Spinal Cord Injury Flashcards
which two vertebral areas are at highest risk of developing SC lesions and why?
- C4-C6 since most flexible
- T12-L1 since least flexible
where does the spinal cord end? what is it called after that?
L1/L2, cauda equina
a vertebral fracture at T12 will hit the T12 spinal cord level True/False. If False, which levels might it be hitting?
False, 3 to 4 levels below it so L3-4
Which horn is associated with the sympathetic nervous system? Is this grey matter or white matter?
Lateral Horn, grey matter
Axons for the UE are usually found in which region of the spinal cord?
the central region.
does the ASIA tell you the independence of your patient?
No! Only the level of the lesion and the severity
is a T2 neurological lesion a paraplegia or a tetraplegia?
paraplegia - starts at T2
what does a T4 paraplegia without abdominals ASIC indicate?
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).
what does a C6 tetraplegia without triceps ASIB indicate?
note that the motor level on the left was C6 and the right was C7.
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?)
to test sensation, what would a 1/2 score indicate?
The patient felt the stimulus but it did not feel the same as the control (face). Could be hyper or hyposensitive!
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?
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.
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?
L2 - the most caudal myotome that is at least 3/5 and everything above it is 5/5.
central cord syndrome can be a complete lesion True/False. Why/why not?
False. There is still some sensation and motor function below the lesion. Typically patients can walk but have trouble using their arms and hands.
Brown sequard lesions involve which part of the spinal cord?
a hemisection - usually injury from gunshot or stabbing
a problem with the anterior spinal artery can result in what syndrome? what is still preserved?
anterior cord syndrome - proprioception, deep touch, vibration sense.
is the conus medullaris part of the spinal cord?
yes.
what tends to denote a periferal nerve lesion as opposed to an upper motor neuron lesion?
flaccid paralysis, no reflexes, no clonus.
what other injury can commonly accompany a SCI?
head trauma
if the lesion is too low for a miami collar but too high for a corset? what does the person wear?
a SOMI - apparently very uncomfortable
what are the 4 cardinal signs of an upper motor neuron lesion?
Clonus
Hyperreflexia
babinski
hypertonus?
Slides also mention that it is common to have spasticity above T12 and flaccidity below T12
what lesion levels may include respiratory deficits?
everything above a low paraplegia (will have an effective but weak cough)
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?
Deltoid - nociceptive pain
calf - neuropathic pain
name potential complications associated with an
SCI
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
What is to be emphasized in treating a TVA or high tetra ASIA/B?
- ROM for neck, UEs, LEs
- neck strengthening and endurance
- pulmonary hygiene
- pt education
Will a C5 high tetra be able to breathe on their own?
potentially yes - C3,4,5 keeps the diaphragm alive.
why is the difference between a C5 and C6 lesion so large?
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
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?
no functional finger movements
what level of paraplegia is considered with abdominals?
T6-T12
