Spinal Cord Injury Flashcards
What is the difference between a complete vs incomplete spinal cord lesion?
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
What is the most common cause of spinal cord injuries?
Motor vehicle accident
Almost all SCIs are _____ injuries, which the exception of cauda equina injuries.
Upper motor neuron injuries
What does the level of the lesion indicate?
Indicates the most distal uninvolved nerve root segment with normal function; muscles must have a grade of at least 3+/5 or fair+ function.
What is the difference between tetraplegia and paraplegia?
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
Describe category A on the ASIA impairment scale.
Complete = no sensory or motor function is preserved on sacral segments S4-S5
Describe category B on the ASIA impairment scale.
Sensory incomplete = sensory but not motor function is preserved below the neurologic level and extends through sacral segments S4-S5
Describe category C on the ASIA impairment scale.
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
Describe category D on the ASIA impairment scale.
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
Describe category E on the ASIA impairment scale.
Sensory and motor functions are normal
Describe 3 characteristics of a complete cord lesion.
- Complete bilateral loss of all sensory modalities
- Bilateral loss motor function with spastic paralysis below level of lesion
- Loss of bladder and bowel functions with spastic bladder and bowel
Describe 4 characteristics of a central cord lesion.
- MOI = cervical hyperextension
- Loss of spinothalamic tracts with bilateral loss of pain and temperature
- Loss of ventral horn with bilateral loss of motor function (mainly UEs)
- Preservation of proprioception and discriminatory sensation
Describe 4 characteristics of a Brown-Sequard syndrome.
- Hemi section of the spinal cord
- Ipsilateral loss of dorsal columns with loss of tactile discrimination, pressure, vibration and proprioception
- Ipsilateral loss of corticospinal tracts with loss of motor function and spastic paralysis below level of lesion
- 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
Describe 4 characteristics of anterior cord syndrome.
- MOI = cervical flexion
- Loss of lateral corticospinal tracts with bilateral loss of motor function, spastic paralysis below level of lesion
- Loss of spinothalamic tracts with bilateral loss of pain and temperature
- Preservation of dorsal columns; proprioception, kinesthesia and vibratory sense
Describe 3 characteristics of posterior cord syndrome.
- Loss of dorsal columns bilaterally
- Bilateral loss of proprioception, vibration, pressure, and epicritic sensations (stereognosis, two point discrimination)
- Preservation of motor function, pain and light touch
Describe 5 characteristics of a cauda equina injury.
- Loss of long nerve roots at or below L1
- Incomplete lesions are common
- Flaccid paralysis of bowel and bladder
- Areflexia
- Potential for nerve regeneration; regeneration often incomplete, slows and stops after ~ 1 year
List the key muscles (myotomes) tested to determine level of motor function.
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)
What are 6 potential complications of SCIs?
DVTs Ectopic bone Orthostatic hypotension Pressure ulcers Spasticity Autonomic dysreflexia
What is spinal shock?
Transient period of reflex depression and flaccidity; may last several hours or up to 24 weeks
What is autonomic dysreflexia?
- 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
List 7 signs and symptoms of autonomic dysreflexia.
- Hypertension
- Bradycardia
- Severe headache
- Blurred vision
- Profuse sweating
- Goosebumps below the level of the lesion
- Flushing above the level of injury
What should the PT do IMMEDIATELY in the case of autonomic dysreflexia?
- Bring patient into an upright position
- Examine/reduce blockage of catheter
- Loosen any tight clothing or restrictive devices
- Notify medical staff ASAP
List 7 possible causes of autonomic dysreflexia.
Distended or full bladder Kink/blockage in the catheter Bladder infections Pressure ulcers Extreme temperature changes Tight clothing Ingrown toe nail
Patients with SCI should consistently change position every ____ and weight shift in sitting at a minimum of every ____.
Change position every 2 HOURS
Weight shift every 15-30 MINUTES
What is the head hips relationship?
A transfer technique that requires the head to move in the opposite direction of the hips.
What is a myelotomy?
Surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function
What is a neurogenic nonreflexive bladder?
The bladder is flaccid as a result of a cauda equina or conus medullaris lesion. The sacral reflex arc is damaged.
What is a neurogenic reflexive bladder?
The bladder emptied reflexively for a patient with an injury above the level of T12. Sacral arc reflex remains intact.
Describe paradoxical breathing,
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.
What is sacral sparing?
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
What is tenodesis?
Utilizing the tight finger flexors in combination with wrist extension to produce a form of grasp
What is a zone of preservation?
A term used to describe poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury.
