Exam 1 Lecture 4: spinal cord Flashcards Preview

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Flashcards in Exam 1 Lecture 4: spinal cord Deck (47)
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1

MOI of SCI


Traumatic

  • –MVA, Falls, GSW (gun shot wounds), war injuries

Non-traumatic

  • –Vascular, vertebral subluxations, infections, abscesses, neoplasms, diseases (MS or ALS)

2

What is the most common age and gender?


•Males 16-30 Y/O
 

3

Employment rates 8 years post injury

 


–37% employment- paraplegic
–30% employment- tetraplegia/quadriplegia
 

4

  • Precent of discharge from total stay (trauma & rehab)

 


•D/C from total stay (trauma and rehab)

  • –89% home
  • –5% nursing home
     

5

Average stay in acute hospital

 


•Acute hospital stay 15 day average
 

6

Rehabilitation stay average

 


•Rehabilitation average stay 44 days
 

7

Metical Cost (1st year & subsequent years)

 

 

–1st year

  • •Quadriplegia
    • –$300,000 to $400,000
  • •Paraplegia
    • –$150,000

–Subsequent years

  • •Quadriplegia
    • –$30,000 to $75,000
  • •Paraplegia
    • –$15,000 to $20,000
       

Numbers are out of date, so we don't really need to know them

8

Life expectancy (increased, decreased, same)

 

decreased (didn't say how much)

9

SCI Classifications

 

•Quad or Tetraplegia- all 4 extremities involved and trunk

  • –Partial or complete cervical cord
    • •Sensory, autonomic, motor

•Paraplegia- LE’s and possibly trunk involved

  • –Partial or complete Thoracic or Lumbar cord or sacral roots
    • •Sensory, autonomic, motor

•Named for the level of last intact or partially intact nerve root

  • –C7 complete vs incomplete (can they possibly walk? How?)
  • –L2 complete vs incomplete (can they walk? How?)
  • –Oblique name each side separately
    • •C5 on R (incomplete) and C6 on L (complete)

•Sacral Sparing- signs that lesion is incomplete

  • –Toe flexion, perianal sensation, sphincter contraction (wink)
     

10

Bowel & bladder training

 

learn to keep track of intake and output so you can go void before it happens on its own

11

Classification:

•Quad or Tetraplegia


Quad or Tetraplegia- all 4 extremities involved and trunk

  • Partial or complete cervical cord
    • •Sensory, autonomic, motor

She has never heard of anything called

12

Classification: Paraplegia

 


•Paraplegia- LE’s and possibly trunk involved

  • –Partial or complete Thoracic or Lumbar cord or sacral roots
    • •Sensory, autonomic, motor
       

13

How are SCI named?

 


•Named for the level of last intact or partially intact nerve root

  • –C7 complete vs incomplete (can they possibly walk? How?)
  • –L2 complete vs incomplete (can they walk? How?)
  • –Oblique name each side separately
    • •C5 on R (incomplete) and C6 on L (complete)
       

14

Sacral Sparing

 


•Sacral Sparing- signs that lesion is incomplete

  • –Toe flexion, perianal sensation, sphincter contraction (wink)

15

Can you use a manual wheelchair with a quadriplegic?

Yes it might be possible. Quadriplegict just means all four limbs are involved, not neccesarily useless.

16

what might we use with paraplegic complete with orthostatic hypotension?

 

Abdominal binder

arm movements

17

Can a C7 SCI patient walk?

 

there is new technology where we can imbed electrodes into leg muscles on a walker that are being created. Problem is there is no sensory feedback or correction

 

It is wireless now

18

AFO

 

Ankle Foot Orthosis

19

KAFO

Knee Ankle Foot Orthosis

20

KO

 

Knee Orthosis

21

Brown Sequard Syndrome

 

Rare (could be from stabbing or other)

Hemi-ipsilateral and contralateral loss (depending on site of lesion and what has crossed and not crossed)

 

  • –Motor- strength deficit or loss
  • –Lateral column damage- areflexia, clonus, +Babinski
  • –Dorsal column damage- lack of proprioception, kinesthesia, vibration sense
  • –Spinothalamic tract- Contralateral (2-4 segments above is damaged) therefore sensory loss in dermatome distribution opposite side
    • •Pain and temperature, sensation
       

22

Anterior Cord Syndrome: Everything


•Mechanism of injury

  • –Anterior spinal artery damage
  • –Cervical flexion injury

•Corticospinal tract- carries what information?

  • –Motor loss

•Spinothalamic tract- carries what information?

  • –Pain and temperature, sensation
    • •contralateral

•DCML involved? NO

  • –Posterior spinal artery

23

Central Cord Syndrome

 


•Hyperextension injury or narrowing of spinal canal

  • –Congenital or stenosis
  • –Sulcus arteries
  • –Most often in cervical region

Very Rare

24

Diplegia

 

Name for when both UE are paralized but not Lower extermities.

25

Posterior Cord Syndrome

 

 

  • •Rare
  • •Posterior spinal artery
  • •Motor intact
  • •Pain and light touch intact
  • •Dorsal columns involved
    • –Proprioception, vibration
       

26

Cauda Equina Injruies

 

 

  • •Can be complete, usually incomplete
  • •LMN lesion- significant due to possible regeneration
  • •MOI- traumatic fracture or dislocation

Has the potential to regenerate because it is a lower motor neuron
 

27

Clinical Manifestations of SCI

 


•Spinal Shock

  • –Post injury areflexia
  • –Hours to weeks symptoms resolve (acute care)

•Motor and Sensory Impairments

  • –Complete or partial loss below level of injury ie. C7 and below

•Body temperature regulation

  • –Hypothalamus can not control blood flow or sweating
    • •Diaphoresis (excessive sweating) above level of lesion

•Respiratory dysfunction

  • –C1 and C2 possibly C3 lesions- phrenic nerve loss
    • •Ventilator
    • •Risk for pneumonia, pulmonary embolism, infections, atelectasis
    • •Coughing, deep breathing, accessary muscle issues

•Spasticity

  • –Hypertonicity, hyperactive stretch reflex and clonus
    • •Can help or hurt with function
    • •Can be treated with medication
      • –Nerve blocks, intrathecal injections
    • •Surgeries for spasticity
      • –Myotomy- muscle release
      • –Neurectomy- cut involved nerve/s (partial or complete)
      • –Tenotomy- lengthening of a tendon

Clinical Manifestations (continued)-Bowel and Bladder dysfunction (see another slide for details)
 

28

Clinical Manifestations of SCI: Spinal Shock

 


–Post injury areflexia
–Hours to weeks symptoms resolve (acute care)

 

First stage

Want it to stop here

29

Clinical Manifestations of SCI:
•Motor and Sensory Impairments
 

 


–Complete or partial loss below level of injury ie. C7 and below
 

30

Clinical Manifestations of SCI: Body temperature regulation
 

 

  • –Hypothalamus can not control blood flow or sweating
    • •Diaphoresis (excessive sweating) above level of lesion