Spinal Cord Injury

Question 1

Complete lesions

Answer 1

• a lesion to the SC where there is no preserved motor or sensory function below the level of the lesion

Question 2

incomplete lesions

Answer 2

a lesion to the SC with incomplete damage to the cord. there may be scattered motor function, sensory function or both below the level of the lesion

Question 3

Autonomic Dysreflexia

Answer 3

• most dangerous complication of SCI and can occur in patients with lesions at or above T6.
• a noxious stimulus below the level of teh lesion triggers the ANS causing a sudden elevation in BP,
• common causes include distended or full bladder, kink or blockage in catheter, bladder infection, ulcers, temp change, tight clothing or even ingrown toenail
• if not treated, condition can lead to convulsions, hemorrhage and death

Question 4

Autonomic Dysreflexia Symptoms

Answer 4

• high BP, severe HA, blurred vision, stuffy nose, profuse sweating
• goosebumps below the level f the lesion, and vasodilation above the level of injury

Question 5

Autonomic dysreflexia treatment

Answer 5

• immediately check catheter for blockage while having the patient assume or remain in a sitting position.
• lying a patient down is contraindicated and will only assist to further elevate BP.
• the pt shoulde be examined for any irritating stimuli and potentially checked for bowel impact

Question 6

Ectopic Bone/ Heterotopic Ossification

Answer 6

-spont formation of bone in the soft tissue. it typically occurs adjacent to larger joints such as knees or the hips. theories regarding etiology range from tissue hypoxia to abnormal calcium metabolism

Question 7

Ectopic Bone/ Heterotopic Ossification symptoms

Answer 7

• early symptoms include edema, decreased range of motion, and increased temperature of the involved joint

Question 8

Ectopic Bone/ Heterotopic Ossification treatment

Answer 8

• medicinelike diphosphates that inhibit ectopic bone formation. physical therapy and surgery are often incorporated into tx. PT should focus on maintaing functional ROM and allowing the patient the most independent functional outcome possible

Question 9

spasticity

Answer 9

• can occasionally be useful to a pt with SCI, however, more often serve to interfere with functional activities.
• spasticity can be enhanced by both internal and external sources such as stress, decubiti, UTI,bowel or bladder obstruction, temp changes or touch

Question 10

Anterior Cord Syndrome

Answer 10

-incomplete lesion that results from compression and damage to the anterior part of the SC or anterior spinal artery. the mechanism of injury is usually cervical flexion. there is loss or motor function and pain and temp sense below the lesion due to damage of teh corticospinal and spinothalamic tracts

Question 11

Brown-sequard’s syndrome

Answer 11

• incomplete lesion usually caused by a stab wound, which produces hemisection of the SC. there is paralysis and loss of vibratory and position sense on teh same side as teh lesion sue to the damage to the corticospinal tract and dorsal columns,
• there is a loss of pain and temp sense on the opposite side of the lesion from damage to the lateral spinothalamic tract.
• pure brown sequard syndrome is rare since most spinal cord lesions are typical

Question 12

cauda Equina injuries

Answer 12

• injury below the L1 spinal level where the long nerve roots transcend. Cauda equina injuries can be complete , however they are frequently incomplete due to the large number of nerve roots in the area. a cauda equina injury is considered a peripheral nerve injury.
• characteristics include flaccidity, areflexia, and impairment of bowel and bladder function. full recovery is not typical due to the distance needed for axonal regeneration

Question 13

Central cord Syndrome

Answer 13

• incomplete lesion that results from compression and damage to the central portion of the SC. the mechanism of injury is usually cervical hyperextension that damages the spinothlamic tract, corticospinal tract and dorsalcolumns. the upper extremities present with greater involvements than the LE and greater motor deficits exist as compared to sensory deficits

Question 14

Posterior cord syndrome

Answer 14

-relatively rare syndrome that is caused bu compression of the posterior spinal artery and is characterized by loss of proprioception, two point discrimination and stereognosis. motor function is preserved

Question 15

SCI sequential recovery stages

Answer 15

• Stage 1: Initial flaccidity, no voluntary movement
• Stage 2: emergence of spasticity, hyoerreflexia, synergies
• Stage 3: voluntary movement possible, but only in synergies, spasticity strong
• Stage 4: voluntary control in isolated joint movements emerging, corresponding decline of spasticity and synergies
• Stage 5: incre voluntary control out of synergy; coordination deficits present
• Stage 6: control and coordination near normal

Question 16

ASIA A

Answer 16

• Complete, no motor or sensory information is preserved in teh sacral segments S4-5

Question 17

ASIA B

Answer 17

• Incomplete: sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-5

Question 18

ASIA C

Answer 18

• incomplete: motor function is preserved below the neurological level, and most key muscles below the neurological level have a muscle grade of less than 3

Question 19

ASIA D

Answer 19

• incomplete: motor function is preserved below the neurological level, and most key muscles below the neurological level have a muscle grade of 3 or more

Question 20

ASIA E

Answer 20

• motor and sensory function is normal