- most common - high impact forces - Occur at path of least resistance (C5-6; T12-L1) - Cause hemorrhage, edema, necrosis of gray matter at/around site

- most common - tend to cause wedge fracture (ant vert body) - spine forced into flexion - anterior cord syndrome

- vertical forces - burst fracture (shatters) - tear drop fracture (piece breaks off)

- due to falls - involve CS - fracture of post elements - avulsion of anterior elements

- Less common - Caused by SC pathology - Tumor, transverse myelitis, syringomyelia, vertebral subluation (RA), infection, vascular malformations (AVM)

- motor and sensory function absent below injury (including lowest sacral levels--S4/5) - Compensation in rehab

Intro to SCI Flashcards by Chelsea Mcclenning

Traumatics SCI

most common
high impact forces
Occur at path of least resistance (C5-6; T12-L1)
Cause hemorrhage, edema, necrosis of gray matter at/around site

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Path of Least Resistance

C5-6
C4
T12-L1

(areas of mobility, instability)

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Traumatic SCI causes:

hemorrhage
edema
necrosis of gray matter around/at site

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Why are L-spine injuries more likely incomplete?

-cauda equina

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Why are T-spine injuries more likely complete?

-ribs increase stability so very high forces cause SCI there

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About ____% of patients with SCI also have_____

- TBI (mod to severe)

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SCI can occur with other injuries like:

fractures of other bones
abdominal injuries
TBI

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Flexion Injury

most common
tend to cause wedge fracture (ant vert body)
spine forced into flexion
anterior cord syndrome

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Compression Injury

vertical forces
burst fracture (shatters)
tear drop fracture (piece breaks off)

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Flexion with Rotation Injury

post to ant

- fracture of lamina, peduncle, facets (avulsion)

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Hyperextension

due to falls
involve CS
fracture of post elements
avulsion of anterior elements

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Non-traumatic SCI

Less common
Caused by SC pathology
Tumor, transverse myelitis, syringomyelia, vertebral subluation (RA), infection, vascular malformations (AVM)

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Syrinx

Cyst in spinal cord

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Complete SCI

motor and sensory function absent below injury (including lowest sacral levels–S4/5)
Compensation in rehab

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Incomplete SCI

-some motor and sensory function preserved below level of injury (including lowest sacral levels–S4/5)

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Zone of Partial Preservation

pts with complete SCI who have partial preservation/sparing of motor and/or sensory function below level of injury
(some little neuron getting through to make connection)

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Damage to DC/ML

-ipsilateral loss of discrimminative touch, vibration, proprioception arms/legs

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Damage to Lateral Corticospinal Tract

-Ipsilateral spastic paresis

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Damage to Spinocerebellar tract

-Ipsilat loss of position and motion sense

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Damage to Spinothalamic tract

-contralat loss pain/temp one segment below lesion

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Somatotopic Arrangement of Corticospinal tract

-lateral fibers to S4/5 (LE)

- -medial fibers to higher up in spinal cord (UE)

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Anterior Cord Syndrome

-Loss: motor function, pain, temp, crude touch below below injury level

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Central Cord Syndrome

Study These Flashcards

Hyperextension injuries
Weak UE
Ok LE
Sparing sacral motor/sensory function

Brown-Sequard Syndrome

Study These Flashcards

Hemisection of cord (stab/gunshot)
Ipsilateral Loss: proprioception, deep/discrim touch, vibration, motor
Contralateral Loss: pain, temp, crude touch

-Usually not perfect hemisection

Posterior Cord

- post spinal Aa strokes, tumors | - Loss: propioception, deep/discrim touch, vibration below injury

Deadliest time for SCI pts

- 1st 24 hours | - hypotension & neurogenic shock

Primary Injury

- due to insult-->local deformation of cord | - irreversable

Secondary Injury

- after initial trauma - ischemia, axonal degeneration, inflammation - may be reversable

Diagnostic Imaging Used

- CT (good at seeing whole spine and Bone) | - MRI--Soft tissue

ASIA Index

- Standardized test for SCI - Tests myotomes/dermatomes to find sensory and motor levels (may be different) - Rostral-caudal sequence

Stabilization Devices

- Internal/External | - stabilize spine

Halo

- C-spine - External - jacket with metal posts; ring screwed into cranium - Very stable; allow mobility (not neck) - 12 Week duration

Cervical Traction

- tongs/halo - in ER - when medical problems don't allow for other devices - increased immobility/bedrest

Cervical Surgery

- enter ant/post/both - in halo after (or other) - increased body mobility after

Minerva Orthosis

-body jacket with straps to head

Cervical Collars

Less stabilization

Thoracolumbar Orthosis

- many types - stable/unstable fractures - limit certain motions/complete stability

Harrington Rods

- rods attached to lamina above and below injury level | - avoid torque forces

Loque Rods

Pre-Stabilization

C SPINE - no neck ROM - Shoulder flex/abd to 90* - ER may be limited T/L SPINE - no hip flexion past 90* - SLR limited to 30*

Long Sitting ROM Requirements

- Full shdr extension and ER - Full elbow extension - Hamstrings to 110*

Transfer ROM Requirements

-neutral DF with knee flexed

ADL ROM Requirements

- tight long finger flexors needed | - full (or more) hip ER for dressing

Tenodesis Grasp

- fingers flex passively with wrist extension | - don't over stretch long finger flexors!

Body Function/Structure Impairments with SCI

1. Mm weakness 2. Loss sensation 3. Loss ROM 4. Pain 5. Respiratory/cardiovascular dysfunction 6. Balance 7. Endurance 8. Alterations to Mm tone

Activity Limitations with SCI

- Directly related to impairments | - --bed mobility, transfers, gait, ADL/IADL, bowel/bladder, sexual functioning

Pain

- various types | - due to injury to cord/nerves/other (including overuse)

_____% of pts have chronic pain

70%

In the first month after injury pressure ulcers form in ______% of patients

30-50%

Ectopic Ossification

- (heterotopic bone) - Ossification of soft tissues below level of injury - larger joints involved - Initially: hot, red, swollen, decrease ROM - Cause? Excessive ROM? - Rx=meds, PT, surgery

Other Complications of SCI

- Ectopic Ossification - Postural Hypotension - Autonomic Dysreflexia - Anxiety/Depression - Respiratory Problems - DVT - Contractures

Autonomic Dysreflexia

-pathology of ANS above T6

Autonomic Dysreflexia: Trigger

noxious stimulus below level of injury

Autonomic Dysreflexia: Reaction to Trigger

- HTN, profuse sweating | - can cause stroke, blindness, death

Autonomic Dysreflexia: Treatment

- monitor BP - sit up (45*) - remove noxious stimulus - inform nurse/MD

84% of patients with _____ injuries and 60% of ____ injuries have respiratory problems

--Upper CS --Lower CS

95% of patients with injuries above ____ require mechanical ventilation

Intro to SCI Flashcards

(57 cards)