Spinal Cord Injury

Question 1

which two vertebral areas are at highest risk of developing SC lesions and why?

Answer 1

• C4-C6 since most flexible

- T12-L1 since least flexible

Question 2

where does the spinal cord end? what is it called after that?

Answer 2

L1/L2, cauda equina

Question 3

a vertebral fracture at T12 will hit the T12 spinal cord level True/False. If False, which levels might it be hitting?

Answer 3

False, 3 to 4 levels below it so L3-4

Question 4

Which horn is associated with the sympathetic nervous system? Is this grey matter or white matter?

Answer 4

Lateral Horn, grey matter

Question 5

Axons for the UE are usually found in which region of the spinal cord?

Answer 5

the central region.

Question 6

does the ASIA tell you the independence of your patient?

Answer 6

No! Only the level of the lesion and the severity

Question 7

is a T2 neurological lesion a paraplegia or a tetraplegia?

Answer 7

paraplegia - starts at T2

Question 8

what does a T4 paraplegia without abdominals ASIC indicate?

Answer 8

incomplete lesion at T4 (spinal cord level not vertebral), with some sensation and motor function around the anus.
Below T4, less than half of the myotomes are at least 3/5 (so of the testable L2-S1, only 1 or 2 of these myotomes are 3/5 or more).

Question 9

what does a C6 tetraplegia without triceps ASIB indicate?

note that the motor level on the left was C6 and the right was C7.

Answer 9

incomplete lesion at C6 in the spinal cord (not the vertebral level), with some sensation but no motor function around the anus.
Below C6, there is no motor function at least three neurological levels below the motor level on each side, so nothing is moving below T1 on the left, or T2 on the right (but there is no myotome for T2 so this would not be tested?)

Question 10

to test sensation, what would a 1/2 score indicate?

Answer 10

The patient felt the stimulus but it did not feel the same as the control (face). Could be hyper or hyposensitive!

Question 11

when should you test the pin prick 10 times? how many times would they need to be correct to get a 1/2 or a 2/2?

Answer 11

test 10 times when the patient no longer looks/sounds confident about their answers. They need 8/10 or more to be considered able to discriminate.

Question 12

L2 - 5/5
L3 - 2/5
L4 - 3/5
L5 - 2/5
S1 - 1/5

everything above these are 5/5.

what is the motor level?

Answer 12

L2 - the most caudal myotome that is at least 3/5 and everything above it is 5/5.

Question 13

central cord syndrome can be a complete lesion True/False. Why/why not?

Answer 13

False. There is still some sensation and motor function below the lesion. Typically patients can walk but have trouble using their arms and hands.

Question 14

Brown sequard lesions involve which part of the spinal cord?

Answer 14

a hemisection - usually injury from gunshot or stabbing

Question 15

a problem with the anterior spinal artery can result in what syndrome? what is still preserved?

Answer 15

anterior cord syndrome - proprioception, deep touch, vibration sense.

Question 16

is the conus medullaris part of the spinal cord?

Answer 16

yes.

Question 17

what tends to denote a periferal nerve lesion as opposed to an upper motor neuron lesion?

Answer 17

flaccid paralysis, no reflexes, no clonus.

Question 18

what other injury can commonly accompany a SCI?

Answer 18

head trauma

Question 19

if the lesion is too low for a miami collar but too high for a corset? what does the person wear?

Answer 19

a SOMI - apparently very uncomfortable

Question 20

what are the 4 cardinal signs of an upper motor neuron lesion?

Answer 20

Clonus
Hyperreflexia
babinski
hypertonus?

Slides also mention that it is common to have spasticity above T12 and flaccidity below T12

Question 21

what lesion levels may include respiratory deficits?

Answer 21

everything above a low paraplegia (will have an effective but weak cough)

Question 22

A patient reports a dull aching pain that gets worse with movement in her deltoid, but a sharp stabbing pain in her calf that won’t go away with anything.

What two types of pain are these?

Answer 22

Deltoid - nociceptive pain

calf - neuropathic pain

Question 23

name potential complications associated with an

SCI

Answer 23

pressure sores
postural hypotension
autonomic dysreflexia - BE AWARE IF HEADACHE, FLUSHING, HIGH BP => sit them up, take bp, check bladder, get help
thrombophlebitis
contractures (esp hamstrings, hip flexors, gastrocs

Question 24

What is to be emphasized in treating a TVA or high tetra ASIA/B?

Answer 24

• ROM for neck, UEs, LEs
• neck strengthening and endurance
• pulmonary hygiene
• pt education

Question 25

Will a C5 high tetra be able to breathe on their own?

Answer 25

potentially yes - C3,4,5 keeps the diaphragm alive.

Question 26

why is the difference between a C5 and C6 lesion so large?

Answer 26

lat dorsi and wrist extensors are now innervated, breathing is out of grey area of innervation, can eat on own and no longer totally dependent for bed mobility and transfers, can now use manual w/c independently indoors.
Can now give pull ups and push ups and practice transfers etc

Question 27

C7 tetra with triceps can do a lot of arm movement, but what is the major restriction that prevents this lesion from being labelled “deluxe” like C8-T1?

Answer 27

no functional finger movements

Question 28

what level of paraplegia is considered with abdominals?

Answer 28

T6-T12