Spinal Cord Injury Flashcards
At a C1-C3 injury, what movements are possible?
Neck flexion
Neck extension
Neck rotation
What are the functional implications of a c1-c3 injury?
- Ventilator dependent
- Total assist on all ADL/IADLs
- Level of communication depends on set-up
What muscles are innervated at a C1-C3 injury?
- sternocleidomastoid
- cervical paraspinal,
- Neck accessories
What movements are possible at a C4 injury?
Neck flexion, Neck Extension Neck Rotation Scapular elevation Inspiration
What are the muscles innervated at a C4 injury?
Upper trap,
diaphragm,
cervical paraspinal
What are the functional implications at a C4 injury?
- May breath without a ventilator
- Total Assist on ADLs and IADLs
- Level of communication depends on setup
Which movements are possible at a C5 injury?
- Shoulder flexion
- Shoulder abductions
- Shoulder extension
- Elbow flexion
- Elbow supination
- Scapular adduction
- Scapular abduction
Which muscles work at a C5 injury?
- Deltoid
- Biceps brachialis
- brachioradialis
- rhomboids
- serratus anterior(partial)
“Shoulder movers, elbow flexors”
What are the functional implications of a C5 injury?
- Low indurance/vital capacity
- Total assist on LE ADLs and IADLs
- Some to total assist in eating, UE dressing, grooming, transportation
- May be able to operate mannual w/c
- Some assist to independent after setup for communication
Which muscles work at C6 injury?
- Clavicular pectoralis,
- extensor carpi radialis longus and brevis
- Serratus anterior
- Lattissimus Dorsi
“Forearm supinators and wrist extensors”
Which movements are important for C6 injury?
- Scapular protraction
- Some horizontal adduction
- Forearm supination
- Radial wrist extension
What are the functional implications for a C6 injury?
- Low endurance and vital capacity
- Some to total assist for bowel, bladder, bed mobility, LE bathing and homemaking tasks
- Some assist to independent for W/C transfers on level surfaces and light meal prep
- Independent with equipment in grooming and pressure relief
- .Independent in eating(except cutting), dressing and bathing upper body, manual w/c indoors and communication
What are the movements at C7-C8
- Elbow extension
- Ulnar wrist extension
- Wrist flexion
- Finger flexion and extension
- thumb flexion, extension and abduction
What muscles are available at a C7-C8 injury?
- Lats
- Sternal Pecs
- triceps
- pronator quadratus
- extensor carpi ulnaris
- flexor carpi radialiss
- flexors digitorum and profundus and superficialis
- abductor pollicis
- Some lubricals
“Elbow extensors, wrist movers, and finger flexors”
What are the functional implications at available at C7-C8 injury?
- Low endurance and vital capacity
- Some to total assist for bowel
- Some assist to independent for bladder, bed mobility, uneven W/C transfers, LE dressing and bathing, standing, complex meal prep and heavy house cleaning
- Independent for level W/C transfers, pressure relief/positioning, eating, dressing and bathing UE, grooming, manual W/C indoors, communication, transportation with modified van, light meal prep/homemaking
AT what SCI injury levels is full UE function spared?
T1- Little finger abductors
How much assistance is needed for a person with a C7-8 level SCI needed for transfers?
Some assist to Independents
What are the five senses used to determine level of injury in SCI?
- Two point discrimination
- kinesthesia
- Proprioception
- Pain
- Light touch
What are some important AD for ADLs at a C1-C4 injury?
1.FOR THE CAREGIVER
handheld shower
Shampoo tray
Padded reclining shower chair or commode chair
What are important AD for ADLs at C5 injury?
Padded tub transfer bend or commode chair
Handheld shower
Long opponens splint with adaptive devices
What important AD for ADLs are used at a C6 injury?
- Universal cuff
- Handles or U cuffs for dressing
- Button hooks, loops on zippers
- Padded tub transfer bench or shower chair, handheld shower
What important AD for ADLs are used at C7-8 injury?
- Sock aid, reacher, shoe horn
2. padded tub, transfer tub bench, hand held shower head
what important AD for ADLs are used at T1-9 injury?
1.Padded tub transfer or shower chair, handheld shower
INDEPENDENT FOR ALL OTHER ADLs
What important AD for ADLs are used at T10-S5 injury?
Padded transfer bench, handheld shower
What are the symptoms of heterotropic ossification?
Swelling
warmth
Decreased ROM
Occurs 1-4 months after injury
What are the tx for heterotropic ossification?
Medication
Maintaining ROM
What is A in the Asia Impariment scale mean?
Complete: NO motor or sensory function is preserved in the sacral segments S4-S5
What below the does B in the AIS mean?
Incomplete: Sensory function is preserved NO motor below the neurological level and includes sacral segments S4-S5
WHat does the C mean in AIS?
Incomplete: Motor function is preserved below teh neurological level and more than half of key mucles below the neurological level have a muscle grade less than three
What does the D mean in AIS?
Incomplete: Motor function is preserved below the neurological level, and at least half of the key muscles below the neurological level have a muscle grade of 3 or more
E in AIS?
Normal: Motor and sensory function is normal
How long does spinal shock last?
24 hours to 6 weeks
What is affected in spinal shock?
Bladder and bowel are atonic or flaccid
Deep tendon reflexes are decreased, and sympathetic functions disturbed
Decreased constriction of blood vessels, low BP, slower heart rate, and no perspiration below the level of injury
What is the prognosis for complete lesions?
Total paralysis and loss of sensation below level of lesion
If there is no sensation or return of motor function below level of lesion 24-48 hours after injury, motor is less likely to return and partial to full return of function to one spinal nerve root level below the fraction can be gained and may occur in the first 6 months after injury
What is the prognosis for incomplete lesions?
Some degree of preservation of sensory and motor nerve pathways below level of lesion,
Progressive return of motor function is possible,
frequently the longer it takes for recovery to begin, the less likely it will occur
What is Central Cord Syndrome?
More damage occurs at the center of the cord than the periphery. Paralysis and sensory loss occur in UE more than LE.
OFten seen in elderly with spinal stenosis
What is Brown Sequard Syndrome?
One side of cord is damaged,
typically due to a gunshot or knife wound,
Proprioception and motor control lost on teh same side as the injury
Sensory is lost on opposite side
What is anterior spinal cord syndrome?
Injury to the anterior apinal atery or anterior are of cord. Loss of motor and sensory function. Proprioception is preserved
What is cauda equina injury?
Injury to peripheral nerves. Often related to injury at L2 or below resulting in flaccid type paralysis.
Loss of motor and sensation is asymmetrical and contextual, but prognosis is better due to regeneration
What is conus medullaris syndrome?
injury to sacral cord and lumbar nerve roots. Results in areflexic bladder, bowel and LE