Spinal Cord Injury Flashcards
What are the symptoms and signs of an UMN lesion?
Spasticity or abnormal distribution in muscle tone which affects flexors more than extensors
stronger deep reflexes
loss of superficial reflexes
positive babinski’s sign
The effects of an UMN lesion are typically seen on the ipsilateral side of the body. T/F?
False - it is typically seen on the contralateral side
What is the Babinski’s sign?
Halux extension (instead of usual flexion) when stroking the lateral part of the sole from heel to toe
What are the signs and symptoms of a LMN lesion?
Weakness
Atrophy
Fasiculations
Absent reflexes
In a C5 spinal lesion what spinal muscle functions are spared?
Deltoid and bicep function
full head, neck and diaphragm control with good shoulder strength and full elbow flexion
In a C6 spinal lesion what spinal muscle functions are spared?
full head, neck and diaphragm control with good shoulder strength and full elbow flexion
also wrist dorsiflexion which allows objects to be picked dup in absence of finger movements
In a C7 spinal lesion what spinal muscle functions are spared?
full head, neck and diaphragm control with good shoulder strength,
full elbow flexion/extension, wrist dorsiflexion/plantarflexion and some finger control
In a C8 spinal lesion what spinal muscle functions are spared?
full head, neck and diaphragm control with good shoulder strength,
full elbow flexion/extension, wrist dorsiflexion/plantarflexion and some finger control with finger flexion possible
A spinal cord injury at T1 or below will still allow full fine motor control of the finger. T/F?
True
Hip abduction requires spinal nerves L1-3. T/F?
True
Which spinal nerves are required for movement of the knees?
L2-5
Which spinal nerves are required for ankle dorsiflexion?
L4-5
The diaphragm is the major inspiratory muscle. Which spinal nerves are innervate it?
C3,4 5 (keep the diaphragm alive!)
Which spinal segments innervated the intercostal muscles which elevate the rib cage and are required for coughing and deep breathing?
T1-7
Which spinal segments innervate the major muscles of expiration?
T6-T12
Patients with a cord injury at what level will require assisted ventilation?
C1-3
How will breathing be affected by a cord injury in C3-5?
Partial or full diaphragmatic function present
diminished ventilation because of loss of intercostal muscle function results in shallow breaths and weak cough
The ability to speak is compromised with assisted ventilation. T/F?
True
The cranial nerves can be affected by a spinal cord injury.. T/F?
False
Patients with a spinal cord injury at what level (or below) usually have sufficient sympathetic function to maintain adequate vasomotor function?
T6
Loss of bladder function results from a disruption of neural pathways between which spinal levels?
S2-4
With a UMN lesion in the sacral region a person may have a static bladder, lack of awareness of bladder filling but still retain voluntary control of urination. T/F?
True
How would a LMN lesion affecting the sacral region affect bladder function?
Flaccid bladder dysfunction
lack of awareness of bladder filling
lack of bladder tone
inability to urinate (volunatrily or involuntarily)
How would a spinal cord injury above S2-4 affect bowel elimination?
spastic defecation with loss of voluntary control of external anal sphincter
How would a spinal cord injury at the level of S2-4 affect bowel elimination?
Flaccid functioning of defecation reflex and loss of anal sphincter tone
ineffective evacuation of stool
What is spinal shock?
A complete loss of motor, sensory, reflex and autonomic function as a result of a sudden, complete transection of the spinal cord
The manifestations of spinal shock occur regardless of whether a UMN or LMN lesion is present. t/f?
True
How long does spinal shock last?
Hours, days or weeks
A UMN lesion at which spinal level or above results in reflexes remaining intact?
T12
What are the four phases of spinal shock?
Areflexia
Initial reflex return
Early hyperreflexia
Spasticity/hyperreflexia
Describe the sequence in which reflexes tend to return following spinal shock?
Bulbocavernosus Cremasteric Ankle jerk Babinski sign Knee jerk
Describe the pathophysiology behind the initial areflexia in spinal shock?
Spinal motor neurons and interneurons recieven continuous excitatory input from supra spinal axons. voluntary movement is superimposed on this background excitation. Following SCI, background excitation is lost and spinal neurons become less excitable
How long does stage one of spinal shock last for?
0-24 hours
Which stage of spinal shock occurs between days 1 and 3?
Stage 2
Describe the pathophysiology behind the initial return of reflexes in stage 2 of spinal shock?
Denervation syoersensitivity, such super sensitivity to a neurotransmitter (increased neuronal firing in response to the neurotransmitter) occurs in denervated neurons
Between which does does stage 3 of spinal shock occur?
Days 4-30
Stage 4 of spinal shock typically starts around 1 month after the initial SCI. How long does it last?
Up until 12 months following SCI
Why is there hyperactivity of reflexes in stages 3 and 4 of spinal shock?
Due to synapse growth seen in these stages
