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NM PCM II > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Whats the leading cause of SCI in people under 65?

A

MVA (overall this is probably most people, 50%)

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2
Q

Whats the leading cause of SCI in people over 65?

A

Falls (20%)

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3
Q

What caused about 18% of SCI cases?

A

Sports and recreation

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4
Q

Non-Traumatic Stroke

A

Spinal stroke, blood flow to spine gets blocked = tissue damage, tumor

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5
Q

Spinal Concussion

A

Sudden, violent jolt injures the tissues around the cord. Usually temporary and goes away in a few hours.

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6
Q

Spinal Contusion

A

Causes bleeding to occur in the spinal column. The pressure from the bleeding can kill neurons. (injury of SC is secondary to bleeding)

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7
Q

Spinal Compression

A

Object (i.e. tumor) puts pressure on the spinal cord.

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8
Q

Shearing/Tearing of SC

A

Torn by some type of injury, neurons are also damaged.

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9
Q

Completely Cut SC

A

Spinal cord is dissected

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10
Q

Other causes of SCI

A

Infection, Vascular malformations, vertebral subluxations, cysts on SC, MS/ALS, disc/vertebral degeneration in neck

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11
Q

Ratio of those at risk

A

Males more likely than females 4:1

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12
Q

What percentage of SCI occurs from 16-30 y.o.?

A

51.6%

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13
Q

Mean Age for traumatic SCI

A

39 y.o.

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14
Q

Mean Age for non-traumatic SCI

A

55 y.o.

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15
Q

Distribution of SCI

A

Cervical 51%
Throacic 35%
Lumbosacral 10%

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16
Q

Types of injury

A

Compression Fx, Burst Fx, Subluxation, Dislocation, Fracture Dislocation

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17
Q

Tetraplegia

A

i.e. Quadriplegia

Paralysis of all four extremities and trunk

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18
Q

Paraplegia

A

Paralysis of all or part of the trunk and both LE

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19
Q

Incomplete Spinal Cord Injury

A

Preserved anal sensation in S4-5 dermatome (light touch/sharp dull)

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20
Q

Motor Incomplete injury

A

Preserved voluntary anal sphincter contraction

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21
Q

MOST to LEAST frequent Incomplete Injuries

A

Incomplete tetra
Complete para
Complete tetra
Incomplete para

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22
Q

Vertebral lesion level

A

Anatomical injury at the vertebrae –> not referring to that nerve root necessarily. (T5 vertebral burst Fx)

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23
Q

Neurological Lesion Level

A

Most caudal level of the SC with NORMAL motor AND sensory function on BOTH the R&L sides of the body

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24
Q

Motor Lesion Level

A

Most caudal level of the SC with NORMAL motor function (can be rated separately from sensory)

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25
Q

Sensory Lesion Level

A

Most caudal level of the SC with NORMAL sensory function (can be rated separately from motor)

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26
Q

Sensory Test Grades

A 
0 = Absent
1 = Altered
2 = Intact
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27
Q

How many sensory points on ASIA?

A

28, LT & PP at each point

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28
Q

How many key motor?

A

10

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29
Q

ASIA Motor Muscle Grading 0

A

Total Paralysis

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30
Q

ASIA Motor Muscle Grading 1

A

Palpable/Visible contraction

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31
Q

ASIA Motor Muscle Grading 2

A

Active movement, full range gravity elim

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32
Q

ASIA Motor Muscle Grading 3

A

Active movement, full range against gravity

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33
Q

ASIA Motor Muscle Grading 4

A

Active movement, full range against gravity and mod resistance in muscle specific position

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34
Q

ASIA Motor Muscle Grading 5

A

Active movement, full range against gravity and full resistance in muscle specific position. Expected from otherwise unimpaired person

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35
Q

ASIA Motor Muscle Grading 5*

A

active movement, full ROM against gravity and sufficient resistance to be considered normal if identifiable inhibiting factors (i.e. pain, disuse) were not present

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36
Q

NT

A

Not Testable (immobilization , severe pain, amputation, contracture >50% normal ROM)

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37
Q

ASIA: Intact Innervation of Key Muscles

A

grade 3/5 or 4/5 AND most rostral key muscle 5/5

If myotome not clinically testable, sensory level serves as motor level also. (so 5-5-5-5-3 = last normal level)

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38
Q

ASIA impairment scale

A 
A = Complete
B = Sensory Incomplete
C =Motor Incomplete
D = Motor Incomplete
E = Normal
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39
Q

ASIA B

A

S4-5 sensory but not motor

40
Q

ASIA C

A

motor S4-5, more than ½ key mm below neurological level

41
Q

ASIA D

A

1/2 or more key muscles >/= 3 MMT

42
Q

FIM (functional independence measure)

A

7 point scale. 6-7 don’t need helper, 6 additional time or AD

43
Q

Vascular Supply of the Spinal Cord

A

Anterior Spinal Artery (2/3)

Posterior Spinal Artery (1/3)

44
Q

What is Brown-Sequard Syndrome?

A

Hemisection of the Spinal Cord; asymmetrical sequelae

45
Q

What does Brown-Sequard Syndrome damage?

A

Corticospinal tract: Spastic paralysis
Fasciculus gracilis/cuneatus: loss of vibration/proprio
Spinothalamic tract: pain and temp

46
Q

Ipsilateral Sx of Brown-Sequard Syndrome

A 
Loss of light touch, deep pressure, proprioceptive sensation
Decreased Reflexes
Lack of Superficial reflexes
Clonus
(+) Babinski Sign
47
Q

Contralateral Sx of Brown-Sequard Syndrome

A

Loss of pain and temp

48
Q

Positive prognostic factor for Brown-Sequard Syndrome

A

Preservation of motor function in dominant hand

49
Q

What is Anterior Cord Syndrome?

A

Damage to anterior portion of SC and/or vascular supply to anterior spinal artery. RELATED TO FLEXION INJURIES OF C-SPINE!

50
Q

S/S anterior cord syndrome

A

Loss of motor function
Loss of pain and temp
Preservation of kinesthesia, vibratory, deep pressure (posterior columns)
Extremely poor prognosis for return of bowel and bladder function, hand function and amb.

51
Q

What is central cord syndrome?

A

Hyperextension injuries to cervical region or narrowing of spinal canal. Injury causes bleeding into central gray matter. The majority of incomplete lesions result int his.

52
Q

S/S central cord synrome

A

More involvement of UE than LE, more motor involvement than sensory.

53
Q

Outcomes with central cord syndrome

A

3/4s ambulatory
1/2 bowel/bladder control
less than 1/2 hand function

54
Q

Positive prognostic factors with Central Cord Syndrome

A

Higher level of education
Absence of spasticity
Younger age

55
Q

S/S Posterior Cord Syndrome?

A

Loss of proprioception
Loss of epicritic sensations (graphesthesia, sterognosis, 2 pt discrim)
Altered gait pattern (wide steppage)

56
Q

What is Sacral Sparing?

A

Most centrally located sacral tracts are spared injury

57
Q

Sacral Sparing: Incomplete Injury

A

Intact sensation, perianal sensation, external anal sphincter contraction

58
Q

Conus Medullaris Syndrome

A

Damage to S4-5 Spinal Segment

59
Q

S/S Conus Medullaris Syndrome

A 
Interferes with:
Bladder and bowel function
Sexual function
Decreased perianal sensation
Diminished Achilles reflexes
Usually bilateral and symmetric
60
Q

What are Cauda Equina injuries?

A

Technically a peripheral nerve root problem because the SC has terminated.

61
Q

S/S Cauda Equina injuries

A

Injuries typically partial, LMN injuries, so LMN Sx (flaccid, decreased reflexes)

62
Q

Where in the spine have the highest frequency of injury?

A

Between C5-7 & T12-L2 (more mobile, less stable)

63
Q

Spinal Shock

A

Period of areflexia, flaccidity, loss of sensation/motor function below the level of the lesion.

64
Q

Areflexia

A

Loss of deep tendon reflexes as well as superficial: bulbocavernosus, cremasteric, plantar reflexes

65
Q

What marks the end of spinal shock?

A

The return of bulbocavernosus reflex

66
Q

Clinical Manifestation of SCI

A 
Motor/Sensory Impairment
Autonomic Dysreflexia
Postural Hypotension
Impaired Temp Control
Respiratory Impairment
Spasticity
B/B Dysfucntion
Sexual Dysfunction
67
Q

What is autonomic dysreflexia?

A

An emergency situation. Lesions above T6 (sympathetic splanchnic outflow)

68
Q

Hallmark Symptom of Autonomic Dysreflexia?

A

Elevated systolic blood pressure (20-40 mmHg above normal)

69
Q

Sx of Autonomic Dysreflexia

A 
Inc. systolic BP
Bradycardia
Headache (severe pounding sudden)
Profuse Sweating
Vasodilation/flushing above lesion level
Piloerection (goosebumps)
Blurred Vision 
COULD HAVE STROKE
70
Q

What should you do if Autonomic Dysreflexia?

A

Sit pt up to dec BP
Immediate Medical Assistance (strong vasodilators)
Check for causes

71
Q

Some causes of autonomic dysreflexia?

A 
Bladder distension (urinary retention)
Rectal distension
Pressure Sores
UTI
Infection
Noxious cutaneous stimuli
72
Q

Postural (orthostatic) hypertension

A

Decreased blood pressure when transitioning to vertical position
Cause: lack of sympathetic vasoconstriction

73
Q

S/S Postural (orthostatic) hypertension

A

Headache, flushed, dizzy, pale. Vision problems: tunnel vision/blackness

74
Q

Prevention of Postural (orthostatic) hypertension

A

compression stocking/ace wrap
Abdominal binder
Slow progression to upright

75
Q

What should you do if Orthostatic hypotension?

A

Lay them down, can put the feet up.
Need to act quickly.
If you’re in a wheelchair you tilt the chair back and allow them to rest the head etc. Slowly back to sitting or can get more people/stretcher to transfer in laying position.
Blood pools most in LE & Abdomen.

76
Q

Indirect Impairment/Complication from SCI

A 
Respiratory Complications
Pressure Sores [Decubitus ulcers]
DVT
Contractures
Heterotopic (Ectopic) Ossification [H.O.]
Pain
77
Q

What is the most common cause of death post SCI?

A

Pneumonia (reduced ventilation, decreased cough/secretion clearance)

78
Q

Respiratory Complications: C1-C4 Positioning

A

May have improved respiratory function when reclined 15 deg with head support

79
Q

Glossopharyngeal Breathing

A

Utilized during emergency situation

80
Q

Paradoxical breathing

A

People without normal abdominal function. Pouching out in stomach and concavity in chest.

81
Q

What is an effective cough?

A

one or two large spouts of air coming out in a forceful exhale.

82
Q

Pressure Sore prevention/Tx

A

Position change every 2 hrs
Skin inspection
Pressure relief equipment
Pressure relief techniques

83
Q

Skin Inspection

A

Can use mirror, check bony prominences (esp heels, ish tub, poor sensation & WB regions)

84
Q

When do you ned to preserve tenodesis grip?

A

C6-7 injuries.

85
Q

Heterotopic Ossification

A

Ectopic bone formation in soft tissues surrounding a joint. Near joint, extra-articular, extra-capsular. Linked with spasticity. Never IN the joint.

86
Q

Where does HO occur primarily?

A

The hip (also, knee, shoulder, elbow)

87
Q

How common is HO?

A

1/4 - 1/2 SCI patients will habe it

88
Q

Factors associated with HO

A 
Complete injury
Trauma
Severe Spasticity
UTI
Pressure Sores
89
Q

Early Sx of HO

A

Swelling, joint/muscle pain, Decreased ROM, erythema, local warmth near joint (Later Sx = contractures/ankylosis)

90
Q

HO prevention

A

NSAIDs, Pulsed low-intensity electromagnetic field, Avoid overly aggressive ROM.

91
Q

HO Tx

A

early ROM exercise, etidronate to prevent calcium deposits, NSAIDs

92
Q

Other secondary conditions

A

Bone Fx, Syringomyelia (tethered SC), Spasticity, Pain

93
Q

Cervical orthoses

A

Philadelphia, Aspen, Miami-J, Halo

94
Q

Thoracolumbosacral orthoses (TLSO)

A

*Jewett brace (hyperextension), Body Cast

95
Q

What is the general concept of orthoses?

A

3 point stabilization. So TLSO for hyperextension = point on pubic bone, sternum and mid back.

NM PCM II (1 decks)

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