SPINAL CORD INJURY Flashcards
SCI
Average age at the time of injury =
42 yo
SCI
80% of SCI patients are
males
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Causes of SCI:
- 38% = MVA
- 30.5% = falls
- 13.5% = Violence
- 9% = sports
- 5% = medical/surgical
- 4% = other/unknown
(last 2 categories used be classified as “others”)
SCI
which is the most common type of SCI?
- Incomplete tetraplegia = 45%
- Incomplete paraplegia = 21.3%
- Complete paraplegia = 20%
- Complete tetraplegia = 13.3%
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Most common ocurrence of SCI is?
Incomplete tetraplegia = 45%
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results in impairment of function in the arms as well as trunk, legs, and pelvic organs. It does not include brachial plexus lesions or injury to peripheral nerves outside the neural canal.
Tetraplegia (AKA quadriplegia)
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Impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal.
Tetraplegia (quadriplegia)
SCI
arm functioning is spared, but depending on the level of injury, the trunk, legs, and pelvic organs may be involved.
paraplegia
SCI
Impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord secondary to damage of neural elements within the spinal canal.
Paraplegia
SCI
No sensory or motor function is preserved in the sacral segments S4-5.
ASIA: A
complete
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- Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5 (light touch or pin prick at S4-S5 or deep anal pressure)
- AND no motor function is preserved more than three levels below the motor level on either side of the body.
ASIA B = Sensory Incomplete
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The sensory level is the most ______, intact dermatome for both pin prick and light touch sensation.
caudal
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- The motor level is defined by the________________________ (on supine testing), providing the key muscle functions represented by segments above that level are judged to be intact (graded as a 5).
- Note: in regions where there is no myotome to test, the motor level is presumed to be the same as the sensory level, if testable motor function above that level is also normal.
lowest key muscle function that has a grade of at least 3
SCI
How do you determine whether the injury is complete or incomplete?
- (i.e. absence or presence of sacral sparing)
- If voluntary anal contraction = No
- AND all S4-5 sensory scores = 0
- AND deep anal pressure = No
- then injury is Complete.
- Otherwise, injury is Incomplete.
SCI
- Headache
- Flushing of the face
- Sweating
- Skin rash
- Hypertension
- Bradycardia
autonomic dysreflexia
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treatmnent of autonomic dysreflexia
- Identify noxious stimuli and remove it
- Monitor BP and HR
- Keep patient sitting up!
- Notify MD – the may need to be medicated to decrease BP
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Common sources of noxious stimuli leading to Autonomic Dysreflexia:
- Bladder or bowel distention
- Decubiti (pressure ulcer)
- Bladder infection or UTI
- In-grown toe nail
- leg strap is too tight
SCI
The afferent stimuli (or strong sensory input) leads to sympathetic response that causes significant local vasoconstriction and life-threatening hypertension. Inhibitory input is blocked and hypertension persists.
autonomic dysreflexia
AKA hyperreflexia
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Impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord secondary to damage of neural elements within the spinal canal. Arm functioning is spared, but depending on the level of injury, the trunk, legs, and pelvic organs may be involved.
Paraplegia
SCI
A collection of muscle fibers innervated by the motor axons within each segmental nerve root.
MYOTOME
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Area of skin innervated by the sensory axons within each segmental nerve root.
DERMATOME
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Tetraplegia key muscles:
(C5 to T1 injury)
- C5: biceps – elbow flexors
- C6: wrist extensors
- C7: triceps - elbow extensors
- C8: finger flexors (distal phalanx of middle finger)
- T1: finger abductors (5th digit)
SCI
Paraplegia key muscles:
(L2 to S1)
- L2: hip flexors
- L3: knee extensors
- L4: ankle dorsiflexors
- L5: long toe extensors
- S1: ankle plantarflexors
SCI
What are the results of Brown-Sequard syndrome?
Hemisection of the spinal cord:
- Ipsilateral proprioception loss at and below that level
- Ipsilateral motor control loss at and below the level of lesion
- Contralateral Pain & temperature loss from side below that level
- Abnormal or absent reflexes on the same side at the level of lesion
- Babinski sign ipsilaterally
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What are the results of anterior cord syndrome?
- loss of motor function (complete paralysis) below level of lesion
- loss of pain & temperature below level of the lesion
- intact 2-point discrimination, proprioception and vibratory senses due to intact posterior column
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What are the results of central cord syndrome?
- Hyperextension injury
- Bilateral motor paresis, UE > LE
- varying degree of sensory loss
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What are the results of posterior cord syndrome?
- Rare
- loss of proprioception, two-point discrimination, graphesthesia, sterognosis below level of the lesion
- wide-based steppage gait pattern typical preservation of motor, pain & light touch
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What are the results of CAUDA EQUINA SYNDROME?
- Bowel, bladder, sexual dysfunction
- Saddle +/- genital sensory loss
- LE weakness
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“Critical PROM” Guidelines: Hamstrings = ______ deg for dressing, transfers, etc
110
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Hip extension = ____ deg for gait training
10°
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Hip flexion = greater than _____ deg for sitting
90°
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Hip abduction = important for _____
self-care & bed mobility
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C2
Occipital protuberance
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C3
Supraclavicular fossa
SCI
C5
Lateral side of antecubital fossa
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C6, C7, C8
- C6 → Thumb
- C7 → Middle finger
- C8 → Little finger
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Medial side of antecubital fossa
T1
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Apex of axilla
T2
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Fourth intercostal space(nipple line)
T4
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Inguinal ligament at mid-pt
T12
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Half the distance between T12 and L2
L1
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Mid-anterior thigh
L2
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Dorsum of foot at 3rd metatarsal phalangeal joint
L5
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Lateral heel
S1
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Popliteal fossa
S2
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Ischial tuberosity
S3
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Perianal area
S4-5
