Exam 1 Lecture 4: spinal cord

Question 1

MOI of SCI

Answer 1

Traumatic

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

Non-traumatic

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

Question 2

What is the most common age and gender?

Answer 2

•Males 16-30 Y/O

Question 3

Employment rates 8 years post injury

Answer 3

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

Question 4

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

Answer 4

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

• –89% home
• –5% nursing home

Question 5

Average stay in acute hospital

Answer 5

•Acute hospital stay 15 day average

Question 6

Rehabilitation stay average

Answer 6

•Rehabilitation average stay 44 days

Question 7

Metical Cost (1st year & subsequent years)

Answer 7

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Numbers are out of date, so we don’t really need to know them

Question 8

Life expectancy (increased, decreased, same)

Answer 8

decreased (didn’t say how much)

Question 9

SCI Classifications

Answer 9

•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)

Question 10

Bowel & bladder training

Answer 10

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

Question 11

Classification:

•Quad or Tetraplegia

Answer 11

Quad or Tetraplegia- all 4 extremities involved and trunk

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

She has never heard of anything called

Question 12

Classification: Paraplegia

Answer 12

•Paraplegia- LE’s and possibly trunk involved

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

Question 13

How are SCI named?

Answer 13

•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)

Question 14

Sacral Sparing

Answer 14

•Sacral Sparing- signs that lesion is incomplete

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

Question 15

Can you use a manual wheelchair with a quadriplegic?

Answer 15

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

Question 16

what might we use with paraplegic complete with orthostatic hypotension?

Answer 16

Abdominal binder

arm movements

Question 17

Can a C7 SCI patient walk?

Answer 17

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

Question 18

AFO

Answer 18

Ankle Foot Orthosis

Question 19

KAFO

Answer 19

Knee Ankle Foot Orthosis

Question 20

KO

Answer 20

Knee Orthosis

Question 21

Brown Sequard Syndrome

Answer 21

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

Question 22

Anterior Cord Syndrome: Everything

Answer 22

•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

Question 23

Central Cord Syndrome

Answer 23

•Hyperextension injury or narrowing of spinal canal

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

Very Rare

Question 24

Diplegia

Answer 24

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

Question 25

Posterior Cord Syndrome

Answer 25

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

Question 26

Cauda Equina Injruies

Answer 26

* •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

Question 27

Clinical Manifestations of SCI

Answer 27

•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)

Question 28

Clinical Manifestations of SCI: Spinal Shock

Answer 28

–Post injury areflexia –Hours to weeks symptoms resolve (acute care) First stage Want it to stop here

Question 29

Clinical Manifestations of SCI: •Motor and Sensory Impairments

Answer 29

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

Question 30

Clinical Manifestations of SCI: Body temperature regulation

Answer 30

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

Question 31

Clinical Manifestations of SCI: Respiratory Dysfunction

Answer 31

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

Question 32

Clinical Manifestations of SCI: Spacticity

Answer 32

–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

Question 33

Clinical Manifestations of SCI: Bowel Dysfunction

Answer 33

•Bladder- UTI risk due to lack of muscle tone * –UMN spastic bladder- automatic or reflex voiding- suprapubic stimulus may elicit this * –LMN flaccid bladder (caudia equina)- Valsalva or manual abdominal pressure to elicit voiding •Bladder training programs- D/C catheter if possible; if not cath or adult diaper * –Timed voiding- attempt urination prior to cath, control intake, monitor with bladder scan

Question 34

Clinical Manifestations of SCI: Bladder Dysfunction

Answer 34

•Bowel * –UMN spastic bowel- above conus medullaris * –LMN flaccid bowel- below conus medullaris * •Bowel training program- suppositories or digital stimulation; control diet, fluids, stool softeners, timing, etc. * •Sexual function- Patients will ask

Question 35

Bladder training programs (or what you must use instead)

Answer 35

• D/C catheter if possible; if not cath or adult diaper * –Timed voiding- attempt urination prior to cath, control intake, monitor with bladder scan

Question 36

List some Indirect Impairments & Complications (9)

Answer 36

1. Presure Sores 2. •Autonomic dysreflexia- can kill your patient 3. •Postural hypotension (orthostatic hypotension)- 4. •Heterotopic ossification- 5. Contractures 6. DVT 7. Pain 8. •Osteoporosis and 9. Renal Calculi (kidney stone)

Question 37

Indirect impairments and Complications: Autonomic dysfreflexia

Answer 37

•Autonomic dysreflexia- can kill your patient * –Increased BP due to vasoconstriction initiated from noxious stimulation (bladder when cath is pinched or elevated, rectal, pressure sores/infection, urinary stones, temperature elevation) * •Symptoms- increased BP, decreased HR, HA, sweating, spasticity, restless, flushing- due to vasodilation above lesion, vasoconstriction below lesion, pupil constriction, nasal congestion, piloerection, blurred vision, syncope. * •Intervention- Check cath, sit up if lying down (raise the head), loosen clothing and abdominal binders, get help! * MAKE SURE YOU NEVER EVER PUT CATHETER BAG ABOVE BLADDER

Question 38

Indirect impairments and complications: Pressure sores

Answer 38

•Pressure sores- pressure or shearing forces combined with bowel and bladder dysfunction, decreased sensation, etc. * –Location- bony prominences * –Best treatment is prevention- turning schedules, pressure relief, skin care

Question 39

Indirect impairments and complications: Postural Hypotension

Answer 39

•Postural hypotension (orthostatic hypotension)- decrease in BP supine to sit or sit to stand * –Tilt table progression, compression hose, abdominal binder, gradual progression

Question 40

Indirect impairments and complications: Heterotopic ossification

Answer 40

•Heterotopic ossification- growth of bone outside the skeleton ie. muscles, tendons, connective tissue

Question 41

Indirect impairments and complications: Contractures

Answer 41

•Contractures- change in muscle length, change in capsular and pericapsular structures

Question 42

Indirect impairments and complications: DVT

Answer 42

•DVT- can cause death if thrown- pulmonary embolus * –Loss of muscle pump, stasis of blood, increase in thrombin * •Symptoms- swelling, erythema, heat * •Intervention- Drugs, hose, turning program, ROM, elevation of LE’s

Question 43

Indirect impairments and complications: Pain

Answer 43

–Traumatic pain- injury ie. MVA, fall, etc. –Nerve root pain- radiating, burning, etc. –Spinal cord Dysesthesias- Deep pain from areas that lack sensation –Musculoskeletal pain ie. shoulder, elbow, or wrist pain from assistive device with walking or W/C propulsion, transfers, etc.

Question 44

Indirect impairments and complications: Osteoporosis & REnal Calculi (kidney stone)

Answer 44

•Osteoporosis and Renal Calculi (kidney stone) * –Calcium metabolism issues- break down bone, increased calcium in blood, deposits in kidney (these are related)

Question 45

Multi podus boot

Answer 45

Question 46

TLSO

Answer 46

TLSO = Thoracic Lumbar Sacral Orthosis

Question 47

Philadelphia Collar

Answer 47

A hard cervical collar