spinal cord injury from book Flashcards
Clonus
an alternating involuntary muscle contraction and relaxation in rapid succession, associated with changes in muscle tone as a consequence of neurological injury or disease.
Complete injury
a diagnostic label that represents an absence of sensory and motor function in the lowest sacral segments (S4–S5).
Crede method
a manual bladder-emptying technique that involves manual application of pressure superficial to the bladder.
Ergometry
the study of physical work activity. In rehabilitation, ergometry often involves the use of a stationary bicycle or treadmill.
Functional level
the lowest segment at which the strength of important muscles is graded 3+ or above out of 5 on a manual muscle test (MMT), and at which sensation is intact; the functional level has implications to functional rehabilitation outcomes.
Incomplete injury
a diagnostic label that represents the preservation of any sensory and/or motor function below the neurological level that includes the lowest sacral segments S4–S5.
Motor level
a diagnostic label that quantifies functional outcome expectations; the motor level is identified by the most caudal section of the spinal cord with normal motor function.
Paraplegia
the loss or impairment in motor and/or sensory function in the thoracic, lumbar, or sacral segments of the cord, resulting in impairment in the trunk, legs, and pelvic organs and sparing of the arms.
Sensory level
identified by the most caudal segment of the spinal cord possessing normal sensation to pin prick and light touch; it has implications for functional outcomes.
Tetraplegia
the loss or impairment in motor and/or sensory function in the cervical segments of the spinal cord, resulting in functional impairment in the arms, trunk, legs, and pelvic organs; previously known as quadriplegia.
Valsalva maneuver
method to facilitate a bowel movement; it involves holding one’s breath while bearing down or pushing through the abdomen.
Zone of partial preservation
refers to the dermatomes and myotomes caudal to the neurological level that remain partially innervated; over time, strength and sensation improve, resulting in better functional outcomes.
Spinal shock is more extensive with lesions above
T1, but even complete lower thoracic injuries are accompanied by some degree of spinal shock.
Neurogenic shock
a life-threatening medical condition resulting from autonomic instability
Spinal shock
temporary and variable phase that can last several days to weeks, during which the true extent of paralysis cannot be determined.
spinal reflexes and motor, sensory, and autonomic function cease below the lesion level.13,20 The extremities below the lesion level become flaccid (or lose tone).
what can happen when neurogenic shock and spinal shock occur simultaneously
because of a loss of sympathetically mediated peripheral vascular tone, causing hypotension and bradycardia. Increased bronchial secretions can also be experienced during this time as well as gastrointestinal motility issues, complicating the clinical scenario.
Resolution of spinal shock is characterized
return of spinal reflexes and hyperreflexia (spasticity) as well as the return of voluntary motor function and sensation.
standard assessment for SCI
The American Spinal Cord Injury Association (ASIA) assessment
The neurological level of injury (NLI) is the
lowest segment of the spinal cord with preserved bilateral normal sensory and antigravity motor function.
ASIA Impairment Scale - A = Complete
No sensory or motor function is preserved in the sacral segments S4–S5.
ASIA Impairment Scale - B Sensory incomplete
Sensory, but not motor, function is preserved below the neurological level and includes the sacral segments S4–S5 (LT or PP at S4–S5 or DAP), and no motor function is preserved more than three levels below the motor level on either side of the body.
ASIA Impairment Scale C motor incomplete
Motor function is preserved at the most caudal sacral segments for voluntary anal contraction or the patient meets the criteria for sensory incomplete status (sensory function preserved at the most caudal sacral segments [S4–S5] by LT, PP, or DAP), and has some sparing of motor function more than three levels below the ipsilateral motor level on either side of the body.
(This includes key or nonkey muscle functions to determine motor incomplete status.) For AIS C—less than half of key muscle functions below the single NLI have a muscle grade ≥3.
ASIA Impairment Scale D Motor incomplete
Motor incomplete status as defined above, with at least half (half or more) of key muscle functions below the single NLI having a muscle grade ≥3.
autonomic dysreflexia
Autonomic dysreflexia (AD) is a dangerous syndrome involving an overreaction of your autonomic nervous system. It causes a sudden and severe rise in blood pressure, in addition to other symptoms. People who’ve had a spinal cord injury are most at risk. AD requires immediate treatment.
orthostatic hypotension
Orthostatic hypotension is most common right after an injury and in the first few weeks of rehabilitation. It is more common with cervical and high thoracic (levels 1‑6) spinal cord injuries. In most cases, the problem resolves and only happens after being in bed for long periods of time, and in the morning. For a few people, however, hypotension can continue, and medications may be needed.
Brown-Séquard syndrome (BSS)
is a rare neurological condition that happens when damage to your spinal cord causes muscle weakness or paralysis on one side of your body and a loss of sensation on the opposite side. The damage occurs on only one side of your spinal cord in a specific area.
Anterior spinal cord syndrome:
Loss of all motor function and sensation (except light touch and proprioception) below the injury due to damage to or infarction of the anterior spinal artery, which supplies all but the posterior (or dorsal) column of the spinal cord. The dorsal column contains the pathway for light touch and proprioception, which is why this is preserved with an infarct of the anterior spinal cord artery.
Cauda equina syndrome
Occurs with burst fractures, epidural abscess or hematoma, or herniated discs at levels L2–S4 with flac- cid paralysis without spasticity as the primary feature (Berven & Huxford, 2010). Cauda equina syndrome is considered a peripheral nerve or lower motor neuron injury and as such has the potential to regenerate with improvement generally ending about 1 year after the injury. The injury can have a sudden onset or may progress over time. This injury requires emergency surgery for spinal decompression.
Central cord syndrome:
Destruction of the central cord versus the periphery of the cord. Paralysis or weakness and sensory loss are greater in the UEs than in the LEs (Aarabi et al., 2013). Intrinsics will return last, if at all (Miller, 2012). The most common etiolo- gies are fracture subluxations and acute disc herniations. Bowel and bladder dysfunction are possible. Central cord syndrome is more common in older people because of narrowing of the spinal cord.
Conus medullaris syndrome:
Injury to the sacral cord and lumbar nerve roots, resulting in the loss of bowel and bladder function and LE function.
Spinal cord infarct
Stroke within the spinal cord vascular distri- bution. The pattern of deficits is dependent on the level of the infarct and the vascular distribution.
Transverse myelitis:
Inflammation across one level of the spinal cord. The myelin sheath is damaged and causes paralysis below the level of the inflammation, which can progress over the course of several weeks. One-third of patients recover fully, one-third recover partially but are left with significant deficits such as spas- ticity and bowel and bladder deficits, and one-third demonstrate no recovery at all (National Institute of Neurological Disorders and Stroke [NINDS], 2015b). Patients are generally treated with aggressive rehabilitation and corticosteroids for their immuno- suppressive and anti-inflammatory properties. Plasma exchange may be used in some cases
Level and injury and preserved motor function of: C1 - C3
Face and neck muscles, allowing for neck movement and facial expressions, use of mouth
Level and injury and preserved motor function of: C4
Neck movement, trapezius for scapular elevation (strongest direction of movement), retraction and depression and diaphragm for respiration
Level and injury and preserved motor function of: C5
Muscles spared: ■ ■■ Biceps ■■ Brachialis ■■ Brachioradialis ■■ Deltoid ■■ Infraspinatus ■■ Rhomboid ■ Supinator Preserved movement: ■ ■■ Elbow flexion ■ Supination, External rotation ■ Shoulder abduction to 90° but limited shoulder flexion
function lost C1-3
Total paralysis (high-level tetraplegia
function lost C4
Paralysis of trunk and UEs and LEs and inability to have an effective cough
Function lost C5
No elbow extension ■■ No hand function ■ Total paralysis of trunk and LEs ■ ■ Patient at high risk for scapular hiking or winging
Level and injury and preserved motor function of: C7-C8
Preserved muscles: ■ ■■ All above muscles ■■ Triceps ■■ Pronator quadratus ■■ Extensor carpi ulnaris ■■ Flexor carpi radialis ■ Flexor digitorum profundus and superficialis ■ ■■ Extensor communis ■■ Thumb muscles ■ Lumbricals (partially) Preserved movement: ■ ■■ Elbow extension ■ Strong wrist extension and flexion ■ ■ Finger flexion and extension ■ ■ Thumb flexion, extension, and abduction ■ ■ Good shoulder movemen
Level and injury and preserved motor function of: C6
Muscles spared: ■ ■■ Extensor carpi radialis ■■ Infraspinatus ■■ Latissimus dorsi ■ Pectoralis major (clavicular portion) ■ ■■ Pronator teres ■■ Serratus anterior ■ Teres minor Preserved movement: ■ ■■ Shoulder movement ■■ Scapular protraction ■■ Horizontal adduction ■■ Supination ■■ Radial wrist extension ■ Tenodesis grasp—wrist extension causing passive finger flexion, thus resulting in a grasp capability
Function lost C6
■ No wrist flexion ■■ No elbow extension ■ No hand function, but functional tenodesis grasp ■ ■ Total paralysis from trunk to LEs
Function lost C7 - C8
Paralysis of trunk and LEs (low-level tetraplegia) ■ ■ Limited grasp and dexterity because of partial intrinsic muscle innervatio
Level and injury and preserved motor function of: T1-T9
Preserved muscles: ■ ■■ Intrinsics ■■ Intercostals ■ Erector spinae, ■■ UEs intact ■ Some patients may be able to ambulate with device
Function lost: T1-T9
Limited trunk stability ■ Paraplegic
Level and injury and preserved motor function of: T10-L1
Preserved muscles: ■ ■■ Intercostals ■■ External obliques ■ Rectus abdominus Preserved movements: ■ ■ Good trunk stability
Function lost: T10 - L1
Weak LEs may be able to ambulate
Level and injury and preserved motor function of: L2 - S5
Preserved muscles: ■ ■■ All trunk muscles ■ Depending on level, some hip, knee, and ankle muscles Preserved movements: ■ ■■ Good trunk stability ■ Partial control of LEs
Function lost: L2-S5
Weak LEs may be able to ambulate
Autonomic dysreflexia
is the response of the ANS to noxious stimuli. Examples include distended bladder, fecal mass, ingrown toenail, toe pushed against the footboard of the bed, kinked cath- eter, or overheating. It is frequently characterized by autonomic symptoms such as perspiration, flushing, chills, nasal congestion, hypertension, and lowered heart rate.
C5:
C6:
C7:
C8:
T1:
C5 - Elbow flexors
C6 Wrist extensors
C7 Elbow extensors
C8 Finger flexors
T1 Finger abductors
