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Clinical Conditions > Spinal Cord Injury (SCI) > Flashcards

Spinal Cord Injury (SCI) Flashcards

1
Q

CNS = brain and spinal cord

A
  • the brain controls how we think, learn, move, and feel
  • the spinal cord carries messages back and forth between the brain and the nerves that run throughout the body
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2
Q

Upper motor neurons (UMN) vs lower motor neurons (LMN)

A
  • upper neurons start in the brain, then comes down the spinal cord
  • in the spinal cord, the upper motor neurons meet up with the lower motor neurons and then it goes to the muscles
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3
Q

Upper motor neurons (UMN)

A
  • location = originate in the motor cortex of the brain and project down to the spinal cord
  • function = responsible for conveying signals from the brain to the lower motor neurons, initiating and controlling the voluntary movements
  • pathway = travel through the brain stem and spinal cord, synapsing with lower motor neurons in the anterior horn of the spinal cord
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4
Q

Lower motor neurons (LMN)

A
  • location = located in the anterior horn of the spinal cord and brainstem, then project to the muscles
  • function = directly innervate skeletal muscles and are responsible for muscle contraction
  • pathway = receive signals from upper motor neurons and transmit these signals to the muscles, facilitating movement
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5
Q

Diagram (slide 5)

A

1.) motor nerve cells
2.) upper motor neuron
3.) midbrain
4.) pons
5.) medulla
6.) spinal cord
7.) lower motor neuron
- the nerve divides into many branches in the skeletal muscle
- each branch ends at motor plate of a single muscle fiber

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6
Q

Spinal nerves

A
  • cervical plexus = C1-C5
  • brachial plexus = C6-T1
  • lumbosacral plexus = T12-S5
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7
Q

Cervical nerves

A
  • C1-C8
  • head and neck
  • diaphragm
  • deltoids and biceps
  • wrist extenders
  • triceps
  • hand
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8
Q

Thoracic nerves

A
  • T1-T12
  • chest muscles
  • abdominal muscles
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9
Q

Lumbar nerves

A
  • L1-L5
  • leg muscles
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10
Q

Sacral nerves

A
  • S1-S5
  • bowel and bladder
  • sexual function
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11
Q

Causes of spinal cord injury

A
  • falls (most common)
  • motor vehicle accidents (most common)
  • sports-related or recreation-related injuries
  • violence-related injuries
  • diseases
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12
Q

Falls

A
  • about 31% of SCIs are caused by falls
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13
Q

Motor vehicle accidents (MVAs)

A
  • MVAs are the most common cause linked to spinal cord injuries
  • constitute over 37% of all SCIs
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14
Q

Sports-related or recreation-related injuries

A
  • athletics activities account for 8% of SCIs, including diving in shallow water and impact sports
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15
Q

Violence-related injuries

A
  • acts of violence caused 15% of all spinal cord injuries
  • includes penetrating injuries from sharp objects such as knives or bullets
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16
Q

Diseases

A
  • certain diseases or conditions can also lead to a spinal cord injury
  • osteoporosis
  • arthritis = lumbar spine pushes into each other, causing an injury
  • cancer
  • spine tumors
  • inflammatory conditions
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17
Q

Incidence and prevalence

A
  • 18,000 new SCIs per year
  • 302,000 people with SCIs in the U.S.
  • 79% of people with SCIs are male
  • average age at time of injury is 43 years old
  • 47% of injuries occur between the ages 16-30
  • average of 11 days spent in ICU/acute care
  • average of 31 days spent in rehabilitation
  • depends on the severity of SCI = typically 6-8 weeks in ICU and 4-6 weeks in rehab, and then 2 weeks to stabilize and get moving
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18
Q

Classification of SCI (the basics)

A
  • quadriplegia (tetraplegia)
  • paraplegia
  • complete injury
  • incomplete injury
  • zone of partial preservation
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19
Q

Quadriplegia (tetraplegia)

A
  • any degree of paralysis of all 4 limbs and trunk musculature
  • C1-C8 injuries
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20
Q

Paraplegia

A
  • any degree of paralysis of the lower extremities with the involvement of the trunk and hips depending on the level of the lesion
  • T1-T12
  • L1-L5
  • S1-S5
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21
Q

Complete injury

A
  • absence of motor or sensory function of the spinal cord below the level of injury
  • the spinal cord is totally severed (nothing is preserved)
  • ex: C8 injury, C8 works, but everything below that does not work
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22
Q

Incomplete injury

A
  • some spinal cord function may be partially or completely intact
  • some level of preservation (depending on where the spinal cord is injured
  • ex: the front, back, or central of the spinal cord is injured
  • there is still some signals that can get through
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23
Q

Zone of partial preservation

A
  • some segments below the neurological level of injury with preservation of motor or sensory findings
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24
Q

Complete spinal cord injury

A
  • the spinal cord is transected (cut off)
  • below the level of injury = all ascending and descending pathways are interrupted (total loss of motor and sensory function)
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25
Q

Clinical signs of complete spinal cord injury

A
  • severe back pain or pressure
  • complete loss of movement and sensation below the level of injury
  • loss of bowel and bladder function
  • possible impaired breathing
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26
Q

Upper motor neuron injury

A
  • location = CNS
  • structures involved in = cortex, brainstem, corticospinal tract, spinal cord
  • disorders = stroke, TBI, SCI
  • tone = increased: hypertonic, spasticity, rigidity
  • reflexes = increased: hyperflexia
  • involuntary movements = muscle spasm: flexor and extensors
  • voluntary movements = impaired or absent: obligatory synergies, dyssenergic patterns
  • muscle bulk = disuse atrophy: variable, widespread distribution
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27
Q

Lower motor neuron injury

A
  • location = PNS
  • structures involved = spinal cord: anterior horn cell, spinal roots, peripheral nerves and cranial nerves
  • disorders = polio, GBS, PNI, peripheral neuropathy, radiculopathy
  • tone = decreased or absent: hypotonia, flaccidity
  • reflexes = decreased: hyporeflexia
  • involuntary movements = with denervation: fasciulations
  • voluntary movements = weak or absent if nerve interrupted
  • muscle bulk = neurogenic atrophy: rapid, focal distribution, severe wasting
28
Q

Incomplete injury

A
  • damage does not cause total transection (not totally cut off)
  • some degree of voluntary movement or sensation below the level of injury
  • categorized by the area of spinal cord that was damaged and clinical signs present
29
Q

Anterior cord syndrome (incomplete injury)

A
  • caused when the head is forced downward to the chest or a severe neck flexion
  • damage to the anterior spinal artery or spinal cord tissue
  • the front 2/3 of the spinal cord is compressed, often due to decreased blood supply from the anterior spinal artery
  • surgery to repair an aortic aneurysm or compression caused by herniated disc, tumor, burst fracture, or a hyper flexion injury (when the head is forced down toward the chest)
30
Q

Clinical signs of anterior cord syndrome

A
  • sudden and severe back pain
  • weakness or paralysis below the level of injury
  • pain and temperature loss at and below the level of injury
  • sexual dysfunction
  • bowel and bladder dysfunction
  • position (proprioception), vibration, and touch are not affected
31
Q

Brown-Sequard syndrome (incomplete injury)

A
  • damage to only one side of the spinal cord
  • usually the result of a sharp penetration (gunshot wound, stab, MVA, etc)
32
Q

Clinical signs of Brown-Sequard syndrome

A
  • partial paralysis or weakness on the same side of the body as the lesion, beginning below the level of injury
  • loss of pain and temperature sensation on the opposite side of the body, beginning below the level of injury
  • decreased levels of touch, vibration, and proprioception (awareness of position and movement) on the same side as injury
  • possible bowel and bladder dysfunction
  • extremities with greatest motor function have the poorest sensation
33
Q

Central cord syndrome (incomplete injury)

A
  • damages the central structures of the spinal cord
  • may be the result of an injury due to trauma (such as when the head snaps backwards after hitting the chin on a downward fall
  • the syndrome commonly occurs in people over the age of 50
  • in conjunction with an underlying weakness in the spine caused by osteoarthritis causing narrowing of the spinal canal, exerbating the compression of the spinal cord from disc herniation or when the neck is hyperextended
34
Q

Clinical signs of central cord syndrome

A
  • paralysis or loss of fine motor skills in the arms and hands
  • some weakness or impairment in the legs
  • some loss of sensation below the level of injury
  • dysfunction of the bowel and bladder
  • tingling, burning, or dull ache
35
Q

Cauda equina syndrome (incomplete injury)

A
  • damage to the nerves that extend below the end of the spinal cord
  • due to trauma or compression
  • L3-L5 herniated disc that damages vertebrae
  • result of a tumor, infection, spinal stenosis, or direct trauma to the area such as from gunshot wounds or a car accident
36
Q

Clinical signs of cauda equina syndrome

A
  • bowel and bladder dysfunction, including urinary retention or incontinence
  • severe lower back pain
  • weakness and flaccid paralysis in lower limbs
  • numbness or loss of sensation in the buttocks, groin, and upper thighs known as saddle anesthesia
  • sexual dysfunction
37
Q

American Spinal Injury Association (ASIA) levels

A
  • A: complete = no sensory or motor function below the level of injury, including S4-S5
  • B: incomplete = sensory function preserved below the level of injury, but no motor function
  • C: incomplete = motor function preserved, more than half of key muscles have a grade less than 3 (cannot fight against gravity)
  • D: incomplete = motor function preserved, at least half of key muscles have a grade greater than or equal to 3
  • E: normal = motor and sensory functions are normal
38
Q

Levels of injury

A
  • if you have a lesion at T1, you’re going to lose a lot more function than a lesion at L1
  • lesion = a region in an organ or tissue which has suffered damage through injury or disease, such as a wound
  • the level of function depends on the level of involvement
  • the higher the level of lesion, the greater care the individual will require
  • SCI level = last fully functioning neurological segment of the cord
39
Q

Diagram (slide 23)

A
  • C4,C5 = biceps
  • C6 = triceps
  • C7, C8 = super quads (still quadriplegic, not having a full grip), but can still push a wheelchair
  • T1 = abdominal muscles
  • T4,T5 = nipple line
  • T10 = belly button, middle and upper abs
40
Q

Levels of injury

A
  • C1-C3 = total paralysis, ventilator dependent
  • C4 = paralysis of intercostals, upper extremities, low respiratory endurance, unable to cough
  • C5 = absence of pronation, all wrist and hand movements
  • C6 = absence of wrist flexion, elbow extension, and hand movements
  • C7-C8 = paralysis of trunk, limited grasp due to partial intrinsic muscles of the hand
  • T1-T9 = lower trunk paralysis
  • T10-L1 = paralysis of lower extremities
  • L2-S5 = partial paralysis of lower extremities
41
Q

Functional limitations of C1-C3 level of injury

A
  • ventilator dependent
  • total assist for all care
  • mobility with power wheelchair
42
Q

Functional limitations of C4 level of injury

A
  • may be able to breath without ventilator
  • total assist for bowel/bladder programs and self care
  • mobility with power wheelchair
43
Q

Functional limitations of C5 level of injury

A
  • may require assist to clear secretions
  • total assist for bowel/bladder program, transfers, setup of meals, lower extremity dressing, and bathing
  • some assist for grooming, and upper dressing
  • independent with power wheelchair
  • some can use manual wheelchair
44
Q

Functional limitations of C6 level of injury

A
  • may require assist to clear secretions
  • independent with upper extremity dressing, bathing, and driving from wheelchair
  • some assist with bowel/bladder program, transfers, manual wheelchair use outside, eating, grooming, lower extremity dressing/bathing
  • total assist for standing
45
Q

Functional limitations of C7-C8 level of injury

A
  • may require assist to clear secretions
  • independent with upper extremity dressing and bathing, level transfers, manual wheelchair use, eating, grooming, driving with modified van or standard car if able to load/unload wheelchair
  • some assist with bowel/bladder program, uneven transfers, and lower extremity dressing
46
Q

Functional limitations of T1-T9 level of injury

A
  • compromised vital capacity and endurance
  • independent with all self care, transfers, and manual wheelchair mobility, driving including loading/unloading wheelchair
47
Q

Functional limitations of T10-L1 level of injury

A
  • independent with all self-care, transfers, and manual wheelchair mobility, driving including loading/unloading wheelchair
  • walking with specialized bracing for short distances
48
Q

Functional limitations of L2-S5 level of injury

A
  • independent with all self care, transfers, and manual wheelchair mobility, driving including loading/unloading wheelchair
  • walking with specialized bracing for functional distance
49
Q

Post traumatic complications after spinal cord injury

A
  • neurogenic shock
  • spinal shock
  • autonomic dysreflexia
  • pressure ulcers (bedsores)
  • respiratory complications
  • spasticity
  • bladder and bowel dysfunction
  • sexual dysfunction
  • orthostatic hypotension
  • deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • osteoporosis and fractures
  • heterotopic ossification
  • psychosocial complications
50
Q

Neurogenic shock

A
  • a sudden loss of sympathetic nervous system signals leading to vasodilation, hypotension, and bradycardia
  • onset = typically occurs shortly after the injury
  • management = stabilization of blood pressure and heart rate, typically in an ICU setting
51
Q

Spinal shock

A
  • a temporary condition that occurs shortly after a SCI
  • just shuts down and as the body stabilizes, the function may return
  • immediate onset = spinal shock typically begins immediately after a spinal cord injury (can last for days to weeks, typically 24 hours to several weeks
  • flaccid paralysis = muscles below the level of injury become flaccid
  • loss of reflexes = reflexes below the level of injury are absent
  • absence of sensory function = sensory input from below the level of injury is not perceived
  • autonomic dysfunction
52
Q

Autonomic dysreflexia

A
  • unable to regulate other systems
  • a potentially life-threatening condition characterized by a sudden and severe increase in blood pressure in response to a noxious stimulus below the level of injury
  • symptoms = severe headache, flushing, sweating, bradycardia, or tachycardia
  • triggers = bladder or bowel distension, pressure sores, or tight clothing
  • management = immediate removal of the trigger, sitting the patient upright, and administering antihypertensive medications if needed
53
Q

Pressure ulcers (bedsores)

A
  • areas impacted (when lying down) = back of the head, scapula, elbow, lower back and buttocks, hip, inner knees, and heels
  • skin and tissue damage caused by prolonged pressure, especially over bony prominentes
  • risk factors = immobility, sensory loss, and poor nutrition
  • prevention = regular repositioning, use of pressure-relieving devices, and maintaining good skin hygiene
  • treatment = wound care, possible surgical intervention for severe cases
54
Q

Respiratory complications

A
  • compromised respiratory function due to paralysis of the respiratory muscles, particularly in injuries at or above the C4 level
  • common issues = reduced lung capacity, difficulty clearing secretions, increased risk of pneumonia
  • management = respiratory therapy, mechanical ventilation for high cervical injuries, and regular monitoring for respiratory infections
55
Q

Spasticity

A
  • increased muscle tone and exaggerated reflexes resulting from the loss of inhibitory signals from the brain
  • impact = can cause pain, joint contractures, and interfere with mobility
  • treatment = physical therapy, oral medications (ex: baclofen, tizanidine), botulinum toxin injections, and in severe cases, surgical interventions like intrathecal baclofen pumps
56
Q

Bladder and bowel dysfunction

A
  • loss of control over bladder and bowel function due to disruption of the autonomic nervous system
  • bladder issues = neurogenic bladder can lead to urinary retention, incontinence, and frequent urinary tract infections (UTIs)
  • bowel issues = neurogenic bowel may cause constipation, incontinence, and difficult with bowel evacuation
  • management = catheterization for bladder management, bowel programs, and medications to regulate function
57
Q

Sexual dysfunction

A
  • altered sexual function, including changes in libido, erectile function, and ejaculation in men, and lubrication, and orgasm in women
  • psychosocial impact = can affect relationships and mental health
  • treatment = sexual counseling, pharmacological treatments and assistive devices
58
Q

Orthostatic hypotension

A
  • a drop in blood pressure upon sitting or standing, leading to dizziness, lightheadedness, or fainting
  • cause = impaired autonomic regulation of blood pressure
  • management = gradual postural changes, use of compression garments, and increasing fluid and salt intake
59
Q

Deep vein thrombosis (DVT) and pulmonary embolism (PE)

A
  • increased risk of blood clots due to immobile and reduced muscle contractions
  • signs = swelling, redness, and pain in the affected limb (DVT) or sudden chest pain and shortness of breath (PE)
  • prevention = anticoagulants, compression stockings, and regular movement
  • treatment = anticoagulant therapy, thrombolytic agents in acute cases
60
Q

Osteoporosis and fractures

A
  • reduced bone density below the level of injury due to immobility and lack of weight-bearing activity, increasing the risk of fractures
  • management = calcium and vitamin D supplementation, biphosphonates, and weight-bearing exercises if possible
61
Q

Heterotopic ossification

A
  • abnormal bone growth in short tissues, particularly around the joints (hips and knees), leading to pain and limited range of motion
  • management = medication and in some cases, surgical removal of the abnormal bone
62
Q

Psychosocial complications

A
  • emotional and psychological challenges, including depression, anxiety, and post-traumatic stress disorder (PTSD)
  • impact = can affect rehabilitation and overall well-being
  • support = counseling, support groups, and possibly medications for mental health issues
63
Q

Long term outcomes of SCI

A
  • less than 1% of people experienced complete neurological recovery by hospital discharge
  • approximately 20 years after the injury, some aging problems (including osteoporosis, arthritis, joint degeneration, constipation, weakening of precarious skin, substance abuse) tend to increase
  • functional status may decline over time
  • life expectancy is slightly below average
  • it is not usually the SCI that causes death but rather more so the complications
64
Q

Aging with SCI

A
  • wear and tear
  • many individuals have lived for decades after injury
  • potential secondary outcomes:
  • overuse of weak muscles
  • shoulder, elbow, and wrist pain
  • rotator cuff injuries
  • skin changes more than pressure injuries
  • depression
  • decreased bone density is more likely than susceptibility to fractures
  • impaired cardiovascular fitness
  • renal and bowel complications
  • diabetes
65
Q

Prognosis for SCI

A
  • you have to strengthen on what is there and reframe your mind
  • incomplete injuries are associated with a better chance of physiological recovery than complete injuries
  • no amount of hard work will cause a nerve function to return but can strengthen what is working
  • rehabilitation will not affect the degree of the spinal cord recovery, but can improve skills to maximize functional abilities
66
Q

Defining improved function

A
  • redefine the new normal
  • in rehabilitation, recovery does NOT always mean regaining physiological functions
  • recovery or improvement means improved functional ability or independence
  • may be comepnsating for a lack of movement or sensation (ex: getting dressed in a different way)
  • might be strengthening preserved muscles in SCI to push a chair independently
67
Q

Summary

A
  • medical interventions have advanced to allow for increased survival rates for people with SCI
  • independence is impacted by level of injury and resultant remaining sensory and strength
  • acute and inpatient rehabilitation of SCI are complicated by many medical issues requiring careful management
  • SCI is most often permanent and requires adjustment to disability with assist of OT

Clinical Conditions (7 decks)

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