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Clinical Neuro II > Lecture 1 Intro to Spinal Cord Injury > Flashcards

Lecture 1 Intro to Spinal Cord Injury Flashcards

1
Q

Most common SCI Cause

A

Vehicular

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2
Q

what does tetraplegia mean?

A

Both UE & LE are paralyzed

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3
Q

what does paraplegia mean?

A

LE are paralyzed

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4
Q

Where in the spine least stable?

A

Cervical
C3 & Below
usually incomplete

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5
Q

Where in the spine most stable?

A
  • Thoracic
  • Usually complete
  • poor vascular supply
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6
Q

Most common injury site in the thoracic spine

A

T12 & L1

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7
Q

Dorsal

A

Sensory

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8
Q

Ventral

A

Motor

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9
Q

Lateral Corticospinal

A

Motor
Ipsilateral
Voluntary motor control of the distal limbs

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10
Q

Ventral Corticospinal

A

Motor
Contralateral
Voluntary control of axial muscle

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11
Q

Rubrospinal

A

Motor
ipsilateral
Voluntary control of UE

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12
Q

Vestibulospinal

A

Motor
Both Ipsilateral and contralateral
Balance and posture

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13
Q

Lateral and medial reticulospinals

A

Motor
Ipsilateral
Posture, balance, modulation of spinal reflexes, axial and proximal limb motions

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14
Q

Anterolateral system

A

Sensory
Lateral
Pain, Temp, Crude touch

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15
Q

Dorsal Column

A

Sensory
Ipsilateral
Proprioception, Vibratory sense, deep touch, and discriminative touch

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16
Q

Dorsal spinocerebellar

A

Sensory
Ipsilateral
Unconscious proprioception from Trunk and LE

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17
Q

Ventral Spinocerebella

A

Sensory
Bilateral
Unconscious proprioception and LE

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18
Q

what is the most important determinate of recovery?

A

Complete vs. incomplete

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19
Q

If the patient is ASIA A at 72 hours

A

10-15% improve
3% improve to ASIA D

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20
Q

If the patient is ASIA B at 72 hours

A

54% with improved strength

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21
Q

If the patient is ASIA C & D at 72 hours

A

86% will improve below the level of injury

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22
Q

Poorest prognosis MRI results ranking

A

hemorrhage (complete injury) > contusion > edema

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23
Q

what is the predictor of rate of recovery & prognosis for achieving antigravity strength?

A

initial strength of muscles

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24
Q

Most UE strength occurs during? Greatest change?

A
  • most UE strength occurs during first 6 months
  • greatest change first 3 months
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25
What does Motor complete mean for patients?
1 year after injury 30 - 80% of patient will regain 1 motor level
26
What is Spinal Shock?
- a period of areflexia
27
what is the Etiology of Spinal Shock?
- result from very abrupt withdrawal of connections between higher centers and the spinal cord
28
Characterization of Spinal Shock
- absence of all reflex activity - impairment of autonomic regulation
29
spinal shock can result in?
hypotension and loss of control of sweating and piloerection
30
Spinal Shock timeline
- initial period of total areflexia 24 hours - gradual return of reflexes 1-3 days after injury - Period of Increasing hyperreflexia 1-4 weeks
31
Primary Effects post SCI
- Autonomic dysfunction - Sensory Impairments - Voluntary Motor paralysis - Spasticity - Heterotopic ossification - Impaired breathing and coughing - Osteoporosis
32
Spasticity is more prevalent in?
cervical and upper thoracic lesions, and in incomplete lesions (Particularly ASIA B and C)
33
Spasticity: Reflexes
return initially weak, then become stronger with time
34
How do the vasomotor centers control BP, HR, and blood flow distribution?
through ANS outflow to the heart and peripheral vasculature
35
Sympathetic
increase HR cardiac contraction peripheral vasoconstriction
36
Parasympathetic
decrease HR decrease ventricular contractility
37
which system doesn't get affected by SCI?
- Parasympathetic
38
Autonomic Dysreflexia
- Typically lesions above T6 - Incidence 48-70% - More common in chronic stage of recovery (3-6months) - More common with complete injuries
39
characteristics of Autonomic Dysreflexia
- sudden rise in SBP (≥ 20mm Hg) - bradycardia - severe pounding headache - blurred vision - muscle spasms - nasal constriction
40
AD - Above lesion
- vasodilation - flushing & sweating - piloerection
41
AD - Below the lesion
Vasoconstriction
42
Most common cause of AD
bladder distention blocked catheter bladder irritation *Noxious stimulus below the lesion
43
Treatment for AD
- medical emergency - *if lying flat, bring pt to an upright position - Monitor BP and HR
44
Dysfunction of thermoregulation caused by SCI greater in?
- Cervical & high thoracic lesions
45
Sympathetic NS regulates temp through?
peripheral vascular tone and sweating
46
Somatic regulates temp through
shivering
47
What is Heterotopic Ossification?
- Formation of new bone within soft tissue
48
Most frequent location of Heterotopic Ossification?
- in the hips and knees
49
When does Heterotopic Ossification first appear?
- 1 month to a year postinjury
50
What is the most restrictive Spinal Orthoses?
Halo
51
Effects of Halo
- Promotes perfusion - Reduces pain - Prevent deformity
52
Pros and Cons of Halo?
- Maximal stabilization for early mobilization but limited shoulder motion and vision - Be mindful of open wounds and pressure injuries in the chest
53
C-Collar: Miami J or Aspen
- Restrictions primarily in flexion and extension middle C-spine
54
Medical Management for GI care
- at risk for gastric dilation - can decompress via NG tube
55
Medical Management for Skin Care
- turning schedule every 2 hours in bed - every 20 minutes when sitting in the chair
56
Medical Management for Respiratory Care
- At risk for PNA, atelectasis, death
57
Medical Management for OA
- Early WB to reduce bone mineral density
58
Tenodesis is used for patients with what level of injury?
C6 - C7 lesions
59
Caution for Tenodesis
- When WB through the UEs must maintain finger flexion at the proximal and distal interphalangeal joints
60

Clinical Neuro II (1 decks)

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