Intro to SCI Flashcards by Kaleb Zier

What patient population is mostly affected by spinal cord injuries.

Young adult males

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Name some of the most common types of traumatic injuries?

MVA
Falls
Violence
Sports

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Name some non-traumatic injuries that can cause SCI?

AVM-arterial venous malformation
Hemorrhage
Subluxation
Abscess
infections such as syphilis or transverse myelitis

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Are cervical or thoracolumbar SCIs more common?

Cervical

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What is the most common type of SCI?

Incomplete Tetraplegia - 39.5%
Complete paraplegia - 22.1%
Incomplete paraplegia - 21.7%
Complete tetraplegia - 16.3%

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What is the average length of stay for a patient in the acute care setting and inpatient rehab setting?

Acute Care - 12 days

Inpatient rehab - 37 days

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What is the life expectancy after SCI?

If injured at 20 y/0

50 years with incomplete
35 years with complete

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Describe the neurological level.

Most caudal level of the spinal cord with normal motor and sensory function on both sides

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What is the motor and sensory level?

Most caudal segment with normal motor or sensory function bilaterally

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How is the motor level tested and what do you if there is a myotome that is not clinically testable (C1-C4, T1-L1, S2-S5)?

Standard MMT scale of 0-5

When you can’t test it, the motor level is the same as the sensory level.

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How is the sensory level tested?

Tested with light touch and pin prick
It’s scored on a 3 point scale
0-Absent, 1-Impaired, 2-normal

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Describe a complete injury.

No sensory or motor function in lower sacral segments

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Describe an incomplete injury

Having motor and/or sensory function below level of injury INCLUDING sensory and/or motor function at S4 and S5.

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How do you determine motor or sensory function at sacral segments S4-S5?

Determine anal sensation and voluntary contraction of exterior anal sphincter.

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What is it called if an individual has motor and/or sensory function below neurological level of injury but does not have function at S4 and S5?

Zones of Partial Preservation

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Describe the ASIA scale.

A - Complete no sensory or motor in sacral segments
B - Incomplete. Sensory but not motor function below neurological level
C - Incomplete. Motor function is preserved below neurological level, and more than half of key muscles have grade or equal to 3 in at least half of muscles
E - Normal

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Describe Brown-Sequard Syndrome.

Damage to 1 side of the cord
Typically caused by penetration wounds (gunshot, stab)
Asymmetrical features
Ipsilateral paralysis and sensory loss (light touch, vibratory)
Contralateral loss of sense of pain and temp
Achieve good functional gains during rehab

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Which syndrome is related to flexion injuries?

Anterior cord syndrome

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Does anterior cord syndrome have a longer or shorter length of stay compared to those with other syndromes.

Longer

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What is the most common SCI syndrome?

Central Cord Syndrome

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How does central cord syndrome normally occur?

Hyperextension injuries to the cervical region (falls)

Also associated with congenital or degenerative narrowing of spinal canal

Are upper extremities or lower extremities more involved with central cord syndrome?

Upper extremities

typically recover ability to ambulate but have distal weakness and loss of fine motor control

Are cauda equina injuries typically complete or incomplete?

Incomplete (due to big # of nerve roots in large area)

Is cauda equina injuries considered an upper motor neuron or lower motor neuron lesion?

Lower motor neuron lesion (LMN)

Name some common causes of cauda equina injuries.

``` Herniated disc in lumbar area Spinal tumors and lesions spinal inflammation Violent injuries Birth complications Lumbar spinal stenosis ```

What is spinal shock?

Period of areflexia that occurs immediately following SCI | Impairment of autonomic regulation with hypotension and loss of control of sweating and piloerection

How long does spinal shock last?

Initial period lasts - 24 hours Gradual return of reflexes up to 1-3 days after injury Increasing hyperreflexia lasting 1-4 weeks Final hyperreflexia 1-6 months after injury

What is autonomic dysreflexia?

Acute onset of autonomic activity from noxious stimulus below level of lesion.

Does blood pressure elevate or go down during autonomic dysreflexia.

Mass reflex response results in ELEVATED BP

What levels do you typically see autonomic dysreflexia?

SCI lesion above T6 | more common in chronic stage of recovery (3-6 months after

What's the most common cause of autonomic dysreflexia?

Bladder and bowel distention/irritation | Other causes include: pressure sores, noxious cutaneous stimuli, sexual activity, labor, skeletal fracture

Name some symptoms of autonomic dysreflexia.

``` HYPERTENSION Bradycardia Headache (severe, pounding) Profuse sweating Increased spasticity ```

What is it important to do if you see someone having an autonomic dysreflexia episode?

Medical emergency Move to upright position to lower BP (avoid supine) Loosen any tight clothing or restrictive devices Monitor BP and pulse

What is the cardiovascular system regulated by?

Brainstem and hypthalamus via sympathetic and parasympathetic nervous system Parasympathetic - vagus nerve Sympathetic - spinal segments T1-L2

With upper SCI injuries there is a loss in sympathetic communication between brainstem and heart but parasympathetic remains intact. What does this tend to cause?

Bradycardia and dilation of peripheral vasculature below level of lesion

Why does orthostatic hypotension occur?

Imbalance in sympathetic and parasympathetic systems, decrease in active muscle contraction, prolonged time in bed Usually only significant in people with SCI above T6

What are some things you should do when moving a patient to upright position to prevent orthostatic hypotension?

Vital signs should be monitored Use compression stockings and abdominal binder Medications may be necessary (ephedrine increase BP, diuretics relieve edema Patient must always be moved slowly

How is temperature control impaired with SCI injuries?

Hypothalamus can no longer control cutaneous blood flow Loss of internal theroregulatory responses Ability to shiver is lost below injury

At what level of SCI injury will you see near normal pulmonary function?

T10 and below

What percentage of people with complete tetraplegia develop pneumonia within 1 year?

10 percent

What level of lesions require artificial ventilator?

C1, C2 | phrenic nerve is lost

What levels innervate the phrenic nerve/diaphragm?

C3, C4, C5

What is paradoxical breathing?

Altered breathing pattern Flattening of upper chest wall Decreased chest wall expansion Dominant epigastric rise during inspiration

Where does spinal control for micturition originate?

S2, S3, S4

When will there be a spastic/hyperrflexic bladder or a flaccid/areflexic bladder?

``` Spastic = above conus medullaris and sacral segments (UMN) Flaccid = at conus medullaris or sacral segments (LMN) ```

Describe some characteristics of a spastic bladder?

Contracts and reflexively empties Reflex arc is intact Detruser muscle is hyperreflexive Lack of coordination between detruser and sphincters

How often do you initially want to cathertization?

every 4 hours

How common are UTIs in SCI injuries?

50% | Major cause of mortality

What levels will you see bowell dysfunction?

Lesions above S2 | S2-S4 or cauda equine lesions = Flaccid or areflexive bowell (LMN)

What are some secondary medical complications with SCI?

``` Pressure Sores (36%) DVT Pain Contractures Heterotopic Ossification Osteoporosis and Fractures ```

What is the difference between nociceptive and neuropathic pain?

Nociceptive - Musculoskeletal or visceral above level | Neuropathic - pain due to injury to central or peripheral nervous system (below level of lesion)