Spinal Cord Injury in the Acute Setting Flashcards
1
Q
What are the white matter?
A
Myelinated tracts in the peripheral
2
Q
What are the gray matter?
A
Neuronal cell bodies, glial cells, and located centrally
3
Q
What do the anterior horns control?
A
Somatic muscles
4
Q
What do the posterior horns control?
A
Sensation
5
Q
What is another way of thinking of somatic movement?
A
Conscious movement (voluntary)
6
Q
What is the difference between afferent and efferent?
A
Afferent is to the brain; efferent is from the brain
7
Q
Upper Motor Neuron damages happen:
A
Within the spinal cord: increased muscle tone, reflexes and spasticity
8
Q
Lower Motor Neuron damages happen:
A
At the anterior horn cell or nerve root exiting through the spinal nerves: decreased muscle tone, absent stretch reflex, flaccidity
9
Q
Spino- refers to
A
Sensory
10
Q
-Spinal refers to
A
Motor
11
Q
What are some of the spinal tracts that involve with sensory function?
A
Ascending/ afferent Spino=sensory Spinothalamic tract Dorsal/ Posterior Column Tract Spinocerebellar Tract
12
Q
What is the lateral spinothalamic tract responsible for?
A
Pain and temperature sensation
13
Q
What is the anterior spinothalamic tract responsible for?
A
Crude touch and pressure sensation
14
Q
What is the dorsal/posterior column tract responsible for?
A
Vibration, deep touch, 2 point discrimination, joint position sense
15
Q
What is the spinocerebellar tract responsible for?
A
Proprioception information to the cerebellum
16
Q
Which tracts are involved with the subconscious tract?
A
Vestibulospinal Tectospinal Superior Colliculi Reticulospinal Rubrospinal
17
Q
Which tract is involved with voluntary control of the skeletal muscle?
A
Corticospinal tract
18
Q
What would you see with damage to the corticospinal tract?
A
Increased tone, increased reflexes, paralysis, + Babinski reflex
19
Q
Which tract is responsible for inner ear info to assess head position?
A
Vestibulospinal
20
Q
Which tract is responsible for information to the head, neck and limbs in response to loud noise, sudden movement, brightness?
A
Tectospinal:
Superior colliculi: visual info
Inferior colliculi: auditory info
21
Q
Where is the sympathetic nervous system located?
A
T1-L2/L3 and contain afferent/sensory nerves
22
Q
Where does the parasympathetic nervous system locate?
A
Brainstem, cranial nerves 3, 7, 9, 10. Located in sacral spinal cord: S2 - S4
23
Q
True or False: Dilating blood vessels leading to the GI tract is part of the sympathetic nervous system.
A
False; this is part of the sympathetic nervous system
24
Q
What are common causes for spinal cord injuries?
A
Motor vehicle collisions
Falls
25
Where would you expect the level of injury would be for patients with quadriplegia?
Cervical region
26
True or False: Pain is not a complication of SCI.
False; pain is a complication of SCI
27
C3, C4, C5 will...
... Keep the diaphragm alive
28
What is C5 responsible for?
Elbow flexion, supination, weak shoulder flexors
Full innervation of rhomboids
29
What is C6 responsible for?
Stability and power of shoulder joint, tenodesis grasp
30
What is C7 responsible for?
Wrist flexors, pronators
31
What is C8 responsible for?
Active grip and release of hand
32
What is L1 responsible for?
Trunk stability, QL
33
What is L2 responsible for?
Flexors, adductors
34
What is L3 responsible for?
Knee extensors
35
What is L4 responsible for?
Ankle dorsiflexors
36
What is L5 responsible for?
Great toe extension, ankle eversion, inversion, hip abductors
37
At what level of SCI would you least likely see wrist and finger dysfunction?
C4
C5
C6
C8
C8
38
What would you see in spinal shock?
Absent sensation
Absent motor control
Areflexia
Loss of autonomic control
39
What would you see in neurogenic shock (injuries above T6)?
Bradycardia
Hypotension
Thermoregulation
40
What are cardiovascular signs of an autonomic nervous system injury?
Neurogenic shock, orthostatic hypotension, autonomic dysreflexia, cardiac dysrhythmia
41
What are bowel signs of an autonomic nervous system injury?
Absent sensation
| Incontinence, constipation
42
What are bladder signs of an autonomic nervous system injury?
Detrusor sphincter, dyssynergia activity (remember hypo-, hyper-)
43
What are sweating signs of an autonomic nervous system injury?
Hyperhidrosis, hypohidroses, reflex sweating below injury
44
What are temperature signs related to autonomic nervous system injury?
Intolerance of hot/cold, poikliothermia
45
What are the sexual signs related to autonomic nervous system injury?
Erectile dysfunction, ejaculation, vaginal lubrication
46
What are signs of autonomic dysreflexia?
Hypertension, bradycardia, pounding headache, diaphoresis
47
Which level of SCI is MOST likely to experience autonomic dysreflexia?
T7 Complete
T7 Incomplete
T6 Complete
T6 Incomplete
T6 Complete injury
48
What should you do to manage a patient experiencing autonomic dysreflexia?
Sit the patient up and remove noxious stimulus
49
Would 120/80 mmHg be considered as hypertensive for a patient with SCI?
Yes, dependent on their baseline value of blood pressure
50
What is considered orthostatic hypotension according to the American Autonomic Society and American Academy of Neurology?
A decrease in systolic blood pressure by 20 mmHg
An decrease in diastolic blood pressure by 10 mmHg
51
True or false: patients with SCI experience decreased vasomotor control, impaired baroreceptor control, decreased tone and the lack of skeletal muscle pump due to paralysis
True
52
True or False: The patient should be reclined or returned to supine if the MAP is below 40, and the patient is symptomatic.
True! Below 60 is the guideline
53
True or False: You should remove all items once the patient is returned to bed.
True
54
True or False: You should use electric blankets or heating pads where there is no sensation for patients with SCI
False; you should not!
55
Parasympathetic response preserved as it is modulated by the cervical levels of the spinal cord lead to:
Decreased heart rate - bradycardia
Decreased contractility
Decreased cardiac output
56
Sympathetic response is blunted if injury is above T6-location of sympathetic ganglia.
Increased heart rate
Increased contractility
Increased cardiac output
57
Which of the following is least likely to be an effect of exercise for patients with SCI?
Autonomic dysreflexia
Reduced exercise tolerance
Increases in stroke volume
Exercise induced hypotension
Increases in stroke volume (you should see reductions in venous return, stroke volume and cardiac output)
58
Internal Intercostals are responsible for:
Assisting with forced expiration, elevation of ribs and expansion of thoracic cavity for inspiration
59
External Intercostals are responsible for:
Inhalation, expansion of chest cavity
60
True or False: A patient with 1100 mL on the incentive spirometry is associated with the need for mechanical ventilation.
False; a patient with <1000 mL on the incentive spirometry is associated with the need for mechanical ventilation
61
Which level of SCI is least likely needing mechanical ventilation?
C2
C3
C4
C5
C5 (may need initial ventilation 2/3)
C2 and higher (mechanical ventilation)
C3-C4: need initial ventilation
62
What is the goal of respiratory management?
Decrease/ prevent atelectasis, enhance clearance of secretions, prevent pneumonia
63
What is the purpose of pre-oxygenating with any suctioning for respiratory management?
To prevent bradycardia and desaturation
64
True or False: It is safe to perform an assisted cough on a patient with a recent IVC filter placement
False; this is a contraindication
65
True or False: It is safe to perform an assisted cough on a patient with flail chest or multiple rib fractures.
False; this is a contraindication
66
True or False; It is safe to perform an assisted cough on a patient with liver injury.
False, this is a contraindication (internal injuries!)
67
Can you perform an assisted cough with a patient who has a diaphragmatic pacemaker?
You can if it is appropriate (consider contraindications)
68
What risk factors puts patients with SCI at increased risk for skin breakdown?
Decreased sensation and lack of voluntary movement
69
What are prevention strategies for skin breakdown?
Frequent repositioning, inspection, skin care and good nutrition
70
Which of the following is least likely a guideline for for positioning in bed?
Reposition every 2 hours
Use of TEDs
Head of bed should be below 30 degrees or fully elevated
Log Roll
Use of TED (do not use these!)
Prevalon boots and sequential compression devices are good!
71
True or False: You should reposition every 30 minutes in sitting and fully recline for 3 minutes to prevent pressure sores.
True
72
What is a caution for the anterior approach of surgical stabilization?
Watch swallowing and for hematoma = Airway emergency!
73
What types of procedures are done as posterior approaches for surgical stabilization?
Posterior cervical discectomy
Thoracic laminectomy/ fusion
Lumbar laminectomy/ fusion
74
What medications are prescribed for neuropathic pain?
Gabapentin
75
What medications are prescribed for spasticity?
Baclofen, cyclobenzaprine
76
What is the scoring range for muscle function on the ASIA scale?
0-5(*); NT
77
What is the scoring range for sensory function on the ASIA scale?
0-2; NT
78
The differentiating factor between complete and incomplete SCI's:
Sensory: S4- S5 AND no motor function is preserved more than three levels below the motor level on either side of the body
Motor: motor function is preserved at the most caudal sacral segments for voluntary anal contraction
79
What characterizes central cord syndrome?
Incomplete spinal cord injury characterized by an impairment in the arms and hands and to a lesser extent in the legs.
80
What prognosis would you expect with a patient who has central cord syndrome?
Good
81
What characterizes anterior cord syndrome?
Associated with flexion type injuries to cervical spine
Light touch, proprioception and sense of vibration remain intact
Sensation to pain, crude touch and temperature is loss
82
What prognosis would you expect with a patient who has anterior cord syndrome?
Poor
83
What characterizes Brown-Sequard Syndrome?
Spinal cord is hemi-sectioned or injured (i.e. GSW or knife stab wound)
Ipsilateral side of the injury, there is loss of motor function, proprioception, vibration, and light touch
Contralerally, there is loss of pain, temperature and crude touch sensation
84
What prognosis would you expect with a patient who has Brown-Sequard Syndrome?
Fair
85
What characterizes Cauda Equina Syndrome?
Injury between the conus and the lumbosacral nerve roots within the spinal canal, also results in areflexic bladder, bowel, and lower limbs
86
What affects the recovery for patients with Cauda Equina Syndrome?
Perineal sensory deficits and unilateral vs. bilateral involvement
87
True or False: Patients who are older than 50 years old have a higher chance of ambulation compared to those with who are less than 50 years old.
False
88
At which level of SCI is least likely to be independent for potential functional outcomes?
C5
C6
C7
C8
C5
89
True or False: a patient with with a C4 SCI should be able to direct others independently with power recliner
True
90
What are some treatment strategies in the acute setting?
Muscle substitution
Momentum
Transfers
Exercise Program and Functional Training
91
Fasciculus Gracilis carries sensory information at what level of the spinal cord?
Everything from T6 below.
92
Fasciculus Cuneatus carries sensory information at what level of the spinal cord?
Everything from T6 above
93
The dorsal columns are responsible for what kind of sensory information
Conveys proprioception, vibratory sensation, deep touch, and discriminative touch
94
What tracts are involved with Brown-Sequard Syndrome?
Ipsilateral: Lateral corticospinal tract, dorsal column
Contralateral: Spinothalamic tracts
95
Why would you lose some sensations several segments below the level of injury?
This discrepancy in levels and impairment on sides of the body occurs because the lateral spinothalamic tracts ascend two to four segments on the same side before crossing and the descending motor tract decussating in the medulla
96
What senses are preserved with Anterior Cord Syndrome?
Proprioception, light touch, and vibratory sense are generally preserved (think that the anterior cord is gone, and you still have posterior columns)
97
Which is the most common cord syndrome out of all of the SCIs?
Central Cord Syndrome
98
True or false: Central cord syndrome results from axial compression injuries to the cervical region.
False; it results from hyperextension injuries
99
True or false: Cauda Equina lesions are UMN injuries.
False; these are peripheral nerve (LMN) injuries
100
True or False: You can only see LMN deficits with conus medullaris syndrome
False; you can see both LMN and UMN signs
101
Rank the following in order of most severe/ long recovery time to least severe/ shorter recovery time:
Neuropraxia
Axonotmesis
Neurotmesis
Neuropraxia > Axonotmesis > Neurotmesis
102
According to the Seddon Classification of Peripheral Neuropathy, which two peripheral neuropathies can you see complete motor paralyses in?
Axonotmesis, neurotmesis
103
True or false: Nerve conduction distal to the lesion is preserved in Neuropraxia
True
104
How many degrees of neuropathies are there according to Sunderland?
5
105
True or false: Wallerian degeneration occurs only when the endoneurium is disrupted.
False; this can occur during axonotmesis, which the encapsulating structures are still intact
106
Patient presents with normal bilateral touch sensation down to C4. Dermatome/myotome testing resulted in:
Normal R light touch sensation to C5
Normal R pinprick sensation to C6
Sensation is impaired one segment below these levels and absent elsewhere
Elbow flexors: R:5 / L:5
Wrist Extensors: R: 5/ L:5
Elbow Extensors R:4/ L:3
Finger Flexors: R: 3/ L:2
VAC: Yes
DAP: No
Sensory Level: C4
Motor Level: C6
Neurological Level: C4
Motor Incomplete
AIS - C
107
How do you designate the neurological level of injury?
The most caudal level with normal motor and sensory function on both sides
108
How do you know if the SCI is complete or incomplete?
Determine if sacral sparing exists. Assess deep anal pressure and voluntary anal sphincter contraction.
109
True or false: Zones of partial preservation can apply to both incomplete and complete SCIs
False: these only apply to complete SCI.
110
True or False: A patient with Brown-Sequard Syndrome would experience ipsilateral loss of sense of pain and temperature due to the spinothalamic tract.
False; The Brown-Sequard Syndrome would experience contralateral loss of sense of pain and temperature due to the spinothalamic tracts
111
Why is full return of innervation not common?
Full return of innervation is not common because (1) there is a large distance between the lesion and the point of innervation; (2) axonal regeneration may not occur along the original distribution of the nerve; (3) axonal regeneration may be blocked by glial-collagen scarring; (4) the end organ may no longer be functioning once reinnervation occurs; and (5) the rate of regeneration slows and finally stops after about 1 year.
112
Which of the following levels of SCI would least likely to experience neurogenic shock?
T1
T5
T8
T12
T12
113
Why does orthostatic hypotension occur in patients with SCI?
It occurs due to the imbalance between parasympathetic and sympathetic nervous system
Patients with SCI experience decreased vasomotor control, impaired baroreceptor control, decreased tone and the lack of skeletal muscles
