Week 7 - Tuesday Flashcards
Spinal cord functions
two way conduction pathway (to and from the brain)
contains motor and sensory neurons
LMN lesion
Lower motor neurons
affects nerve fibers traveling to relevant nerves via anterior horn or motor nuclei of cranial nerves
UMN Lesions
Upper motor neurons
where most spinal cord injuries occur
occurs in neural pathway above anterior horn cell of spinal cord
where is the injury/condition if UMN and LMN is affected?
spinal cord and adjacent spinal root involvement
tumor or big cut at the spine
Quadriplegia/tetraplegia
partial or total loss of all 4 limbs and torso
C1-C7
loss of sensory and motor
Triplegia
partial or total loss of use of 3 limbs
usually both legs and one arm
Paraplegia
partial or total loss use of lower extremities
torso may be involved
Monoplegia
partial or total loss of use of one limb (usually arm)
Hemiplegia
Up to full paralysis of one side of body
may have trouble speaking or breathing
Diplegia
Stiffness, weakness or lack of mobility in muscle groups on both sides of body
ASIA A: Complete
no motor or sensory function is preserved in S4-S5
ASIA B: Incomplete
sensory is preserved below neurological level and includes sacral segments
motor function is not preserved
ASIA C: Incomplete
motor function is preserved below the neurological level
ASIA D: Incomplete
motor function is preserved with muscle grade > 3
ASIA E
normal
SCI Syndromes
Central cord syndrome
Brown-Sequard Syndrome
Anterior Cord Syndrome
Posterior Cord Syndrome
Conus Medullaris Syndrome
Cauda Equina Syndrome (Not considered a true SCI b/c it is nerves)
Which is the most common SCI Syndrome
Central Cord Syndrome
Central Cord Syndrome
Usually occurs in cervical spine
greater involvement of the UEs than the LEs
Brown-Sequard Syndrome
One side of spinal cord
Results from a hemi-section of the spinal cord
What can cause Brown-Sequard Syndrome
spinal tumor
spinal cord infection
inflammation of spinal cord
penetrating wounds to spinal cord
Anterior cord syndrome
affects anterior 2/3 of the spinal cord, sparing posterior third
typically poorer prognosis for functional improvement
Least common SCI syndrome
Posterior Cord syndrome
Posterior cord syndrome
loss of proprioception and sense of vibration below level of injury
motor function, sensation of pain, temperature and touch remain intact
Conus Medullaris Syndrome
terminal end of spinal cord (T12-L2 in adults)
most commonly caused by trauma or tumors
very LE weakness
SCI clinical picture
Spinal shock: period of areflexia (days to months)
impaired temperature control
respiratory impairment
spasticity
B/B changes
SCI: secondary complications
Pressure sores
Autonomic dysreflexia (AD)
postural hypotension
heterotopic bone formation
contractures
pain
DVT
osteoporosis
muscle spasms
Muscle spasms
involuntary muscle movements
interrupted signals between reflexes and brain
AD
Autonomic Dysreflexia
overactivity of autonomic nervous system
causes sudden onset of high BP
associated with lesion at or above T6
AD interventions
place pt. in upright position
loosen tight clothing, leg bags
NOT OUR JOB:
Check B/B, other sources
pharmacological interventions
Which brace is common after an SCI
Thoraco-Lumbar Brace
SCI PT management: Acute phase
respiratory management
Prevention of complications
ROM maintenance
strengthening/facilitation of active movements as permitted medically
Orientation to vertical
WE WILL HELP THEM MOVE THEIR LEGS
SCI PT Management: Rehab phase
Functional expectations
education
ROM, strength, function
W/c prescription and management
ambulation (as appropriate)
Tenodesis Grasp and release
person may be able to send signal to control the wrist but not fingers
when wrist is extended, tendons along the fingers will shorten and close fingers
when wrist is flexed, tendons will lengthen and extend outward passively
