Week 4- SCI Flashcards
1
Q
how is a radiculopathy diff from a SCI
A
radiculopathy effects nerve root whereas SCI affects actual spine
2
Q
traumatic risk for SCI is greater in
A
younger adults (males) or older adults
3
Q
what are the two types of SCI
A
traumatic
non traumatic
4
Q
the following characteristics describe what type of SCI
- 1/2 of all SCI
- external physical impact
- increased incidence in younger adults (males) or older adults
A
traumatic SCI
5
Q
the following characteristics describe what type of SCI
- acute/ chronic disease processes
- ex) tumour, infection, bleeds, DDD
A
non-traumatic SCI
6
Q
historically SCI meant what?
A
high mortality
this is still preset only in low income countries
7
Q
what are the top 3 leading causes to SCI in America’s
A
- transport
- falling
- assault
8
Q
what specifically causes a SCI
A
contusion
compression
concussion
tear/ cutting Spinal cord neves
9
Q
________ bruise within the spinal cord
A
contusion
10
Q
__________ pressure on the spinal cord from outside source
A
compression
11
Q
_____ sudden, temporary (hours) , from violent jarring trauma to tissue around spinal cord
A
concussion
12
Q
what is the mechanism how does a SCI happen, what are the 3 main contributions of injury?
A
- impact + persistent/intermittent compression
- burst fracture/ bone fragments compressing spinal cord
- fracture dislocation injury - distraction
- pulling 2 vertebrae apart
- stretching of spinal cord - laceration/ transecion (rare)
- seen in military, “missile” injuries. sharp bone fragments cutting through tissue
13
Q
what is the ant blood supply of spinal cord
A
anterior spinal artery
- from vertebral art
- supplies 2/3rds of the cord
14
Q
what is the post blood supply of spinal cord
A
posterior spinal arteries
- from pica
- 1/3rd of spinal cord
15
Q
following a SCI ________ happens to neurons
A
death to neurons
16
Q
how do neurons die after a SCI
1.
2.
A
- Necrosis:
- damaged cells swell + burst
- can cause surrounding tissue to die (cause inflammation)
- common result of ischemia - Apoptosis:
- cell suicide
- planned death
- Controlled
- non inflammatory
17
Q
______ damage is usually worse than ________ damage
A
secondary
initial
18
Q
inflammation if left untreated = increase in
A
cell damage
19
Q
primary SCI characteristics
A
- immediate mechanical damage
- damage to:
- neuronal axons
- blood vessels - ischemia:
- rupture of tissue
- increased pressure
- shock= decrease BP
- Vasospasm, decreased blood flow
cell death via Necrosis:
- neuronal
- glial cells
initiates secondary injury cascade
20
Q
Secondary injury phase SCI characteristics
A
- starts mins after injury and continues for long time (years, months)
- early cell death- necrosis
- late cell death- Apoptosis
- cellular, molecular, and biochemical processes activated that continue damage to Spinal cord tissue
21
Q
Secondary injury phases in order
A
ACUTE (First 2 days)
1. continued hemorrhage + ischemia
- increasing edema (swelling)
- excitoxicity (increased glutamate)
- inflammation (up to 70% damage)
- demyleination
INTERMEDIATE (2 weeks)
6. scar formation (astrogliosis)
CHRONIC (2 weeks - yrs)
7. cyst formation
- Wallerian degradation
22
Q
________ principle: too much/ too little = Bad!
A
goldilocks
23
Q
how long does it take microglial, astrocytes cells to arrive to injury site
A
within minutes
24
Q
______ abnormal increase in astrocytes in space left behind by death of surrounding neurons
A
astrogliosis
25
astrogliosis
starts ___ - ____ day post
completed ___ - ____ weeks post SCI
Benefits:
-
-
disadvantages:
-
-
7-10 days
2-3 weeks
benefits:
- keeps inflammatory cells at damaged site
- protect surrounding tissue
disadvantages;
- physical barrier to nerve growth
- emits chemical signals that axon regeneration
26
cysts are a continued formation of ?
scar tissue forming
27
_________ is disintegration if axons and myelin sheaths after connection with the cell body is interrupted
Wallerian Degeneration
28
what are the two characterizing SCI
1. complete lesion (~45%)
- no sensation/ motor control below injury
2. incomplete lesion
- some function
- highly variable
29
the following characteristics are present in what level SCI?
Head, neck, shoulder movement
- Limited
Arm movement
- Paralysis
Trunk movement
- paralysis
Pelvis
- paralysis
Legs
- paralysis
personal care:
- complete dependence
mobility:
- motorized wheelchair w/ head/ mouth control
C1-C4 (quadriplegia)
30
the following characteristics are present in what level SCI?
Head, neck, shoulder movement
- Full
Arm movement
- varying
Trunk movement
- paralysis
Pelvis
- paralysis
Legs
- paralysis
personal care:
- variable
mobility:
possible manual wheelchair
C5-C8 (quadriplegia)
31
the following characteristics are present in what level SCI?
Head, neck, shoulder movement
- Full
Arm movement
- Full
Trunk movement
- varying
Pelvis
- paralysis
Legs
- paralysis
personal care:
- moderate
mobility:
manual wheelchair
T1-T12 (paraplegia)
32
the following characteristics are present in what level SCI?
Head, neck, shoulder movement
- Full
Arm movement
- Full
Trunk movement
- Full
Pelvis
- varying
Legs
- Varying
personal care:
- good
mobility:
- possible walking
L1-L5 (paraplegia)
33
the following characteristics are present in what level SCI?
Head, neck, shoulder movement
- Full
Arm movement
- Full
Trunk movement
- Full
Pelvis
- impaired; bowel, bladder, post buttock, leg sensation
Legs:
- Varying
personal care:
- independent w/ personal care
S1-S5 (paraplegia)
34
what are some examples of Incomplete SCI symptoms
1.
2.
3.
4.
1. ant cord syndrome
- lost:
- movement
- pain
- temp sensation
preserved:
- proprioception, vibration, deep touch
2. central cord syndrome
lost;
- movement (upper>lower)
- sensation
- possible bowel/bladder function loss
3. post cord syndrome
lost:
- proprioception, vibration, discriminatory touch
- coordination of limb movement difficult
preserved:
- movement
- pain and temp, light touch sensation
4. brown-sequard syndrome
- damage to one side of spinal cord
- commonly a penetration wound
- movement: ipsilateral
- vibration ipsilateral
- pain: contralateral
- temp: contralateral
(pain + temp starting at 1 or 2 levels below lesion)
*presents like stroke patient*
35
true or false?
dependant on the lesion you can have impaired SNS control via spinal levels but intact PSN regulation (cranial nerves)
true
36
what are the two main types of symptoms of SCI
1. pain (30-90%)
2. Autonomic dysreflexia
37
what are the two types of pain?
1. Nociceptive Pain
2. Neuropathic Pain
38
what are the key characteristics of Nociceptive Pain
- typical pain
- not from neural cites
- musculoskeletal
- inflammatory pain
- treated with:
- exercise
- physiotherapy
- NSAIDS
39
what are the key characteristics of Neuropathic Pain
- damage to nervous tissue
- CNS misinterpreting signals of pain
ex) perceiving pain w/ no actually pain present
- can be immediate or longer
- stimulus can be from noxious stimuli (hyperalgesia) or non painful stimulus (allodynia)
40
what is the treatment of Neuropathic Pain
there's a problem:
- effective treatments are lacking
- resistant to meds
some theories:
- stim of motor cortex
- some meds (antidepressants + amitriptyline)
41
what is the biggest concern with ANS dysregulation?
+
other things related to it
below the lesion there is damage to the regulation of arteries to perform vasoconstriction/ vasodilation
- loss of vascular tone
- loss of sympathetic outflow to heart if above T5
- hypotension (no vasocontriction)
- blood pooling
- reduced vascular return to heart
42
Autonomic Dysreflexia affects what levels of the spinal cord injuries more?
high level SCI (above/ at T6)
43
in Autonomic Dysreflexia noxious stimulus (full bladder, skin irritation, distension in bowl) below level on injury results in what
overreaction
44
give an example describe how Autonomic Dysreflexia works when ur bladder is full
ex)
bladder is full, this noxious stimulus is sensed via SNS but not higher order brain structures. when the SNS senses this and the higher order brain structures dont they cannot turn off the action of the SNS. so when the SNS responds it causes a flight/fight response = vasoconstriction = hypertension which could be potentially life threatening because they cannot bring BP down
45
are the following symptoms above the level of injury or below?
- increase BP
- no sweating
- Vasocontriction
- Vasodilation
- decrease heart rate
- increase sweating
- headache
- pale
- flushed face
- bradycardia
- blurred vision
- hypertension
- cool skin
above
below
below
above
above
above
above
below
above
above
above
below
below
46
in terms of the ASIA Scale name the following grades
sensory:
grade:
0=
1=
2=
grade:
0= absent sensation
1= impaired or altered
2= normal sensation
the total normal score is 112
47
what does the ASIA scale do to assess sensory function
1.
2.
light touch
pin prick
48
what does the ASIA scale do to assess motor function
tests the function of muscle strength example:
hip flexors
elbow flexors
finger flexors
etc
49
where does the ASIA scale assess motor function
cervical and lumbar regions
C5-T1
L2-S1
50
Why doesn't the ASIA scale assess thoracic regions for motor function
we don't have much motor control over our thoracic muscles
51
myotome testing is used to assess motor or sensory
motor
52
dermatome testing is used to assess motor or sensory
sensory
53
explain the 6 point scare for motor myotome testing
0= total paralysis
1= palpable/visible contraction
2= active movement, Full ROM, gravity eliminated
3= active movement, full ROM, against gravity
4= active movement, full ROM, against gravity + moderate assistance (weakness)
5=normal active movement and full ROM and full resistnace in functional muscle position
54
the level of neurological injury is defined as
the most caudal (distal) functioning root level with intact sensation and >/= grade 3 motor function.
55
if someone has the following
WHAT IS THE NEUROLOGICAL LEVEL OF INJURY and why?
is this complete or incomplete and why?
SENSORY
light touch:
C2: 2 2
C3: 2. 2
C4: 2. 2
C5: 2. 2
C6: 2. 2
C7: 0. 0
Pin prick
C2: 2. 2
C3: 2. 2
C4: 2. 2
C5: 2. 2
C6: 2. 2
C7: 0. 2
C8: 0
MOTOR
C2
C3
C4
C5: 5 5
C6: 5 5
C7: 5 5
C8: 3 3
T1: 1 0
C6
because that the last spinal cord level with full intact sensation and with a motor grade of 3 or higher.
compete because there is zero sensation in the light touch and [in prick tests. after C6 and C7 there is zero sensation left
56
what is the timeline for SCI rehab?
1-3 weeks
2-3 months
outpatient rehab
community programs
acute care
impatient rehab
3-12 months
yearly medical review
57
what are the SCI treatments for acute care (1-3 weeks)
1. neuroprotection (minimize further damage)
(limit cell death)
1-2 weeks
2. Neuroplasticity
(repair)
3. Compensation
(use surviving cells to do previous task that were done from damaged cells)
or early treatments:
- to help keep inflammation down:
Methylprednisolone (drug)
decompression surgery
stabilization of neck
58
cervical + high thoracic spinal cord injuries disrupt the outflow of the SNS.
which can result in
- loss in vascular tone
(below level of injury)
- loss of sympathetic
outflow to heart if above
~T5
- hypotension
- blood pooling
- reduced vascular return
59
what are the symptoms of Autonomic Dysreflexia
- overreaction of ANS
- in high level of SCI
- noxious stimuli below level of injury results in overreaction
- life threatening left unchecked --> sudden peripheral vasoconstriction + acute hypertension
60
SNS responds to noxious stimuli
causes increase in fight/flight
causes vasoconstriction
body unable to bring down B
61
what are the SCI treatments for Inpatient Rehab (2-3 month)
- mobility
- self care *
- preparing for return home*
Skills training:
- postural control8
- strengthening
- bed/ mat mobility
- transfers
- bladder routine
- bowel routine
- respiratory management *
- assistive deep breathing + coughing *
- upper limb devices + tenodesis *
62
what are the SCI treatments for outpatient Rehab (3-12 month)
avoid complications associated w/ immobilization
- ROM
- Position changes
- skin care
- help with bladder + bowel
CIMT: constraint -induced movement therapy
- training that forces use of affected upper limb to encourage recovery
- this maintains integrity but CANNOT be used in COMPLETE SCI
BWSSTT: Body weight supported treadmill training
- individuals w/ some control of lower limb
FES:
- reinforces muscle activation
- for phrenic (respiration) and sacral (urination), limb (neuroplasticity) nerves.
63
what are the benefits BWSSTT
improved function
preserve muscle mass
reverse atrophy
64
what are some examples of community programs/ yearly medical review for SCI
- aerobic activity:
- swimming, hand cycling, wheeling
- strengthening:
- weight, bands
65
what are some examples of new research for SCI
- spinal cord stim ; jumps over damage
- brain spinal cord interference ; cortical implants
