limitation of ROM
Bone Fracture
SCI patients see bone demineralization
Syringomyelia
Fluid filled cavity within spinal cord extending multiple levels
Decrease in motor function is sign of new pathology
Spasticity
Hypertonicity of muscle below lesion
Nociceptive Pain
People with spastic paresis or paralysis, reflex is exaggerated
Neuropathy Pain
Pain or sensory disturbance due to abnormal processing of afferent input
