Mod 4: SCI Flashcards
some causes of SCI: trauma from-
damage to vascular supply, ligaments, discs, vertebral bodies, nerve roots
SC swelling
ischemia in surgery
trauma w/ too much movement to head/trunk
non-trauma causes of SCI:
transverse myelitis (infection/inflamm of whole SC)
spinal stroke
vascular malformation: hemorrhage, thrombus, embolus
spina bifida,
hysterical paralysis (conversion disorder)
arthritis or spondylolysis can force SC into ext & compress
where does SC terminate? (vertebral level)
L1/L2
impairment or loss of motor/sensory in cervical segments d/t damage of neural elements within spinal canal
-damages trunk, UE, LE
tetraplegia
impairment or loss of motor/sensory fxn of thoracic, lumbar or sacral (not cervical) segments of SC
-includes cauda equina & conus medullaris
paraplegia
partial preservation of sensory/motor fxn is found below the neuro level & includes the lowest sacral segment
incomplete SCI
If its an L2 complete injury: which nerve segments are functional? which LE myotome is still functional?
L2- hip flexion functions
L3 & below doesn’t
dermatomes & myotomes caudal to the neurological level that remain partially innervated
-trace levels in complete injuries
Zone of Partial preservation
spinal levels of tetraplegia: high, middle, Low
high: C1-C5
mid: C6
low: C7-8
spinal level of paraplegia
T1 & below
Asia scale: no sensory/motor in S4/5
Asia A Complete
Asia scale: has sensory but no motor fxn (lowest sacral intact)
Asia B Incomplete
Asia scale: has motor & sensory fxn, greater than half of key mm below neuro level & MMT grade <3 (gravity min)
Asia C Incomplete
Asia scale: has motor fxn, greater than half of key mm below neuro level & MMT greater or equal to 3 (against gravity control)
Asia D Incomplete
Asia scale: sensory/motor fxn are normal though SCI
Asia E Incomplete
UE weakness > LE weakness
-injured by cervical hyperext
-damage to spinothalamic, corticospinal & dorsal columns
-motor deficits (fine motor) > sensory
-most common
Central Cord Syndrome
loss of corticospinal & dorsal columns on injured side (ipsilat)
loss of spinothalamic on contralat side
Brown Sequard Syndrome
loss of corticospinal & spinothalamic tract below the level of injury
-retains dorsal columns below level of injury
-cervical flexion injury
Anterior Cord Syndrome
loss of dorsal columns below level of injury
-retain corticospinal & spinothalamic tract below level of injury
Posterior Cord Syndrome
LMN injury to lumbosacral nerve roots below L1
-saddle anethesia, areflexic bladder, flaccidity
Cauda Equina Lesion
Stabilization methods for SCI
laminectomy- remove bone for decompression
fusion- stability
internal fixation- Harrington rods
closed techniques w/ wear schedeul: TLSO, HALO, Philly collar
techniques for self-pressure relief
forward lean
side lean (weight shift)
w/c push-ups
active insufficiency of finger flexors position
-a functional position for cervical SC (>C7)
tenodesis
autonomic dysreflexia:
SC level
s/s
response
T6 & above
high BP, low pulse, sweating below level
Sit them up! & find stimulus
(kinked catheter, bladder distension, wrinkled sock etc)
