spinal cord injury- CC4 Flashcards
what are the immediate (acute) consequences of a SCI in the neck?
quadriparesis/plegia
sensory loss (touch, proprioception, pain, temp) and sensory abnormalities (parasthesia, pain)
hypotension, urinary retention, orthopedic pain
what are the immediate (acute) consequences of a SCI below T1?
paraparesis/plegia
sensory loss (touch, proprioception, pain, temp) and sensory abnormalities (parasthesia, pain)
hypotension, urinary retention, orthopedic pain
what does paraparesis mean?
partial paralysis of lower limbs
what does plegia mean?
total paralysis
what type of bladder will someone have in an injury at or above T10
spastic bladder
what type of bladder will someone have in an injury below T12
flaccid bladder
what does it mean if someone has a spastic bladder?
unable to voluntary relax the urethral sphincter
the detrussor muscle will continue to contract
explain what the term “autonomic dysreflexia” means
- Episodes of crazy high BP (ex. 240/160 mmHg)
- HR might drop to 40 bpm (called paradoxical hypertension)
- *Occurs in response to strong afferent input
what are some examples of things that could trigger an autonomic dysreflexic response?
“nervous system overstimulation”
- Nociceptor (ex. Overly full bladder)
- Bladder-emptying (if neurogenic bladder)
- Strong cutaneous inputs can also trigger
what does an A mean on the ASIA scale?
COMPLETE
no motor or sensory function below injury
what does a B mean on the ASIA scale?
INCOMPLETE
sensory (only) below injury
including S4-S5 segment (anal sensation
what does a C mean on the ASIA scale?
IMCOMPLETE
sensation + limited motor function below injury level
what does a D mean on the ASIA scale?
INCOMPLETE
sensation + significant motor function below the injury level
what does an E mean on the ASIA scale?
NORMAL
sensory & motor function is normal
can the nerve cell bodies that were crushed by the initial traumatic injury be treated?
NO. there is no hope for these neurons
what are the 3 broad approaches to SCI treatment?
- neuroprotection
- neurorestoration
- neurorehabilitation
what does neuroprotection mean?
protect surviving cells/axons so they don’t succumb to toxic environment caused by the injury
what does neurorestoration mean?
replace cells, provide neurotrophins, establish a growth permissive environment to promote regeneration & re establishment of neural circuitry
what does neurorehabilitation mean?
strength exisiting (atrophied?) systems, retain circuits or develop alternative strategies to accomplish desired tasks
the finding that CPG output can be modified through training in a cat has what type of implications?
that there is spinal cord plasticity and that is is activity dependent
what were the consequences for the “stepping” in CPG modification in humans?
terrible fatigue because of keeping person up at night
much better voluntary walking ability though!
of the 4 cases presented in class of people with stepping onset, what were some common factors that these patient’s neurologically complete injury had?
- sensitivity to the hip joint angle
- rhythmic but NOT reciprocal between agonists & antagonists
- significant pathology
- pressure ulcer to the bone present
- severe hip problems
- herniated disc at L4/L5
in what type of injuries can the “interlimb” reflex be seen
it is observed in all persons with chronic cervical SCI
most of them occur in distal upper limb muscles
note: it is rare to see in proximal limb muscles
where do you see the interlimb reflex
most of them occur in distal upper limb muscles
it is rare to see in proximal limb muscles
is the interlimb reflex more likely to be excitatory or inhibitory?
almost always excitatory
what does the fact that there is minimal latency in the interlimb reflex suggest?
that there is a near/direct pathway between sensory afferent & cervical motoneuron
once the interlimb reflex appears in a person, how long does it usually exist in that person?
forever!
after initial onset of the interneuron reflexes, do they get stronger or weaker?
they continue to strengthen over about 1-2 years
what are the interlimb reflexes likely due to?
likely due to new growth within the spinal cord below the lesion
are the more likely to see autonomic dysreflexia after a complete or incomplete SCI?
complete SCI
why do you see a drop in HR even though there is an increase in BP?
because the vagal innervation to the heart is still intact
