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S6- Neuro 2 > Week 3- SCI Intro and Pathophysiology > Flashcards

Week 3- SCI Intro and Pathophysiology Flashcards

1
Q

PART 0: SPINAL CORD ANATOMY REVIEW

A

PART 0: SPINAL CORD ANATOMY REVIEW

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2
Q

How many vertebrae are there?

A
  • 7 Cervical
  • 12 Thoracic
  • 5 Lumbar
  • 5 Sacral (fused)
  • 4 Coccyx (fused)
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3
Q

How many spinal nerves are there?

A
  • 8 Cervical (C1-C8)
  • 12 Thoracic (T1-T12)
  • 5 Lumbar (L1-L5)
  • 5 Sacral (S1-S2)
  • 1 Coccygeal
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4
Q
  • Our spinal cord is a continuous structure starting at the base of the medulla and running all the way down to the __-__ intervertebral space in adults.
  • At this point, the spinal cord tapers into the _______ __________. And then you’ll see this bundle of spinal nerves extending inferiorly from the lumbosacral region and conus medullaris that forms the ______ _______.
A
  • L1-L2

- conus medullaris, cauda equina

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5
Q
  • The spinalnerves exitthecervicalspine_____their corresponding vertebral body level. (ex: C7 nerverootexits aboveC7 through the C6-C7 neural foramen. C8exitsin between T1 and C7, since there is no C8 vertebral body level.)
  • After the cervical region, this layout transitions with the spinal nerves exiting ________ their respective vertebrae.
A
  • ABOVE

- BELOW

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6
Q

What are the 3 parts of the central gray matter?

A
  • Dorsal Horn
  • Intermediate Zone
  • Ventral Horn
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7
Q

What is the white matter made of?

A

-Ascending and Descending columns

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8
Q
  • White matter increase _______ to _______.

- Volume of gray matter is highest in ______ and ________ regions.

A
  • caudal to cranial

- cervical and lumbosacral

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9
Q

What are the 2 main blood supplies to the spinal cord?

A
  • Anterior and Posterior Spinal Artery

- **Several radicular arteries found throughout the cord supplying segmental vasculature to the SC.

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10
Q

What are the (3) Ascending Sensory Tracts?

A
  • Dorsal Column Medial Lemniscus Pathway
  • Anterolateral Pathways
  • Spinocerebellar Pathway
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11
Q

Dorsal Column Medial Lemniscus Pathway:

  • (Conscious) __________, vibration, ______ and _________ touch.
  • Second order neurons cross in _______ _______ in internal arcuate fibers.
A
  • proprioception, vibration, light and discriminative touch

- caudal medulla

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12
Q

Anterolateral Pathway:

  • _____, _________, ______ touch
  • Second order neurons cross at level of ______ ______ through anterior commissure.
A
  • pain, temp, crude touch

- spinal cord

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13
Q

Spinocerebellar Pathway:

  • Unconscious proprioception from ____________.
  • Terminates in __________.
A
  • trunk and limbs

- cerebellum

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14
Q

What are the (6) Descending Motor Tracts?

A
  • Lateral Corticospinal Tract
  • Anterior Corticospinal Tract
  • Rubrospinal Tract
  • Vestibulospinal Tract
  • Reticulospinal Tract
  • Tectospinal Tract
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15
Q

Lateral Corticospinal Tract:

  • Function: Volitional movement of _________ ______.
  • Cross at the _____________ and descend contralaterally.
A
  • contralateral limbs

- pyramidal decussation

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16
Q

Anterior Corticospinal Tract:

  • Function: Control of bilateral _______ and _______ muscles.
  • Descend ipsilaterally until level of _________, at which point splits into bilateral innervation.
A
  • axial and girdle

- spinal cord

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17
Q

Rubrospinal Tract:

  • Function: Assists LCST with descending drive for movement of _________ limbs.
  • Originates in _________, crosses in _________, and descends contralaterally.
A
  • contralateral limbs

- red nucleus, midbrain

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18
Q

Vestibulospinal Tract:

  • Medial VST: Originates in ______ medulla, descending bilaterally to cervical region to control positioning of _____/______.
  • Lateral VST: Originates in ______, descends ipsilaterally down spinal cord to aide in _______ _______ and _______.
A
  • rostral medulla, neck/head

- pons, truncal control and balance

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19
Q

Reticulospinal Tract:

  • Function: Aids in ________ and ____-related movements.
  • Originates in both _______ and _______ RF and descends __________.
A
  • posture and gait-related movements

- pontine and medullar RF and descend ipsilaterally

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20
Q

Tectospinal Tract:

  • Function: Assists with coordination of _____ and ____ movements.
  • Originates in __________, crosses in _________, and descends contralaterally to upper cervical cord.
A
  • head and eye movements

- superior colliculus, crosses in midbrain

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21
Q

Autonomic Nervous System:

  • What are the 2 parts of the ANS?
  • Which is located at the thoracic/lumbar region?
A
  • Sympathetic/Parasympathetic Nervous System

- Sympathetic

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22
Q

__________ Nervous System:

  • Fight or Flight
  • Pupil dilation
  • Bronchodilation
  • Cardiac acceleration
  • Digestive Inhibition
  • Piloerection
  • Systemic vasoconstriction
A

Sympathetic

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23
Q

_____________ Nervous System:

  • Rest and Digest
  • Pupil constriction
  • Bronchoconstriction
  • Cardiac deceleration
  • Digestion stimulation
A

Parasympathetic

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24
Q

PART 1: INTRO AND ACUTE MANAGEMENT

A

PART 1: INTRO AND ACUTE MANAGEMENT

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25
Q
  • What are the (2) ways a spinal cord injury can occur?

- Which is more common and makes up around 90% of cases seen?

A
  • Traumatic
  • Non-Traumatic

-Traumatic

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26
Q

Why does the MOI (force direction) matter in spinal cord injuries?

A

Depending where/direction of force often dictates where in spinal cord we will see the damage.

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27
Q
  • ________ injury is most common in lumbar injuries.
  • _______-_______ injury is most common in cervical injuries.
  • ___________ injuries are almost exclusive to cervical injuries.
A
  • flexion
  • flexion-rotation
  • hyperextension
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28
Q

What are the (4) spinal areas of greatest frequency of injury?

A

-C5, C7, T12, L1

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29
Q

What are a few (3) non-traumatic causes of SCI?

A
  • disc prolapse
  • vascular insult
  • infections
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30
Q

Traumatic Cervical Injury:

  • ___ and ___ most frequently involved areas of injury.
  • Flexion, vertical loading, and extension accompanied by ________ or __________.
A
  • C5 and C7

- rotation or lateral flexion

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31
Q

Traumatic Thoracic Injury:

  • Less likely to be injured from traumatic causes due to rib cage and higher _______ as compared to cervical region.
  • ___-____ _______ is most common site of injury.
  • Common MOI: _______ motion or vertical compression.
A
  • stability
  • T12-L1 junction
  • Flexion
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32
Q

Traumatic Lumbar Injury:

  • Neurological damage from trauma is usually incomplete due to large vertebral canal and relatively good ________ supply.
  • Most injuries occur at ___
  • Most common MOI: ______ injuries
A
  • vascular
  • L1
  • flexion
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33
Q

Do we typically have to worry about the sacrovertebral column injuries? Why or why not?

A

-No, because by the time we get down there we are talking about the conus medullaris and cauda equina.

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34
Q
  • What is the average age of injury?
  • Are males or females more at risk?
  • What percentage of injuries are cervical, thoracic, lumbar?
  • What is the most frequent SCI?
  • The frequency of complete vs incomplete paraplegia is about _______.
A
  • 43 years old
  • Male (78%)
  • Cervical (>50%), Thoracic (33%), Lumbar (the rest)
  • Incomplete Tetraplegia
  • equal
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35
Q

What are the (2) main ways to classify SCIs?

A
  • Tetraplegia

- Paraplegia

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36
Q
  • Tetraplegia involves injury to the _______ spinal cord. It involves ____ extremities and the trunk.
  • Paraplegia involves injury to the _______/________ spinal cord. It involves ______ and _____.
A
  • cervical (C1-C8), all 4

- thoracic/lumbar (T1-L5), BLEs and trunk

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37
Q

What is another way that we classify SCIs? (2)

A
  • Complete

- Incomplete

38
Q

Complete SCI:
-Absence of ______ and ______ function below lesion level.
-More _______ presentation of SCI.
Can have Zones of Partial Presentation (ZPP), what is this?

A
  • sensory and motor function
  • severe
  • Dermatomes and myotomes caudal to the sensory and motor levels that remain partially innervated.
39
Q

Incomplete SCI:

  • Involves partial preservation of _______ and ______ functions below the lesion level.
  • _______ prognosis than complete SCI due to preserved axon function.
  • Incomplete SCIs occur _____ frequently than complete.
A
  • sensory and motor
  • Better
  • more frequently
40
Q

The degree of SCI (Complete vs Incomplete, level of neurological injury) is determined by what?

A

-ASIA Exam

41
Q

SCI Acute Medical Management:

  • What is the primary goal of management?
  • What 2 things may be done to help stabilize the spine?
  • What drug has a small window of opportunity and helps to stabilize cell membranes, decreases inflammation, increases nerve impulse generation, and improving blood flow to damaged areas? What is the timeframe?
A
  • Stabilize spine, smallest movements can worsen.
  • Surgery (closed or open decompression), External support devices (HALO, CTLSO, TLSO, ISO)
  • Methylprednisone (3-8 hours)
42
Q

How does methylprednisone help incomplete vs complete SCIs?

A
  • INCOMPLETE: Enhances return of some function below spinal level
  • COMPLETE: increases chances for return of function of the last preserved spinal level post-SCI
43
Q

What are (3) pathophysiological secondary sequelae of SCIs?

A
  • Ischemia
  • Edema
  • Demyelination and necrosis of axons progressing to scar tissue formation
44
Q

PART 2: COMPLICATIONS OF SCI PT.1

A

PART 2: COMPLICATIONS OF SCI PT.1

45
Q

List some complications of SCI.

A
  • Spinal Shock
  • Autonomic Dysreflexia
  • Pressure Ulcers
  • Postural Hypotension
  • Pain
  • Spasticity
  • Contractures
  • Heterotopic Ossification (HO)
  • Edema
  • DVT
  • Osteoporosis & renal calculi
  • Respiratory compromise
  • Bladder & bowel dysfunction
  • Sexual dysfunction
46
Q

What are the (3) main autonomic dysfunctions related to SCIs (T6 and above)?

A
  • Spinal Shock
  • Autonomic Dysreflexia
  • Impaired Thermoregulation
47
Q

Spinal Shock:

  • Temporary phenomenon with injuries ___ and above.
  • Cord in its entirety ceases to function below the lesion and is thought to be due to loss of ________ tone.
  • Spinal reflexes, voluntary motor control, sensory function, and autonomic control are absent below the level of the lesion
  • Initially: ↑ ↑ BP → ↓ BP, HR, hypothermia, venous stasis
  • Usually resolves within ___-____ days of the injury. What is the 1st thing to typically return?
A
  • T6
  • sympathetic tone
  • 1-3 days, sacral/anal reflexes
48
Q

Autonomic Dysreflexia:

  • Over-activity of the ANS, only seen with injuries ____ and above.
  • Caused by irritating stimulus introduced to body ______ level of SCI.
  • What is the most common cause?
  • What are some other causes?
A
  • T6
  • below
  • Most common = FULL BLADDER
  • full bowel, wounds/pressure sores, burns, ingrown toenails, kinked clothing, foreign object pressing against skin
49
Q

What are the symptoms of autonomic dysreflexia? (5)

A
  • Pounding HA**
  • goose bumps
  • sweating above level of injury
  • bradycardia
  • skin blotching
50
Q

Why are we on high alert for the symptoms of autonomic dysreflexia?

A

-It is the bodies way of saying that something is wrong.

51
Q

What are the (6) steps of intervention if we see autonomic dysreflexia symptoms come on?

A
  1. ) If patient lying down, sit them up immediately.
  2. ) If already in sitting, remain in sitting (DO NOT LIE DOWN), perform pressure relief
  3. ) Check catheter
  4. ) Check clothing
  5. ) Check skin
  6. ) Initiate emergency response if not resolved within 10 minutes
52
Q

Why is patient education so important with autonomic dysreflexia patients?

A

-They could be at home one day and have if happen and they need to react or instruct someone on how to react.

53
Q

Impaired Thermoregulation:

  • Only seen with injuries ___ and above.
  • Due to loss of ________ output.
  • Body’s ability to control blood vessel response that conserve or dissipate heat is lost. (sweat/shiver lost, hypo/hyperthermia risk)
  • ______ level injuries result in greater disturbances in temperature control.
A
  • T6
  • sympathetic output
  • Higher level
54
Q

What are the S/Sx of impaired thermoregulation? (2)

A
  • Hyperthermia: skin feels hot and appears flushed, feeling weak, dizziness, HA, visual disturbances, nausea, tachycardia, weak or irregular HR
  • Hypothermia: shivering, exhaustion/drowsiness, confusion, slurred speech,
55
Q

What patient education is important with patients who have impaired thermoregulation?

A

Appropriate clothing to match the weather outside and not what they are feeling.

56
Q

PART 3: COMPLICATIONS OF SCI PT.2

A

PART 3: COMPLICATIONS OF SCI PT.2

57
Q

Spasticity:

  • ___% of SCI patients will experience spasticity (__% identify it as problematic).
  • More common with _______ lesions.
  • Why is skin breakdown with spasticity of concern specifically with these patients?
  • Will often elect to get what to help with spasticity?
A
  • ~65% (50%)
  • cervical lesions
  • These are WC bound patients and are at increased risk for breakdown as opposed to ambulatory patient.
  • Baclofen pump
58
Q

Pulmonary Dysfunction:

  • “__, __, ___ keeps the patient alive” (without these, patients will need supportive devices or techniques to breath)
  • Below ____= normal ventilatory and respiratory function.
A
  • “C3, C4, C5 keeps the patient alive”

- T10

59
Q

Neurological Level of SCI and Muscles of Respiration:

  • C1-C2 = What respiratory muscles are functional?
  • C3-C4 = ?
  • C5-C8 = ?
  • T1-T5 = ?
  • T6-T10 = ?
  • T11 and below = ?
A
  • C1-C2 = SCM, Upper Trap, Cervical extensors
  • C3-C4 = Partial diaphragm, Scalenes, LS
  • C5-C8 = Diaphragm, Pecs, SA, Rhomboids, Lats
  • T1-T5 = Some intercostals, Erector Spinae
  • T6-T10 = Intercostals and abdominals
  • T11 and below = Respiratory muscles intact
60
Q

Bladder Dysfunction:

  • What level of spinal cord injury can we see this?
  • Alteration of reflexive and voluntary control of micturation.
  • ______ of SCI determines type of dysfunction.
  • Lesion _______ conus medullaris/sacral segments = spastic/hyperreflexic bladder. (involuntary voiding)
  • Lesion ______ CM/sacral segments segments = flaccid/areflexic bladder. (overflow and stress incontinence)
A
  • Any level
  • Level
  • Above = spastic/hyperreflexic
  • To = flaccid/areflexic
61
Q

What are some ways to manage bladder dysfunction? (4)

A
  • External collection devices (catheter)
  • Intermittent catheterizations
  • Medication
  • Surgery (Suprapubic catheter, bladder augmentation)
62
Q

What is the biggest drawback to catheters?

A

-Indwelling catheters are a breeding ground for infection. (UTIs often seen if used chronically)

63
Q

Bowel Dysfunction:

  • ___% of patients with SCI report bowel dysfunction, and 34% require assistance to manage.
  • _____ of SCI determines type of dysfunction
  • Above ___: spastic/reflex bowel (Excrement is involuntary and incomplete).
  • ___-____: flaccid/areflexive bowel (Bowel overfills and over-distends)
  • Bowel dysfunction is the 2nd most common cause of ________ ____________.
  • 40% of individuals with SCI will report significant health problems related to bowel management. What are (3) examples?
A
  • 98%
  • Level
  • S2 = spastic/reflex bowel
  • S2-S4 = flaccid/areflexive bowel
  • autonomic dysreflexia
  • rectal prolapse, hemorrhoids, abdominal pain and bloating
64
Q

What are some ways to manage bowel dysfunction?

A

-Reflex Bowel Programs (trigger bulbocavernosus reflex through Digital Stim Programs or Bowel Suppositories)

65
Q

What are the symptoms of bladder and bowel dysfunction? (6)

A
  • Fever/chills
  • Nausea
  • HA
  • Increased spasticity
  • Autonomic dysreflexia
  • Dark or bloody urine
66
Q

Sexual Dysfunction:

  • Males: Directly related to level and completeness of injury. Erectile capacity spared with _____ lesions, but fertility can be impacted.
  • Females: Menstruation and fertility more likely to be ________.
A
  • UMN

- spared

67
Q

Blood Pressure Instability:

  • What is the most common issue? Why?
  • ____ dysfunction common
  • ___ and up: bradycardia, excessive peripheral vascular dilation
A
  • Orthostatic hypotension, due to lack of an efficient muscle tone AND loss of sympathetic vasoconstriction response in the LE’s causes Venous Pooling.
  • Cardiovascular (CV)
  • T6 and up
68
Q

What are some ways to manage blood pressure instability?

A

-TED stockings, abdominal binder**, ace wraps, monitoring fluid intake

69
Q

Are abdominal binders or LE compression garments more helpful in preventing orthostasis in SCI.

A

-abdominal binders

70
Q

Pain:

  • _________ and __________!
  • What are some common causes of pain in this population? (4)
A
  • Neuropathic and Orthopedic!

- Irritation and damage to neural elements, mechanical trauma, surgical interventions, poor handling and positioning

71
Q
  • Neuropathic Pain is poorly localized c/o numbness, tingling, burning, shooting, and aching pain and visceral discomfort ______ level of injury.
  • This can be exaggerated by what things? (5)
A
  • below level of injury

- noxious stimuli, UTI, spasticity, bowel impaction, cigarette smoking

72
Q

Orthopedic Pain common sites of pain include ______ _______ injuries and __________.

A
  • shoulder overuse injuries
  • low back

a lot of these are preventative

73
Q

Osteoporosis and Renal Calculi:

  • Due to changes in calcium metabolism. (bone mineral density found to decrease for up to ___ years after injury.)
  • Decreased ______ may lead to demineralization of bones which can lead to vertebral compression frx and other frx.
  • Calcium from bones absorbed into blood and deposited into the kidneys which can result in what?
A
  • 3 years
  • WB
  • kidney stones
74
Q

What are some ways to manage Osteoporosis and Renal Calculi?

A
  • Early mobilization
  • Therapeutic standing
  • Administration of calcium supplements
  • Good dietary management
75
Q

PART 4: THE ASIA EXAM

A

PART 4: THE ASIA EXAM

76
Q

What is the gold standard for how we pull together diagnostic, clinical and prognostic information about a person’s SCI.

A

-The ASIA Exam

77
Q
  • Do all SCIs have an ASIA exam completed?

- How long does the ASIA Exam take?

A
  • Yes

- 60-90 minutes (no time to do often)

78
Q

What are the (4) main parts to the ASIA Exam?

A
  • Determine Motor Level
  • Determine Sensory Level
  • Determine Neurological Level
  • Determine ASIA Level
79
Q

Motor Level:

  • Refers to the most _______ segment with normal motor function on each side of the body.
  • Performed by examining ________ in UE and LE, as well as voluntary _____ contraction.
A
  • caudal

- myotomes, anal contraction

80
Q

Sensory Level:

  • Refers to the most _______ segment of the spinal cord with normal sensory function on each side of the body.
  • Evaluated via a key sensory point within each of the ____ dermatomes on the R and L (light touch, sharp/dull) and deep ______ sensation.
A
  • caudal

- 28, anal sensation

81
Q

Neurological Level:

  • Refers to the most caudal segment of the spinal cord with normal _______ and _________________ function on both sides, provided there is normal function rostrally.
  • Helpful in predicting which parts of the body may be affected by paralysis and loss of function.
  • Used for prognostic indicators and expected ___________ capabilities.
  • Determined by evaluating integrity of what (3) things?
A
  • sensory and antigravity muscle function
  • functional capabilities
  • motor function, sensory function, sacral reflex activity
82
Q

ASIA Level:

  • Determine whether lesion is _______ or _________.
  • ASIA level involves looking at _______/_______ exam, but also considers any preservation of ________ segments.
  • S4-S5 innervates what?
A
  • Complete or incomplete
  • sensory/motor, sacral segments (S4-S5)
  • anus
83
Q

What are the 5 ASIA Levels?

A
  • A = Complete
  • B = Sensory Incomplete
  • C = Motor Incomplete
  • D = Motor Incomplete
  • E = Normal
84
Q

ASIA A: Complete

  • No ________ or _______ function is preserved in the _________ segments.
  • ______ may be present.
A
  • sensory or motor, sacral (S4-S5)

- ZPP

85
Q

ASIA B: Sensory Incomplete

  • ________ but not _______ function is preserved below the neurological level and includes the _________ segments (light touch/pin prick at S4-5 or deep anal pressure).
  • AND no motor function is preserved more than ____ levels below the motor level on either side of the body.
A
  • Sensory but not motor, sacral (S4-S5)

- 3 levels

86
Q

ASIA C: Motor Incomplete

  • _____ function is preserved at the most caudal sacral segments for voluntary anal contraction.
  • OR patient meets criteria for _______ ________ status (sensory function preserved at most caudal sacral segments (S4-S5) by LT, PP, or DAP), and has some sparing of motor function more than ___ levels below ipsilateral motor level on either side of the body. (This includes key or non-key muscle functions to determine motor incomplete status.)
  • For ASIA C - less than half of key muscle functions below the single NLI have a muscle grade ≥ ___.
A
  • Motor function
  • sensory incomplete status, 3 levels
  • ≥3
87
Q

ASIA 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 ≥ ___.

A
  • ≥3
88
Q

ASIA E = _________

A

-Normal

89
Q

SCI Prognosis:

  • ___% of people with SCI who survive the first 24 hours are still alive 10 years later.
  • Mortality rates are significantly higher in _______ post injury (__-__ more likely to die prematurely than people without SCI).
  • Life expectancy = ___% of normal and varies based on level of injury. (Higher injury and older age = more negative effects on life expectancy)
  • What are the 2 leading causes of death in SCI patients?
  • About ___% of persons with SCI are re-hospitalized one or more times during any given year following injury.
A
  • 85%
  • first year (2-5x more likely)
  • 90%
  • Pneumonoia and Septicemia
  • 30%
90
Q

SCI Prognosis:

  • What are some prognostic indicators for walking? (5)
  • Which is the #1 prognostic indicator for walking?
A
  • ASIA Level***
  • Early exam of reflexes
  • SCI syndromes
  • Acquired SCI < Traumatic SCI
  • Age

S6- Neuro 2 (18 decks)

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