Spinal Cord Injury

Question 1

What is the difference between a complete vs incomplete spinal cord lesion?

Answer 1

Complete = a lesion to the spinal cord where there is no preserved motor or sensory function below the level of the lesion

Incomplete = a lesion to the spinal cord with incomplete damage to the cord. There may be scattered motor function, sensory function, or both below the level of the lesion

Question 2

What is the most common cause of spinal cord injuries?

Answer 2

Motor vehicle accident

Question 3

Almost all SCIs are _____ injuries, which the exception of cauda equina injuries.

Answer 3

Upper motor neuron injuries

Question 4

What does the level of the lesion indicate?

Answer 4

Indicates the most distal uninvolved nerve root segment with normal function; muscles must have a grade of at least 3+/5 or fair+ function.

Question 5

What is the difference between tetraplegia and paraplegia?

Answer 5

Tetraplegia = injury occurs between C1 and C8, involves all four extremities and trunk

Paraplegia = injury occurs between T1 and T12-L1, involves both LEs and trunk

Question 6

Describe category A on the ASIA impairment scale.

Answer 6

Complete = no sensory or motor function is preserved on sacral segments S4-S5

Question 7

Describe category B on the ASIA impairment scale.

Answer 7

Sensory incomplete = sensory but not motor function is preserved below the neurologic level and extends through sacral segments S4-S5

Question 8

Describe category C on the ASIA impairment scale.

Answer 8

Motor incomplete = motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade less than 3/5

Question 9

Describe category D on the ASIA impairment scale.

Answer 9

Motor incomplete = motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of 3/5 or more

Question 10

Describe category E on the ASIA impairment scale.

Answer 10

Sensory and motor functions are normal

Question 11

Describe 3 characteristics of a complete cord lesion.

Answer 11

1. Complete bilateral loss of all sensory modalities
2. Bilateral loss motor function with spastic paralysis below level of lesion
3. Loss of bladder and bowel functions with spastic bladder and bowel

Question 12

Describe 4 characteristics of a central cord lesion.

Answer 12

1. MOI = cervical hyperextension
2. Loss of spinothalamic tracts with bilateral loss of pain and temperature
3. Loss of ventral horn with bilateral loss of motor function (mainly UEs)
4. Preservation of proprioception and discriminatory sensation

Question 13

Describe 4 characteristics of a Brown-Sequard syndrome.

Answer 13

1. Hemi section of the spinal cord
2. Ipsilateral loss of dorsal columns with loss of tactile discrimination, pressure, vibration and proprioception
3. Ipsilateral loss of corticospinal tracts with loss of motor function and spastic paralysis below level of lesion
4. Contralateral loss of spinothalamic tract with loss of pain and temperature below level of lesion; at level of lesion bilateral loss of pain and temperature

Question 14

Describe 4 characteristics of anterior cord syndrome.

Answer 14

1. MOI = cervical flexion
2. Loss of lateral corticospinal tracts with bilateral loss of motor function, spastic paralysis below level of lesion
3. Loss of spinothalamic tracts with bilateral loss of pain and temperature
4. Preservation of dorsal columns; proprioception, kinesthesia and vibratory sense

Question 15

Describe 3 characteristics of posterior cord syndrome.

Answer 15

1. Loss of dorsal columns bilaterally
2. Bilateral loss of proprioception, vibration, pressure, and epicritic sensations (stereognosis, two point discrimination)
3. Preservation of motor function, pain and light touch

Question 16

Describe 5 characteristics of a cauda equina injury.

Answer 16

1. Loss of long nerve roots at or below L1
2. Incomplete lesions are common
3. Flaccid paralysis of bowel and bladder
4. Areflexia
5. Potential for nerve regeneration; regeneration often incomplete, slows and stops after ~ 1 year

Question 17

List the key muscles (myotomes) tested to determine level of motor function.

Answer 17

C5 = elbow flexors (biceps/brachialis)
C6 = wrist extensors (extensor carpi radialis brevis and longus) 
C7 = elbow extensors (triceps) 
C8= finger flexors (flexor digitorum profundus)
T1 = small finger abductors (abductor digiti minimi) 
L2 =  hip flexors (iliopsoas) 
L3= knee extensors (quadriceps) 
L4 = ankle dorsiflexors (Tibialis anterior)
L5 = long toe extensors (extensor hallucis longus)
S1 = ankle plantar flexors (gastrocnemius/soleus)

Question 18

What are 6 potential complications of SCIs?

Answer 18

DVTs
Ectopic bone
Orthostatic hypotension
Pressure ulcers 
Spasticity 
Autonomic dysreflexia

Question 19

What is spinal shock?

Answer 19

Transient period of reflex depression and flaccidity; may last several hours or up to 24 weeks

Question 20

What is autonomic dysreflexia?

Answer 20

1. Can occur in patient with lesions at or above T6

2. A noxious stimulus below the level of the lesion triggers the ANS causing a sudden elevation in BP

Question 21

List 7 signs and symptoms of autonomic dysreflexia.

Answer 21

1. Hypertension
2. Bradycardia
3. Severe headache
4. Blurred vision
5. Profuse sweating
6. Goosebumps below the level of the lesion
7. Flushing above the level of injury

Question 22

What should the PT do IMMEDIATELY in the case of autonomic dysreflexia?

Answer 22

1. Bring patient into an upright position
2. Examine/reduce blockage of catheter
3. Loosen any tight clothing or restrictive devices
4. Notify medical staff ASAP

Question 23

List 7 possible causes of autonomic dysreflexia.

Answer 23

Distended or full bladder
Kink/blockage in the catheter 
Bladder infections
Pressure ulcers 
Extreme temperature changes 
Tight clothing 
Ingrown toe nail

Question 24

Patients with SCI should consistently change position every ____ and weight shift in sitting at a minimum of every ____.

Answer 24

Change position every 2 HOURS

Weight shift every 15-30 MINUTES

Question 25

What is the head hips relationship?

Answer 25

A transfer technique that requires the head to move in the opposite direction of the hips.

Question 26

What is a myelotomy?

Answer 26

Surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function

Question 27

What is a neurogenic nonreflexive bladder?

Answer 27

The bladder is flaccid as a result of a cauda equina or conus medullaris lesion. The sacral reflex arc is damaged.

Question 28

What is a neurogenic reflexive bladder?

Answer 28

The bladder emptied reflexively for a patient with an injury above the level of T12. Sacral arc reflex remains intact.

Question 29

Describe paradoxical breathing,

Answer 29

A form of abnormal breathing that is common in tetraplegia where the abdomen rises and the chest is pulled inward during inspiration. On expiration the abdomen falls and the chest expands.

Question 30

What is sacral sparing?

Answer 30

An in complete lesion where some of the innermost tracts remain innervated. Characteristics include:

Sensation of the saddle area
Movement of the toe flexors
Rectal sphincter contraction

Question 31

What is tenodesis?

Answer 31

Utilizing the tight finger flexors in combination with wrist extension to produce a form of grasp

Question 32

What is a zone of preservation?

Answer 32

A term used to describe poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury.