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10 - Rehabilitation > 10-06 Traumatic Spinal Cord Injury > Flashcards

10-06 Traumatic Spinal Cord Injury Flashcards

1
Q

Spinal Cord Injury (Traumatic/Non-Traumatic)

A
  • Traumatic SCI is most common
  • 39% of SCI is non-traumatic
  • Non-traumatic not caused by accidents - Thrombus, Embolism, RA, Diseases, Vascular issues
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2
Q

Common causes of SCI

A
  • MVA (40%)
  • Falls (27.9%)
  • Violence (15%)
  • Sports (8%)
  • Men > Women (3.5:1): Men are more adventuresome, take more risks
  • Average age: 16-30 yo
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3
Q

SC Anatomy

A
  • Spinal nerves exit below corresponding level of spine (exception is cervical, exit above)
  • 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)
  • SC ends at T12
  • SC tapers into conus medullaris at lower border of T1
  • Cauda Equina (LMN Lesion)
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4
Q

Lesion

A
  • Loss of sensation and/or motor function below segmental level of injury (ex: C6 SCI = loss of C6 motor and sensation at C6 and below C6
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5
Q

Cervical Nerve Root Innervation

A
  • C1-C3: Facial muscles
  • C4: Diaphragm and traps
  • C5: Delts
  • C6: Wrist extensors
  • C7: Triceps
  • C8-T1: Hands and fingers
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6
Q

Thoracic Nerve Root Innervation

A
  • T2-T8: Chest Muscles

- T6-T12: Abdominals

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7
Q

Lumbar Nerve Root Innervation

A
  • L1-S1: LE muscles
  • S1-S2 hip and foot muscles
  • S3 bowel and bladder
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8
Q

Key Muscles

A
  • Elbow Flexion (Biceps Brachii @ C5)
  • Wrist Extension (Extensor Digitorum @ C6)
  • Elbow Extension (Triceps Brachii @ C7)
  • Finger Flexion - Distal (Flexor Digitorum Profundus @ C8)
  • Finger Abduction (Dorsal Interossei @ T1)
  • Hip Flexion (Iliopsoas @ L2)
  • Knee Extension (Quadriceps @ L3)
  • Ankle DF (Tibialis Anterior @ L4)
  • Great Toe Extension (Extensor Hallicus Longus @ L5)
  • Ankle PF (Gastrocnemius @ S1)
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9
Q

Spinal Tracts

A
  • Tracts either cross at SC or brain
  • SC cross section with areas/tracts labeled (pain, temp, proprioception, vibration, motor, LE)
  • Autonomic (fight or flight) system, located at horns of T6 and above, innervation to systems, vitals
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10
Q

Posterior Column (Dorsal Column/Medial Lemniscal Tracts (DCML)

A
  • Fasciculus Gracilis + Cuneatus = Posterior Column
  • FG = Proprioception (light touch) @ LE
  • FC = Proprioception (light touch) @ UE
  • Ascending tracts, cross at the brain (thalamus)
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11
Q

Corticospinal Tract

A
  • Only descending motor tract to muscles

- Crosses at the brain (medulla), possibly explains deficiency opposite side

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12
Q

Spinothalamic Tract

A
  • Pain and temperature (and light touch)
  • Crosses at segmental SC level
  • Still ascends 1-2 levels before crossing
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13
Q

Shared tracts

A
  • Pain and temp on same tract (Spinothalamic)
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14
Q

Duplicated tracts

A
  • DCML crosses at brain, spinal thalamic crosses at SC
  • Light touch spared with unilateral SCI
  • Duplication makes light touch not a good sensation to test
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15
Q

Tetraplegia (Quadraplegia)

A
  • Cervical lesion
  • Paralysis of all 4 extremities and trunk
  • Affected areas include respiratory muscles at level C2-C4
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16
Q

Paraplegia

A
  • Thoracic, lumbar or cauda equina lesion

- LE and trunk paralysis (bad postural control)

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17
Q

Neurological Level (ASIA)

A
  • Most caudal level of SC with NORMAL motor and sensory function on both R and L
18
Q

Motor Level (ASIA)

A
  • Most caudal segment with normal MOTOR function BILATERALLY
19
Q

Sensory Level (ASIA)

A
  • Most caudal segment with normal SENSORY function BILATERALLY
20
Q

Complete Injury

A
  • No sensory or motor function in the lowest sacral segment (S4-S5)
21
Q

Incomplete Injury

A
  • Motor and/or sensory function below the neurological level INCLUDING sensory and/or motor at S4-S5
22
Q

ASIA A (ASIA Impairment Scale)

A
  • Complete Injury, “worst”

- NO motor or sensory function preserved IN THE SACRAL segments S4-S5.

23
Q

ASIA B (ASIA Impairment Scale)

A
  • Incomplete

- SENSORY, but not motor function is PRESERVED BELOW the neurologial level and includes sacral segments S4-S5

24
Q

ASIA C (ASIA Impairment Scale)

A
  • Incomplete
  • MOTOR function preserved below neurological level, and MORE THAN HALF of key muscles BELOW neurological level have a muscle grade LESS than 3
25
Q

ASIA D (ASIA Impairment Scale)

A
  • Incomplete
  • MOTOR function preserved below neurological level, and AT LEAST HALF of key muscles BELOW neurological level have a muscle grade of 3 or MORE
26
Q

ASIA E (ASIA Impairment Scale)

A
  • Best

- Motor and sensory function is normal

27
Q

Brown-Sequard Syndrome

A
  • Injury to hemisection of SC (usually stabbing)
  • Ipsilateral loss: Proprioception and vibration
  • Contralateral loss: Pain and temperature
  • Loss = several dermatome levels below lesion level
28
Q

Central Cord Syndrome

A
  • UE involvement > LE involvement
  • Pt can walk, but not move arms
  • Caused by cervical hyperextension injury
  • Compressive forces –> hemorrhage and edema in central SC
29
Q

Posterior Cord Syndrome

A
  • Rare injury
  • Loss of proprioception, epicritic sensation
  • Widens basse steppage gait
  • Intact pain and light touch
  • Intact motor
30
Q

Anterior Cord Syndrome

A
  • Preserves proprioception and balave
  • Loss of pain and temperature (spinothalamac tract damaged)
  • Loss of motor (corticospinal tract damaged)
  • Caused by cervical flexion injury –> damage to anterior SC
31
Q

Sacral Sparring

A
  • Incomplete lesion
  • Sacral tracts are spared from injury (most central of sacral tracts preserved)
  • Intact perianal sensation
  • External sphincter muscle contracts
  • Often first sign of incomplete cervial SCI
32
Q

Cauda Equina Injuries

A
  • Usually incomplete
  • Peripheral injury (not central), LMN
  • Potential to regenerate like peripheral nerves
  • Full neurological recovery is uncommon
  • Long axons make location of injury far from site of innervation
  • Scarring on axons may block regeneration
  • Muscle may not be functional once regeneration occurs
33
Q

Spinal Shock

A
  • Reflexes depressed or absent
  • Flaccidity
  • Loss of sensation
  • Loss of motor function
  • Spinal column protects itself by shutting down; takes days or weeks to open itself up again
34
Q

Motor/Sensory Impairments

A
  • Complete or partial loss of muscle function below level of lesion
  • Impaired or absent sensory function below level of lesion
  • Dependent on type of lesion and where lesion occurs
35
Q

Autonomic Dysreflexia

A
  • Medical condition is life-threatening; Treat as emergency, take pt to ER.
  • Occurs in SCI T6 and above with complete and incomplete lesions
  • Noxious stimulus below level of lesion
36
Q

Automatic Dysreflexia (Intervention)

A
  • Immediate intervention required
  • Activate code (depends on facility)
  • If pt flat, bring to sitting (to lower BP)
  • Identify stimulus and relieve it (usually bladder)
  • If can’t immediately find stimulus, drain bladder
37
Q

Orthostatic Hypotension

A
  • More common at T6 and above
  • Sx: Nausea, dizziness, fainting
  • Lack of muscle tone –> peripheral venous pooling
38
Q

Orthostatic Hypotension (Intervention)

A
  • Gradually, slowly progress to upright position to allow CV system adaptation
  • Abdominal binder or compression stockings
  • Reverse sx by returning to original position
39
Q

Temperature Control

A
  • Loss of internal thermo0regulatory responses
  • Loss of ability to shiver
  • No vasodilation response with heat
  • No vasoconstriction response with cold
  • Paralysis
  • Loss of sweating
  • Compensatory diaphoresis above level of lesion
  • Educate pt that they cannot regulate body temperature, and needs to be monitored, especially with exercise
40
Q

Respiratory Impairment

A
  • C1-C3 Loss or impaired spontaneous breathing
  • Ventilator required, or phrenic nerve stimulator
  • Decreases cough function to expel secretions on their own
41
Q

Spasticity

A
  • Flaccidity during spinal shock, then muscle spasticity below level of lesion
  • Spasticity increases over first 6 months, plateaus at one year
  • May learn to trigger spasticity to assist with function (minimal to moderate)
  • If interferes with function, medical management: oral, intrathecal injection, baclofen pump

10 - Rehabilitation (25 decks)

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