Spinal Cord Injury - Part 2

Question 1

Cervical Tetraplegia - High Cervical Nerves (C1-C4) - Characteristics (6)

Answer 1

Paralysis of arms, hands, trunk and legs.
May not be able to breathe on their own, or control bladder/bowels.
Ability to speak sometime impaired.
Requires complete assistance with ADLs.
May be able to use specialized powered wheelchair.
Not able to drive.

Question 2

Cervical Tetraplegia - Low Cervical Nerves (C5) - Characteristics (5)

Answer 2

C5-C7: control arms and hands. usually able to breathe on their own and speak normally.
Can raise arms and bend elbows.
Some or total paralysis of wrists, hands, trunk and legs.
Weak cough (accessory resp. muscles not working).
Needs assistance with most ADLs.

Question 3

Cervical Tetraplegia - Low Cervical Nerves (C6) - Characteristics (5)

Answer 3

C5-C7: control arms and hands. usually able to breathe on their own and speak normally.
Paralysis in hands, trunk and legs, wrist flexion possible.
Can move in and out of wheelchair and bed with assistive equipment.
May be able to drive a car.
May be able to manage bowel or bladder with special equipment.

Question 4

Cervical Tetraplegia - Low Cervical Nerves (C7) - Characteristics (5)

Answer 4

C5-C7: control arms and hands. usually able to breathe on their own and speak normally.
Hand function is possible.
Able to do most ADLs but need assistance with complicated ones.
May be able to drive an adaptive vehicle.
May be able to manage bowel or bladder with special equipment.

Question 5

Thoracic Paraplegia (T1-T5) - Abilities (5)

Answer 5

Corresponding nerves affect muscles, upper chest, mid back and abdominal muscles.
- Head control and upper limbs
- Respiratory control
- Functional independence in self care and house keeping
- Use of a manual wheelchair
- Adapted vehicle use

Question 6

Thoracic Paraplegia (T1-T5) - Disabilities (4)

Answer 6

Corresponding nerves affect muscles, upper chest, mid back and abdominal muscles.
- Lower limb control
- Autonomic dysreflexia
- Respiratory endurance might be compromised
- Assistance on transfers might be necessary

Question 7

Thoracic Paraplegia (T5-T9) - Disabilities (6)

Answer 7

Nerves affect muscles of the trunk (abs and back) depending on the level of injury.
- LL control
- Autonomic dysreflexia
- Respiratory endurance
- A lot of patients develop spastricity

Question 8

Thoracic Paraplegia (T5-T9) - Abilities (4)

Answer 8

Nerves affect muscles of the trunk (abs and back) depending on the level of injury.
- Head control and UL
- Transfers from bed to chair and back
- Adapted car
- Orthostasis with orthosis (depending on trunk control)

Question 9

Thoracic Paraplegia (T10-L1) - Abilities (6)

Answer 9

Nerves affect muscles of the trunk (abs and back) depending on the level of injury.
- Normal respiratory function
- Good trunk control (lower abs working)
- Car driving
- Transfers
- Orthostasis with orthosis
- Walking with orthosis and elbow crutches.

Question 10

Thoracic Paraplegia (T10-L1) - Disabilities (3)

Answer 10

Nerves affect muscles of the trunk (abs and back) depending on the level of injury.
- Partial paresis of LL
- Spasticity might be present
- Gait and orthostasis with orthosis and crutches have a very high energy cost. Most patients prefer wheelchair for transport.

Question 11

Lumbar (L1-L5) and Sacral Nerves (S1-S5) (4)

Answer 11

Some loss of function in hips and legs.
Little or no voluntary control of bowel or bladder, can manage on their own with special equipment.
Lumbar: Depending on strength, wheelchair or walking with assistive device.
Sacral: Most likely able to walk.

Question 12

Spinal Cord Injury Syndromes (6)

Answer 12

Incomplete lesions with a distinct clinical picture and specific sign and symptoms.
- Central cord syndrome
- Brown-séquard syndrome
- Anterior cord syndrome
- Posterior cord syndrome (rare)
- Conus medullaris syndrome
- Cauda equina syndrome

Question 13

Central Cord Syndrome (CCS) - Young vs Older, Clinical Representation (3)

Answer 13

Most common incomplete SCI.
45-50 yr. hyperextension injuries with cervical spondylosis or spinal stenosis.
Young: Flexion-compression injury during high impact accident causing a fracture or herniation.
- Upper limb weakness
- Bladder dysfunction
- Sensory loss

Question 14

Brown-Séquard Syndrome - Cause, Ipsilateral vs Contralateral

Answer 14

From a hemi-lesion of SC due to traumatic (gunshot or stab wound) or vascular etiology. Radiotherapy.
Ipsilateral: loss of proprioception and touch sense, hypertonic paresis (uncontrolled movements)
Contralateral: Loss of pain and temperature sense several levels below the lesion.

Question 15

Anterior Cord Syndrome - Clinical Representation (4)

Answer 15

Flexion injury compromising anterior spinal artery (occlusion).
- Complete motor paralysis (corticospinal tract)
- Loss of pain and temp sensation (spinothalamic tract)
- Orthostatic hypotension
- Bladder/bowel/sexual dysfunction (maybe)

Question 16

Posterior Cord Syndrome - Cause, Clinical Representation (3)

Answer 16

Rare.
Compression by disc or tumor, infection of posterior spinal artery or a clot. Vitamin B12 deficiency.
- Proprioception, stereognosis, 2point discrimination and vibration lost below lesion.
- motor function, pain and temp sensation perserved.
- May have bladder and bowel continence.

Question 17

Cauda Equina Syndrome - Cause, Clinical Representation

Answer 17

Damage to cauda equina caused by a burst fracture of a lumbar vertebra or central herniated disc (L4,L5,S1).
- Lower MN syndrome: flacid paralysis with no spinal reflex.
- Paresthesia in lower limbs.
- Loss of bladder/bowel reflex.
- Chronic lower back pain.

Question 18

Conus Medullaris Syndrome - Definition, Cause and Clinical Representation

Answer 18

Insult to conus medullaris and compressive damage to spinal cord (T12-L2) caused by trauma or tumor.
UMNS and LMNS.
- Paresthesia in lower limbs.
- Loss of bladder/bowel reflex.
- Chronic lower back pain.
- Sacral reflex might be preserved.