Packet 17 - Nervous System (3)

Question 1

Full upper extremity control, with varying degree of trunk control/balance.

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 1

Thoracic level injuries

Full upper extremity control, with varying degree of trunk control/balance.

Path. Change:Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 2

Affects bowel/bladder control, sexual function.

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 2

Sacral level injuries

Affects bowel/bladder control, sexual function.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 3

Related to autonomic signals from brain not transmitted to parts of spinal cord below level of injury.

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 3

ANS dysfunction

Related to autonomic signals from brain not transmitted to parts of spinal cord below level of injury.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 4

Good shoulder and elbow function.

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 4

Below C4

Good shoulder and elbow function.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 5

Flaccid paralysis (no reflex activity) (muscles atrophy). Usually caused by a fracture, dislocation, or instability of vertebral column (complete).

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 5

LMN injury

Flaccid paralysis (no reflex activity) (muscles atrophy).

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 6

Varying degree of lower extremity function.

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 6

Lumbar level injuries

Varying degree of lower extremity function.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 7

Good head control; requires ventilatory assistance.

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 7

Above C4

Good head control; requires ventilatory assistance.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 8

Spastic paralysis (has spinal reflex). Usually caused by a penetrating injury (gunshot or knife wound). (incomplete).

1. ) Above C4 2.) Below C4
2. ) Thoracic level injuries 4.) Lumbar level injuries
3. ) Sacral level injuries 6.) UMN injury
4. ) LMN injury 8.) ANS dysfunction

Answer 8

UMN injury

Spastic paralysis (has spinal reflex).

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 9

ANS dysfunction

Causes bradycardia related to sympathetic system being no longer able to regulate the vasovagal reflex.

1. ) Postural hypotension
2. ) Altered thermoregulation
3. ) Increased vasovagal response
4. ) Autonomic dysreflexia

Answer 9

Increased vasovagal response

Causes bradycardia related to sympathetic system being no longer able to regulate the vasovagal reflex.

ANS dysfunction

Related to autonomic signals from brain not transmitted to parts of spinal cord below level of injury.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 10

ANS dysfunction

Related to loss of autonomic control over mechanisms that regulate temperature, like shivering, sweating, etc. Poikilothermia.

1. ) Postural hypotension
2. ) Altered thermoregulation
3. ) Increased vasovagal response
4. ) Autonomic dysreflexia

Answer 10

Altered thermoregulation

Related to loss of autonomic control over mechanisms that regulate temperature, like shivering, sweating, etc.

Poikilothermia.

ANS dysfunction

Related to autonomic signals from brain not transmitted to parts of spinal cord below level of injury.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 11

ANS dysfunction

Painful stimuli activates sympathetic activity, which results in hypertension. The parasympathetic system tries to decrease BP by decreasing HR and causing vasodilation. Parasympathetic impulses are unable to reach vessels below injury, resulting in increased hypertension and increased bradycardia (vicious cycle).

1. ) Postural hypotension
2. ) Altered thermoregulation
3. ) Increased vasovagal response
4. ) Autonomic dysreflexia

Answer 11

Autonomic dysreflexia

Painful stimuli activates sympathetic activity, which results in hypertension. The parasympathetic system tries to decrease BP by decreasing HR and causing vasodilation. Parasympathetic impulses are unable to reach vessels below injury, resulting in increased hypertension and increased bradycardia (vicious cycle).

Above T6 or higher

ANS dysfunction

Related to autonomic signals from brain not transmitted to parts of spinal cord below level of injury.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 12

ANS dysfunction

Related to loss of sympathetic-mediated vasoconstriction with position change.

1. ) Postural hypotension
2. ) Altered thermoregulation
3. ) Increased vasovagal response
4. ) Autonomic dysreflexia

Answer 12

Postural hypotension

Related to loss of sympathetic-mediated vasoconstriction with position change.

ANS dysfunction

Related to autonomic signals from brain not transmitted to parts of spinal cord below level of injury.

Path. Change: Damage to spinal cord → altered neural transmission and reflex activity.

P/C Factors:

• Fracture, dislocation, instability of vertebral column (complete).
• Penetrating injuries (gunshot or knife wounds) (incomplete).

Interventions:

Question 13

When someone has a spinal cord injury, we usually say that it is an UMN injury (spastic paralysis, has spinal reflex). We call it an UMN injury because at every level of the spinal cord there is an UMN that starts in the brain and ends at that level of the spinal cord.

In order for an LMN injury to occur, injury has to occur below the point where the spinal cord ends (T₁₂ / L₁ vertebra level). LMN injury = flaccid paralysis (no reflex) (muscles atrophy)

Answer 13