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Neurology > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Conduit for crucial information from the brain to most of the body

A

Spinal Cord`

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2
Q

Length of SC

A

42-45cm long

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3
Q

Width of SC

A

10-15mm

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4
Q

Width of Spinal Canal

A

17mm

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5
Q

Where the SC ends in children

A

L3

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6
Q

Where the SC ends in adult

A

L2

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7
Q

How many segments SC has?

A

31 segments

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8
Q

“Horse’s Tail”

A

Cauda Equina

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9
Q

Prolongation of pia mater

A

Filum Terminale

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10
Q

Center for micturation

A

Conus Medullaris

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11
Q

Bundle of nerve roots after the inferior of SC

A

Cauda Equina

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12
Q

Connects the distal tip of SC to the distal dural sac to coccyx

A

Filum Terminale

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13
Q

Distal tip of the SC

A

Conus Medullaris

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14
Q

Three blood supply of spinal canal

A

Anterior Spinal Artery, Posterior Spinal Artery, Radicular artery of Adamkiewicz

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15
Q

What area does ASA supplies in the SC?

A

Anterior upper 2/3

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16
Q

What area does PSA supplies in the SC?

A

Posterior upper 1/3

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17
Q

What area does Adamkiewicz supplies in the SC?

A

Lower 2/3

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18
Q

Area in the SC with the least blood supply

A

Watershed areas

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19
Q

Level of watershed area in the SC

A

T4-T6

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20
Q

Drainage of SC

A

Internal vertebral venous plexus

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21
Q

Sensory Neurons

A

1ON, 2ON, 3ON

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22
Q

Motor Neurons

A

UMN and LMN

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23
Q

Axons for ascending tracts

A

2ON

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24
Q

Axons for descending tracts

A

UMN

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25
Q

Neuron for pain modulation and reflexes

A

Interneuron

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26
Q

Inhibitory interneuron that controls message that presynaptic neuron will relay

A

Pre-synaptic interneuron

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27
Q

Interneuron that inhibits gamma motor activity

A

Renshaw cell

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28
Q

Inhibitory and excitatory internueron

A

Post-synaptic interneuron

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29
Q

True or False: Is the autonomic neurons afferent?

A

False, efferent

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30
Q

Four target organs signaled by post-ganglionic neurons

A

Cardiac Muscle, Adipose Tissue, Smooth Tissue, Glands

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31
Q

Part of SC that composed of cell bodies of neurons and Rexed lamina

A

Gray Mater

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32
Q

Part of SC that is composed of axons and tracts

A

White Mater

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33
Q

Rexed Lamina: For Pain

A

RL I and II

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34
Q

Rexed Lamina for Sensory

A

RL I - VII

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35
Q

Rexed Lamina for Motor

A

RL VIII - X

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36
Q

Rexed Lamina: For posture and balance

A

RL VII

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37
Q

Rexed Lamina: For touch and pressure

A

RL III - IV

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38
Q

Rexed Lamina: For joint activity

A

RL VI

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39
Q

Rexed Lamina: Connects R and L sides

A

RL X

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40
Q

Rexed Lamina: For visceral sensation and pain

A

RL V

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41
Q

Rexed Lamina: Motor function

A

RL VIII and IX

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42
Q

Rexed Lamina I

A

Lissauer’s tract

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43
Q

Rexed Lamina II

A

Substantia Gelatinosa

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44
Q

Rexed Lamina III and IV

A

Nucleus Proprious

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45
Q

Rexed Lamina V

A

Visceral Nucleus

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46
Q

Rexed Lamina VI

A

Deep Nucleus

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47
Q

Rexed Lamina VII

A

Clarke’s Column

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48
Q

Rexed Lamina VIII and IX

A

Motor Pools

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49
Q

Rexed Lamina X

A

Central Gray Commissure

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50
Q

Three Ascending tracts

A

Dorsal Column, Spinothalamic, Spinocerebellar

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51
Q

Five Descending tracts

A

Corticospinal, Rubrospinal, Vestibulospinal, Reticulospinal, Tectospinal

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52
Q

Transmits discriminative touch, proprioception, 2-point discrimination, epicritic sensation

A

Dorsal Column

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53
Q

Transmit crude touch, pain, and temperature

A

Spinothalamic tract

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54
Q

Transmit information about posture, coordination, balance

A

Spinocerebellar

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55
Q

3 epicritic sensations

A

Barognosis, Sterognosis, Graphesthesia

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56
Q

Rexed lamina of DCML

A

3&4: Nucleus Proprious

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57
Q

Decussation of DCML

A

Lower dorsal MO

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58
Q

Funiculus for LE

A

Gracilis (Below T6)

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59
Q

Funiculus of UE

A

Cuneatus (Above T6)

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60
Q

STT for crude touch

A

Anterior STT

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61
Q

STT for pain and temperature

A

Lateral STT

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62
Q

Rexed lamina of Lateral STT

A

I, II, and V: Lissaeur’s, Susbtantia Gelatinosa, Visceral Nucleus

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63
Q

Rexed lamina for Anterior STT

A

3&4: Nucleus Proprious

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64
Q

Decussation of STT

A

2 segments above

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65
Q

Spinocerebellar that decussates

A

Ventral SCT

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66
Q

Spinocerebellar that not decussates

A

Dorsal SCT

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67
Q

Rexed lamina of Spinocerebellar Tract

A

7: Clarke’s column

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68
Q

2 Decussation of SCT

A

At level of SC and Before cerebellum

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69
Q

CST that decussates

A

Lateral CST; 90%

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70
Q

CTS that does not decussates

A

Anterior CST: 10%

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71
Q

Controls tone of flexor muscles

A

Rubrospinal Tract

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72
Q

Controls postural muscle

A

Reticulospinal Tract

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73
Q

Controls posture and coordination

A

Vestibulospinal tract

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74
Q

Controls bright and sudden movements

A

Tectospinal

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75
Q

Area of the brain that is for processing of visual information

A

Tectum of Midbrain

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76
Q

Facilitatory tract for Flexion

A

CST and Rubrospinal

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77
Q

Facilitatory tract for Extension

A

Vestibulospinal and Reticulospinal

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78
Q

Inhibitory tract for Flexion

A

Vestibulospinal and Reticulospinal

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79
Q

Inhibitory tract for Extension

A

CST and Rubrospinal

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80
Q

True or False: Posture is more maintained by extensors to fight against gravity

A

True

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81
Q

Injury above the midbrain will result into?

A

Decorticate

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82
Q

Injury below the midbrain will result into?

A

Decerebrate

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83
Q

Flexor predominate extremities

A

Decorticate

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84
Q

Extensor predominate extremities

A

Decerebrate

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85
Q

Facilitate or inhibit movement or reflexes

A

Reticulospinal

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86
Q

Reflex postural movements in response to visual stimulus

A

Tectospinal

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87
Q

Ascending tract for pain and arousal

A

Spinoreticular

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88
Q

Ascending tract for cutaneous sensation

A

Spino-olivary

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89
Q

Ascending tract for spinovisual reflex

A

Spinotectal

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90
Q

Three sensory fiber type for proprioceptive touch

A

A-alpha, A-beta, A-delta

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91
Q

Two sensory fiber type for crude touch and pain

A

A-delta and C

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92
Q

The function of Merkel’s disc

A

Light touch information

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93
Q

The 2 functions of Meissner’s Corpuscle

A

Discriminative touch and texture

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94
Q

The 3 functions of Ruffini’s ending

A

Heat, joint activity, skin stretch

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95
Q

The 3 functions of Krause end bulb

A

Cold, touch, pressure

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96
Q

The 2 functions of Pacinian Corpuscle

A

Pressure and Vibration

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97
Q

The 3 functions of Free Nerve Endings

A

Tickle, Itch, Pain

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98
Q

Two motor fiber type

A

A-alpha and A-gamma

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99
Q

Motor fiber type for voluntary action

A

A-alpha

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100
Q

Motor fiber that facilitates contraction of muscle due to activation of muscle spindle

A

A-gamma

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101
Q

Sensory organ for reflex

A

GTO

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102
Q

Sensory organ for stretch stimulus

A

Muscle spindle

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103
Q

Pre-ganglionic autonomic neuron

A

B fibers

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104
Q

Post-ganglionic autonomic neuron

A

C fibers

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105
Q

4 target organs of Autonomic neuron

A

Cardiac muscle, smooth muscle, adipose tissue, glands

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106
Q

What kind of outflow does the sympathetic and parasympathetic nervous system have?

A

Efferent system

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107
Q

Level of PSNS

A

Craniosacral

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108
Q

Level of SNS

A

Thoracolumbar

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109
Q

Cranial level of PSNS

A

Brainstem

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110
Q

Thoracolumbar of SNS

A

T1-L2

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111
Q

Sacral level of PSNS

A

S2-4

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112
Q

PSNS proportion

A

1 pre-ganglionic: 4 post-ganglionic

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113
Q

SNS proportion

A

1 pre-ganglionic: 20 post-ganglionic

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114
Q

Superficial Reflex: Upper Abdominal

A

T7-T9 or T10

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115
Q

Superficial Reflex: Lower Abdominal

A

T10 or T11-T12

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116
Q

Superficial Reflex: Cremasteric

A

T12-L1

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117
Q

Superficial Reflex: Plantar

A

S1-S2

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118
Q

Superficial Reflex: Gluteal

A

L4-L5 or S1-S3

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119
Q

Superficial Reflex: Anal

A

S2-S4 or S4-S5

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120
Q

Three visceral reflexes

A

Bulbocavernosus, rectal, micturation

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121
Q

Reflex level of visceral reflexes

A

S2-S4

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122
Q

Babinski Reflex

A

L3-L5, S1

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123
Q

DTR Grading: Absent

A

0

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124
Q

DTR Grading: Hyperreflexive

A

3

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125
Q

DTR Grading: Normal

A

2

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126
Q

DTR Grading: Hyporeflexive

A

1

127
Q

DTR Grading: Clonus

A

4

128
Q

Law that states: “once the agonist is stimulated, the antagonist relaxes”

A

Sherrington’s Law of Reciprocal Innervation

129
Q

Monosynaptic reflex flow

A

Afferent neuron to efferent neuron

130
Q

Polysynaptic reflex flow

A

Afferent neuron to interneuron to efferent neuron

131
Q

Insult to the spinal cord that may result in alterations in the sensory, motor, and/or autonomic function below the level of the lesion

A

Spinal Cord Injury

132
Q

What gender is more affected by SCI?

A

Males

133
Q

What age range is predisposed to SCI?

A

16-30 years old (26 y.o)

134
Q

Most common MOI of SCI

A

MVA

135
Q

The most common injury that results from SCI

A

Hyperextension injuries

136
Q

The most common MOI of SCI in older adults

A

Falls

137
Q

Two etiology of SCI

A

Traumatic and Non-traumatic

138
Q

4 causes of traumatic SCI

A

MVA, Falls, Violence, Sports

139
Q

The most common sport that results from SCI

A

Diving

140
Q

6 causes of non-traumatic SCI

A

Tumors/neoplasm, infections, toxins, degenerative processes, congenital malformation, vascular disorder

141
Q

The common type of SCI among infants or children

A

SCIWORA (SCI without radiographic abnormality)

142
Q

MOI of SCIWORA in infants

A

Mishandling or improper handling of infants

143
Q

MOI of SCIWORA in a teenager

A

Motor Accidents

144
Q

Incontinence seen in UMNL

A

Urge

145
Q

Erection seen in LMNL

A

Psychogenic (Sympathetic)

146
Q

Ejaculation seen in UMNL

A

Present but may need stimulation

147
Q

Incontinence seen in LMNL

A

Urinary Retention

148
Q

Paralysis and bladder seen in UMNL

A

Spastic

149
Q

Ejaculation seen in LMNL

A

Present without stimualtion

150
Q

Erection seen in UMNL

A

Reflexogenic (Parasympathetic)

151
Q

Is UMNL/LMNL complete or incomplete SCI?

A

Incomplete

152
Q

3 stimulatory techniques to improve Urge Incontinence

A

Suprapubic tapping, Lower abdominal stroking, Hair pulling

153
Q

2 stimulatory techniques to improve Urinary Retention

A

Crede Maneuver, Valsalva Maneuver

154
Q

(+) Reflexogenic Erection indicates what?

A

(+) Sacral Paring

155
Q

What type of SCI usually has Psychogenic Erection?

A

Cauda Equina Syndrome

156
Q

Painful erection

A

Priapism

157
Q

Vaginal Spasm

A

Vaginismus

158
Q

Painful intercourse for female

A

Dyspareunia

159
Q

Female oral sex

A

Cunnilingus

160
Q

Male oral sex

A

Fellatio

161
Q

Cross-section injury with the worst prognosis

A

Anterior Cord Syndrome

162
Q

Cross-section injury with the best prognosis

A

Central Cord Syndrome

163
Q

MOI of Anterior Cord Syndrome

A

Hyperflexion or Flexion

164
Q

S/sx of ACS

A

Bilateral motor, pain and temperature loss; Spared DCML

165
Q

MOI of Posterior Cord Syndrome

A

Hyperextension or extension injury

166
Q

S/sx of PCS

A

Bilateral proprioception and vibratory loss; Spared CST and LSTT

167
Q

Two non-traumatic causes of PCS

A

Syphilis and Vitamin B12 Deficiency

168
Q

What specific cause of PCS in syphilis?

A

(+) Tabes dorsalis: problem in dorsal SC

169
Q

What stage of syphilis does PCS come out?

A

Tertiary stage

170
Q

What DCML s/sx seen in syphilis?

A

(+) Sensory ataxia

171
Q

Sensory ataxia

A

No relay of somatosensation as input for balance

172
Q

Vitamin B12 deficiency causes what condition can lead to PCS?

A

(+) Posterolateral sclerosis problem with DCML

173
Q

What DCML s/sx seen in Vitamin B12 deficiency?

A

Sensory Ataxia

174
Q

MOI of central cord syndrome

A

Hyperextention

175
Q

MOI of central cord syndrome in older adults

A

Cervical Osteophytes

176
Q

Location of UE in the SC

A

Near in the center

177
Q

Another name of Central Cord Syndrome

A

Walking SCI

178
Q

MOI of Brown-Sequard Syndrome

A

Gunshot, Stab wounds

179
Q

S/sx of Brown-Sequard Syndrome

A

Ipsilateral: motor, proprioception, vibratory loss; Contralateral: pain and temperature loss

180
Q

What level does the C/L pain and temp loss manifest?

A

2 segment below the level of the lesion

181
Q

The spinal level that causes quadriplegia

A

Cervical

182
Q

The spinal level that causes paraplegia

A

Thoracolumbar

183
Q

The spinal level that causes tetraplegia

A

Cervical

184
Q

Most common spinal level affected in paraplegia

A

T12-L1

185
Q

Most common spinal level affected in SCI

A

C5 incomplete paraplegia

186
Q

A brief period of areflexia that occurs from 24 hours to 3 days

A

Spinal Shock

187
Q

How to test for Spinal Shock?

A

Bulbocavernosus reflex

188
Q

Bulbocavernosus reflex procedure

A

Pinch the glans penis/clitoris or pull the indwelling foley catheter

189
Q

(+) Bulbocavernosus reflex

A

Anal sphincter contraction

190
Q

Pharmacological management for spasticity

A

Baclofen intake

191
Q

4 PT management for spasticity

A

Slow Icing, NMES, Daily Stretching program, slow PROMS

192
Q

What is autogenic inhibition?

A

You will fatigue the muscle to induce relaxation

193
Q

What is reciprocal inhibition?

A

You will activate the antagonists and relax the agonist

194
Q

Surgical management for muscle

A

Myotomy

195
Q

Surgical management for spinal cord

A

Myelotonomy

196
Q

Surgical management for spinal nerve

A

Neuroctomy

197
Q

Surgical management for tendon

A

Tenotomy

198
Q

Surgical management for ventral root

A

Rhizotomy

199
Q

Surgical management for dorsal root intractable pain

A

Dorsal Rhizotomy

200
Q

Surgical management for scissoring gait

A

Myotomy of adductor longus

201
Q

Surgical management for crutch gait

A

Myotomy of hamstrings

202
Q

Hypersensitivity to external stimuli that were commonly seen in injuries above T6

A

Autonomic Dysreflexia or Hyperreflexia

203
Q

Five causes of autonomic dysreflexia

A

BILPA: Bladder distention, Ingrown toenail, Labor pain, Pressure sores, Aggressive stretching

204
Q

Cause of OH

A

Immediate Transition from STS

205
Q

AD or OH: Tachycardia

A

Orthostatic Hypotension

206
Q

AD or OH: Pounding headache

A

Autonomic Dysreflexia

207
Q

AD or OH: Fainting

A

Orthostatic Hypotension

208
Q

AD or OH: Piloerection

A

Autonomic Dysreflexia

209
Q

AD or OH: Bradycardia

A

Autonomic Dysreflexia

210
Q

AD or OH: Dizziness

A

Orthostatic Hypotension

211
Q

AD or OH: Facial Flushing

A

Autonomic Dysreflexia

212
Q

AD or OH: Lightheadedness

A

Orthostatic Hypotension

213
Q

AD or OH: Decrease BP

A

Orthostatic Hypotension

214
Q

AD or OH: Increase BP

A

Autonomic Dysreflexia

215
Q

AD or OH: Diaphoresis

A

Autonomic Dysreflexia

216
Q

Diaphoresis

A

Excessive sweating

217
Q

Management for Orthostatic Hypotension

A

Elevate the legs and give ankle pumps

218
Q

Management for Autonomic Dysreflexia

A

Sit the patient up and give sublingual calcibloc

219
Q

Process of bone growth at an abnormal site

A

Heterotrophic ossification

220
Q

Diagnosis where there is HO on the muscle

A

Myositis Ossification

221
Q

4 common sites of HO

A

Hips, Knees, Shoulder, Elbow

222
Q

What causes the presence of neurogenic HO?

A

Traumatic SCI

223
Q

Site of HO in TBI and CVA

A

Shoulder

224
Q

Site of HO in Burns

A

Posterior elbow

225
Q

Site of HO in UE

A

Brachialis

226
Q

Site of HO in LE

A

Quadriceps

227
Q

Pharmacological management for HO/MO

A

Etidronate Disodium (didronel)

228
Q

Laboratory hallmark seen in (+) HO or MO

A

Increase alkaline phosphatase

229
Q

Slowing down of blood flow

A

Virchow’s triad

230
Q

Virchow’s triad

A

Hypercoagulability, Intimal wall damage, Venous stasis

231
Q

Preventive PT management for DVT

A

AROMS and Ankle Pumps

232
Q

Pharmacological management for DVT

A

Blood thinners

233
Q

3 blood thinners used for DVT

A

Heparin, Coumadin, Warfarin

234
Q

Immobilization causes ____?

A

Decrease bone desposition

235
Q

What law states that increase pressure = increase bone deposition?

A

Wolff’s law

236
Q

PT management for osteoporosis

A

WB and muscle contraction

237
Q

Two commons sites of fracture in SCI patients

A

The distal femur and proximal tibia

238
Q

PT management for fractures

A

WB activity on tilt table

239
Q

Most common site of pressure sores in supine

A

Sacrum

240
Q

Most common site of pressure sores in infants

A

Occiput

241
Q

Most common site of pressure sores in sitting

A

Ischial tuberosity

242
Q

Bed positioning to prevent pressure sore

A

Turning every 2 hours

243
Q

Wheelchair positioning to prevent pressure sore

A

Chair pushups or WB relief activities every 15-20 mins

244
Q

Common cardiac problem in SCI

A

Arythmia

245
Q

The most common cause of death in SCI

A

Pneumonia

246
Q

The second common cause of death in SCI

A

Atelectasis

247
Q

“ASIA” scale

A

American Spinal Injury Association

248
Q

Sensory scoring of ASIA

A

O= absent, 1 = impaired, 2 = normal, NT = not testable

249
Q

Two sensations tested in ASIA

A

Light touch and Pinprick

250
Q

Patient’s position in assessing ASIA scale

A

Frog-legged position

251
Q

What is the grade if the patient cannot identify the stimulus as a pinprick or light touch?

A

Grade 0

252
Q

Motor scoring: 5

A

Normal full active ROM against gravity with full resistance

253
Q

Motor scoring: 1

A

Palpable contraction

254
Q

Motor scoring: 3

A

Full active ROM against gravity

255
Q

Motor scoring: 2

A

Full AROM, gravity eliminated

256
Q

Motor scoring: 4

A

Full AROM against gravity with moderate resistance

257
Q

What is the sensory level?

A

Most caudal segment with intact sensation (2/2 score) both pinprick and light touch

258
Q

What is the motor level?

A

Most caudal segment with at least 3/5 and the segment immediately above should be 5/5

259
Q

What is the neurological level of injury (NLI)

A

Caudal part where motor and sensory level coincide

260
Q

What is a complete injury?

A

There is no sacral sparing

261
Q

What is an incomplete injury?

A

There is sacral sparing

262
Q

Motor criteria for sacral sparing

A

Voluntary anal contraction (VAC)

263
Q

Procedure for VAC

A

Contraction of anal sphincter upon command

264
Q

Sensory criteria for sacral sparing

A

Deep anal pressure, light touch sensation, and pinprick sensation at S4-5

265
Q

Procedure of DAP

A

Patient can feel the pressure put by the PT at the internal anal wall

266
Q

Location of touch sensation and pinprick

A

S4-5

267
Q

(+) Sensory sacral sparing

A

1/3 criteria

268
Q

ASIA classification A prognosis

A

Worst

269
Q

ASIA classification E prognosis

A

Best

270
Q

ASIA classification A name

A

Complete

271
Q

ASIA classification B name

A

Sensory Incomplete

272
Q

ASIA classification C name

A

Motor Incomplete

273
Q

ASIA classification D name

A

Motor Incomplete

274
Q

ASIA classification E name

A

Normal

275
Q

ASIA classification A sacral sparing

A

(-) sensory or motor sacral sparing

276
Q

ASIA classification B sacral sparing

A

(+) sensory; (-) Motor

277
Q

ASIA classification C sacral sparing

A

(+) sensory; (+) Motor = >50 muscles below NLI is 0-2/5

278
Q

ASIA classification D sacral sparing

A

(+) sensory; (+) Motor = >50 muscles below NLI is 3-5/5

279
Q

ASIA classification E sacral sparing

A

Normal

280
Q

Total number of dermatomes assessed in ASIA scale

A

28 dermatomes

281
Q

Total points in sensory assessment in ASIA scale

A

112 points LT/PP

282
Q

Total number of myotomes assessed in ASIA scale

A

10; 5 = UE + 5 = LE

283
Q

Total points in motor assessment in ASIA scale

A

100; 50 = UE + 50 = LE

284
Q

C1-C3 respiratory outcomes

A

Glossopharyngeal breathing

285
Q

C5 respiratory outcome

A

Manually assisted coughing and quad coughing

286
Q

C6 respiratory outcome

A

Self-assisted coughing

287
Q

C4 wheelchair

A

Power wheelchair

288
Q

4 controls of power wheelchair

A

Tongue control, Chin control, Voice control, Sip & Puff

289
Q

C5 wheelchair

A

Joystick

290
Q

C5 wheelchair projections

A

Oblique handrim projections

291
Q

C5 orthosis

A

Balanced forearm orthosis

292
Q

C6 wheelchair projections

A

Vertical handrim projections

293
Q

C6 orthosis

A

Tenodesis splint and wrist driven flexor hinge orthosis

294
Q

C7 wheelchair handrims

A

Friction handrims

295
Q

C8 wheelchair handrims

A

Standard Handrims

296
Q

What wheelchair activity can C8 patient can do?

A

Wheelie

297
Q

T1-T8 foot orthosis

A

KAFO

298
Q

L4-L5 Assistive device

A

Loftstrand

299
Q

T9-T12 gait pattern

A

Swing to

300
Q

L1-L3 foot orthosis

A

KAFO

301
Q

T1-T8 Assistive device

A

Walker

302
Q

L4-L5 gait pattern

A

2 point

303
Q

T9-T12 foot orthosis

A

KAFO

304
Q

T1-T8 Gait Pattern

A

Swing to

305
Q

L1-L3 Gait pattern

A

4 point

306
Q

T9-T12 Assistive device

A

Walker

307
Q

L4-L5 foot orthosis

A

AFO

308
Q

L1-L3 Assistive device

A

Loftstrand

309
Q

C6 2 ADL

A

Indep bed mobility with equipment and indep sliding board transfers

310
Q

C7 3 basic ADL

A

Prop up (elbow extension), LE ROM, Dress upper and lower garments

311
Q

C7 4 independent ADLS

A

Indep driving, bed mobility, transfers in all surface, toileting

312
Q

T1 ADL

A

Wheelchair to floor transfers

313
Q

T4 ADL

A

Squat-pivot transfers

Neurology (14 decks)

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