Spinal Cord Injury

Question 1

What are the symptoms and signs of an UMN lesion?

Answer 1

Spasticity or abnormal distribution in muscle tone which affects flexors more than extensors
stronger deep reflexes
loss of superficial reflexes
positive babinski’s sign

Question 2

The effects of an UMN lesion are typically seen on the ipsilateral side of the body. T/F?

Answer 2

False - it is typically seen on the contralateral side

Question 3

What is the Babinski’s sign?

Answer 3

Halux extension (instead of usual flexion) when stroking the lateral part of the sole from heel to toe

Question 4

What are the signs and symptoms of a LMN lesion?

Answer 4

Weakness
Atrophy
Fasiculations
Absent reflexes

Question 5

In a C5 spinal lesion what spinal muscle functions are spared?

Answer 5

Deltoid and bicep function

full head, neck and diaphragm control with good shoulder strength and full elbow flexion

Question 6

In a C6 spinal lesion what spinal muscle functions are spared?

Answer 6

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

Question 7

In a C7 spinal lesion what spinal muscle functions are spared?

Answer 7

full head, neck and diaphragm control with good shoulder strength,
full elbow flexion/extension, wrist dorsiflexion/plantarflexion and some finger control

Question 8

In a C8 spinal lesion what spinal muscle functions are spared?

Answer 8

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

Question 9

A spinal cord injury at T1 or below will still allow full fine motor control of the finger. T/F?

Answer 9

True

Question 10

Hip abduction requires spinal nerves L1-3. T/F?

Answer 10

True

Question 11

Which spinal nerves are required for movement of the knees?

Answer 11

L2-5

Question 12

Which spinal nerves are required for ankle dorsiflexion?

Answer 12

L4-5

Question 13

The diaphragm is the major inspiratory muscle. Which spinal nerves are innervate it?

Answer 13

C3,4 5 (keep the diaphragm alive!)

Question 14

Which spinal segments innervated the intercostal muscles which elevate the rib cage and are required for coughing and deep breathing?

Answer 14

T1-7

Question 15

Which spinal segments innervate the major muscles of expiration?

Answer 15

T6-T12

Question 16

Patients with a cord injury at what level will require assisted ventilation?

Answer 16

C1-3

Question 17

How will breathing be affected by a cord injury in C3-5?

Answer 17

Partial or full diaphragmatic function present

diminished ventilation because of loss of intercostal muscle function results in shallow breaths and weak cough

Question 18

The ability to speak is compromised with assisted ventilation. T/F?

Answer 18

True

Question 19

The cranial nerves can be affected by a spinal cord injury.. T/F?

Answer 19

False

Question 20

Patients with a spinal cord injury at what level (or below) usually have sufficient sympathetic function to maintain adequate vasomotor function?

Answer 20

T6

Question 21

Loss of bladder function results from a disruption of neural pathways between which spinal levels?

Answer 21

S2-4

Question 22

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?

Answer 22

True

Question 23

How would a LMN lesion affecting the sacral region affect bladder function?

Answer 23

Flaccid bladder dysfunction
lack of awareness of bladder filling
lack of bladder tone
inability to urinate (volunatrily or involuntarily)

Question 24

How would a spinal cord injury above S2-4 affect bowel elimination?

Answer 24

spastic defecation with loss of voluntary control of external anal sphincter

Question 25

How would a spinal cord injury at the level of S2-4 affect bowel elimination?

Answer 25

Flaccid functioning of defecation reflex and loss of anal sphincter tone ineffective evacuation of stool

Question 26

What is spinal shock?

Answer 26

A complete loss of motor, sensory, reflex and autonomic function as a result of a sudden, complete transection of the spinal cord

Question 27

The manifestations of spinal shock occur regardless of whether a UMN or LMN lesion is present. t/f?

Answer 27

True

Question 28

How long does spinal shock last?

Answer 28

Hours, days or weeks

Question 29

A UMN lesion at which spinal level or above results in reflexes remaining intact?

Answer 29

T12

Question 30

What are the four phases of spinal shock?

Answer 30

Areflexia Initial reflex return Early hyperreflexia Spasticity/hyperreflexia

Question 31

Describe the sequence in which reflexes tend to return following spinal shock?

Answer 31

``` Bulbocavernosus Cremasteric Ankle jerk Babinski sign Knee jerk ```

Question 32

Describe the pathophysiology behind the initial areflexia in spinal shock?

Answer 32

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

Question 33

How long does stage one of spinal shock last for?

Answer 33

0-24 hours

Question 34

Which stage of spinal shock occurs between days 1 and 3?

Answer 34

Stage 2

Question 35

Describe the pathophysiology behind the initial return of reflexes in stage 2 of spinal shock?

Answer 35

Denervation syoersensitivity, such super sensitivity to a neurotransmitter (increased neuronal firing in response to the neurotransmitter) occurs in denervated neurons

Question 36

Between which does does stage 3 of spinal shock occur?

Answer 36

Days 4-30

Question 37

Stage 4 of spinal shock typically starts around 1 month after the initial SCI. How long does it last?

Answer 37

Up until 12 months following SCI

Question 38

Why is there hyperactivity of reflexes in stages 3 and 4 of spinal shock?

Answer 38

Due to synapse growth seen in these stages