38% = MVA 30.5% = falls 13.5% = Violence 9% = sports 5% = medical/surgical 4% = other/unknown (last 2 categories used be classified as others)

SPINAL CORD INJURY Flashcards by Lourdes Rodriguez

SCI

Average age at the time of injury =

42 yo

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SCI

80% of SCI patients are

males

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SCI

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”)

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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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SCI

Most common ocurrence of SCI is?

Incomplete tetraplegia = 45%

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SCI

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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SCI

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)

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SCI

arm functioning is spared, but depending on the level of injury, the trunk, legs, and pelvic organs may be involved.

paraplegia

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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

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SCI

No sensory or motor function is preserved in the sacral segments S4-5.

ASIA: A
complete

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SCI

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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SCI

The sensory level is the most ______, intact dermatome for both pin prick and light touch sensation.

caudal

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SCI

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

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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.

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SCI

Headache
Flushing of the face
Sweating
Skin rash
Hypertension
Bradycardia

autonomic dysreflexia

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SCI

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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SCI

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

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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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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. Arm functioning is spared, but depending on the level of injury, the trunk, legs, and pelvic organs may be involved.

Paraplegia

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SCI

A collection of muscle fibers innervated by the motor axons within each segmental nerve root.

MYOTOME

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SCI

Area of skin innervated by the sensory axons within each segmental nerve root.

DERMATOME

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SCI

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)

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SCI

Paraplegia key muscles:

(L2 to S1)

L2: hip flexors
L3: knee extensors
L4: ankle dorsiflexors
L5: long toe extensors
S1: ankle plantarflexors

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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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# SCI 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

# SCI What are the results of **central cord syndrome**?

* Hyperextension injury * **Bilateral motor paresis, UE \> LE** * **varying degree of sensory loss**

# SCI 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

# SCI What are the results of CAUDA EQUINA SYNDROME?

* Bowel, bladder, sexual dysfunction * Saddle +/- genital sensory loss * LE weakness

# SCI “Critical PROM” Guidelines: Hamstrings = ______ deg for dressing, transfers, etc

110

# SCI Hip extension = ____ deg for gait training

10°

# SCI Hip flexion = greater than _____ deg for sitting

90°

# SCI Hip abduction = important for \_\_\_\_\_

self-care & bed mobility

# SCI Ankle DF = ____ for gait, minimal neutral for positioning in WC

10°

# SCI slight tightness in finger flexors for functional use of the hand

Tenodesis

# SCI Shoulder extension & ER with scapula adduction, elbow extension, wrist extension and supination WFL for

UE weight bearing activities

# SCI Providing _____________ is crucial to MMT

proper proximal stabilization

# SCI What are the 2 additional clinical considerations when treating patients with SCI?

* Orthostatic hypotension * Autonomic dysreflexia

# SCI Sudden drop in BP caused by a change from lying to sitting or standing position

ORTHOSTATIC (POSTURAL) HYPOTENSION

# SCI **Orthostatic hypotension** is more common in SCI lesions at the level of

**T6** & above = loss of sympathetic control of peripheral vasoconstriction leads to hypotension. Loss of muscle tone = poor venous return to heart and brain

# SCI ways to **prevent** orthostatic hypotension

* Change to upright positions slowly and monitor patient closely * Abdominal binder * Compression stockings

# SCI **Signs and symptoms** of orthostatic hypotension

* Lightheadiness or dizziness * Loss of vision or blurred vision * Fainting

# SCI gait training: gait pattern and bracing options are dependent on muscles available, T12 – L4/5 injury: usually \_\_\_\_\_

**KAFO**

# SCI gait training: gait pattern and bracing options are dependent on muscles available: L4/5 injury: usually \_\_\_\_\_

**AFO**

# SCI **indications** for gait training in patients with SCI

* no contractures * adequate UE strength * motivation * endurance * realistic expectations.

# SCI describe three **benefits** of gait training for SCI patients

* mobility * skin care * cardiac & respiratory function * B & B function * morale

# SCI important functional activities for patients with SCI

* **Rolling:** for bed mobility * **Prone:** skin relief & stretching of hip flexors * **Prone on elbows:** sh girdle stability * **Balance:** long and short sitting (CRUCIAL) * **Gait training**

# SCI Treatment principles crucial to working with the SCI population:

* Trunk-arm relationship (body type) * Relationship between balance and speed: momentum * Head-hips relationship (movement strategy) * Unweighting of body part is necessary for moving it * Muscle endurance: often using small muscles to move heavy loads * Awareness of COM over BOS within new functional body

# SCI Shoulder ER for

triceps

# SCI ER for

supination

# SCI compensations Scapula adduction for

latissimus

# SCI compsensations Hip flexion for

knee flexion

# SCI **C2**

Occipital protuberance

# SCI **C3**

Supraclavicular fossa

# SCI **C4**

Top of acromioclavicular jt

# SCI C5

Lateral side of antecubital fossa

# SCI **C6, C7, C8**

* C6 → Thumb * C7 → Middle finger * C8 → Little finger

# SCI Medial side of antecubital fossa

**T1**

# SCI Apex of axilla

**_T2_**

# SCI Third intercostal space

**T3**

# SCI Fourth intercostal space(nipple line)

**T4**

# SCI Fifth intercostal space

**T5**

# SCI Sixth intercostal space

# SCI Inguinal ligament at mid-pt

**T12**

# SCI Half the distance between T12 and L2

# SCI Mid-anterior thigh

# SCI Medial femoral condyle

**L3**

# SCI Medial malleolus

**L4**

# SCI Dorsum of foot at 3rd metatarsal phalangeal joint

**L5**

# SCI Lateral heel

# SCI Popliteal fossa

**S2**

# SCI Ischial tuberosity

**S3**

# SCI Perianal area

**S4-5**

# SCI Respiration, **C3-5** innervates the

**diaphragm**

# SCI Respiration, T1 to T6 innervates the

**intercostals**

# SCI Respiration, T6 to T12 innervates the

**abdominals**

# SCI a T3 SCI patient will breathe using

diaphragm and some intercostals | (no abdominals)

# SCI Decubiti develop when capillary pressure exceeds ___ mmHg

**30**

# SCI A patient with a decubiti ulcer in one heel shows **Reactive Hyperemia** (redness) What is the decubiti ulcer stage?

**Stage I**

# SCI A patient with a decubitus ulcer shows present with **dermis involvement** in one heel. What is decubiti ulcer stage?

**stage II**

# SCI A patient with a decubiti ulcer in one heel shows **subcutaneous fatty tissue is involved** What is the decubiti ulcer stage?

**STAGE III**

# SCI A patient with a decubiti ulcer in one heel shows muscle and bone that are destroyed…. What is the decubiti ulcer stage?

**Stage IV**

# SCI Skin integrity: ________ IS KEY!!!!

**prevention** * Pressure Reliefs * Weight shifts for pressure reliefs * Appropriate sitting surfaces (cushions) * Appropriate sleeping surfaces (mattresses)