SCI Flashcards
(142 cards)
1
Q
How many cervical nerves are there?
A
8
2
Q
How many thoracic nerves?
A
12
3
Q
How many lumbar nerves?
A
5 pairs
4
Q
What are lower motor neurons?
A
Begins in the spinal cord, and goes to innervates muscles
5
Q
What is a myotome?
A
the muscles that each spinal nerve innervates
6
Q
What is a dermatome?
A
the area of the body that each spinal nerve gathers sensory information from
7
Q
People with complete injuries below T12-L1 are unlikely to experience spasticity.
A
True
8
Q
What is the neurotransmitter of upper motor neurons?
A
Glutamate
9
Q
What is the neurotransmitter of lower motor neurons?
A
acetylcholine
10
Q
What are descending tracts?
A
information is traveling from the brain down the spinal cord to other parts of the body.
11
Q
What are ascending tracts?
A
information coming from areas in the periphery and going up to the brain.
sensory pathways that begin at the spinal cord and stretch all the way up to the cerebral cortex
12
Q
What is the corticospinal tract (pyramidal)?
A
UMN from cortex to spinal cord
13
Q
What does the lateral corticospinal tract control? (Descending track)
A
Control of limb muscles
14
Q
What does the ventral (anterior) corticospinal tract control? (Descending track)
A
Control of axial (trunk) muscles
15
Q
What does the vestibulospinal tract (descending track) do?
A
Innervates extensor and axial muscles; involves balance control and posture
16
Q
What is the main action of the reticulospinal tract? (Descending track)
A
to dampen down activity in the spinal cord. Without this path way, there is increased extensor tone observed
17
Q
What is the tectospinal tract responsible for? (Descending track)
A
reflex turning of head in response to sights and sounds (superior collicus)
18
Q
What is the superior collicus?
A
structure in the midbrain that is part of the brain circuit for the transformation of sensory input into movement output.
19
Q
What does the lateral spinothalamic tract carry? (Ascending track)
A
information about pain and temperature
Although pain signals travel through this tract to the thalamus and eventually reach the cortex, you don’t consciously experience pain until these signals arrive in the cerebral cortex, where they are processed.
20
Q
What does the ventral spinothalamic tract carry? (Ascending track)
A
information about pain, temp, crude touch. To the thalamus
21
Q
What is the dorsal column pathway? (Ascending track)
A
The largest ascending tract, conveys proprioception, fine touch and vibration.
22
Q
How are SCI a bimodal distribution?
A
See lots of injuries in young age (MVA, sports) and lots in older age (falls)
23
Q
Spinal cord injury
A
Defined as damage to the spinal cord that temporarily or permanently causes changes in its function.
24
Q
Traumatic vs non-traumatic SCI?
A
- Traumatic SCI = due to external physical impact
- Non-traumatic SCI = due to acute or chronic
disease process
25
What is an incidental finding?
looking for something else on imaging but come across something that may cause symptoms soon in Non traumatic spinal cord injury
26
What is decompression surgery?
Want to reduce swelling to decrease pressure to limit further damage --> take a drill and slightly expose spinal cord so it can expand out the back
27
What is central cord syndrome?
typically affecting the cervical region. It results in disproportionate upper extremity weakness and fine motor control loss compared to the lower extremities.
28
What is Brown-Sequard Syndrome?
Motor function is weak on that side below the level of injury. Proprioception and light touch will be affected on same side. Pain and temperature will be affected on the other side due to cross over.
29
What is anterior cord syndrome?
results in a loss of motor function, pain and temperature sensation below the level of the injury, while preserving proprioception and vibration sense.
Dorsal column is in tact
Damage to blood vessels, no blood supply to a specific area
30
What is posterior cord syndrome?
impaired proprioception, vibration sense, and fine touch sensation, while motor function and pain and temperature sensation are preserved.
31
What spinal levels are associated with sympathetic preganglionic?
T1-L2
32
What happens with a T1-T5 injury?
May be hard to achieve predicted HR max with Autonomic Nervous System
Injury above, t6, inervation of the heart will be compromised
33
What is the risk of injury at T6 level or above?
puts an individual at a higher risk for autonomic dysreflexia
34
Where would sweating happen in an injury?
Above level of injury
If injury at T6 , they will not be able to sweat below that level, thermo regulation will be affected
35
Why does parasympathetic innervation of the heart not get affected in an ANS injury?
Parasympathetic innervation of heart occurs in brain stem which is typically above injuries but we cannot balance the heart system due to sympathetic system being interrupted from injury.
36
Where are preganglionic cells located?
In spinal cord in grey matter
37
How does disruption of sympathetic outflow limit aerobic exercise?
Cardiovascular impairment:
1. HR
2. Contractility (SV)
3. Venous blood pooling in lower limbs (less venous return)
38
What is the Autonomic Standards Assessment Form?
Check autonomic function and give a score
Heart and blood pressure
- Laying down vs sitting up, it’s normal for changes, if it does not change, there is an issue
39
What is autonomic dysreflexia?
1. An over-activity of the Autonomic Nervous System
- an irritating stimulus is introduced to the body below the level of spinal cord injury (overfull bladder)
- stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury
- since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system
- this results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure
- nerve receptors in the heart and blood vessels detect this rise in blood pressure and send a message to the brain
- the brain sends a message to the heart, causing the heartbeat to slow down and the blood vessels above the level of injury to dilate
- however, the brain cannot send messages below the level of injury, due to the spinal cord lesion, and therefore the blood pressure cannot be regulated
40
Should we lay people down or sit people up if they are experiencing autonomic dysreflexia?
Don't lay people down as it increases pressure in the head
- Figure what is triggering it. Can be anything causing pressure but usually bowel or bladder distention
41
What are the signs and symptoms of autonomic dysreflexia?
- Increased BP
- Decreased HR (irregular)
- Sweaty above injury level
- Headache
- Anxiety
- Blurred Vision
42
What is the response to autonomic dysreflexia?
1. Sit Upright (Orthostatic Hypotension)
2. Loosen clothing, monitor HR/BP (something tight might be the issue)
3. Look for stimulus, bladder distension, kink in catheter, pressure sores
4. Seek treatment if BP remains elevated
43
What are the facts about autonomic dysreflexia?
90% of people affected if injury above T6; 20-40mmHg above person's typical systolic
44
What is the pathway of autonomic dysreflexia?
Vasoconstriction is happening below level of injury, elevating blood pressure detected by baroreceptors. Cervical nerves then attempt to slow heart rate but descending signals to inhibit HR is blocked
45
What is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI)?
Main neurological outcome measure in clinical trials.
46
What is the process of sensory (dorsal column tract) for ISNCSI?
Test dermatome that corresponds with certain spinal cord location.
2 test, light touch and pin prick
47
Light touch test
Light touch
(Q1) Can you feel me touching you
* if it’s no, there will be a zero in that column,
* if the answer is yes, move to Q2
Q) Does it feel the same as your face
* if it’s yes , they get a 2
* If it’s no, then you get a 1
Eyes closed when doing light touch
Touching both face and the selected area
48
Pin Prick test
Pin prick
(Q1) is this sharp or dull
* if it’s accurate move to Q2
* if they are not accurate they get a zero
Q) Does it feel the same as your face
* if it’s yes , they get a 2
* If it’s no, then you get a 1
Eyes closed when doing pin prick
Touching both face and the selected area
Texting sharp or dull
Do the test at least ten times
49
Motor test
Motor test
Provide resistance, expecting different results based on the individual (age)
50
What is the pain (nociception) process for ISNCSI?
Poke the cheek with a pointy pin and blunt end, then do with eyes closed to see if they can tell difference.
51
What does a 'Yes' response for pain (nociception) for ISNCSI mean?
Have to be right 9/10 times. Score of 2.
52
What are we trying to determine in ISNCSI?
Trying to determine where do scores go from 2 to something different—-> tells us which possible neurological location is affected
53
What does a score of 5 in ISNCSI motor test indicate?
Normal or expected. Full range of motion
54
What does a score of 4 for ISNCSI motor test indicate?
Muscle strength and can actively move a specific muscle group against gravity and somewhat against moderate resistance.
55
What does a score of 3 in motor test for ISNCSI indicate?
Can move it against gravity but not additional resistance.
56
What does a score of 2 in motor test for ISNCSI indicate?
Can't move it against gravity but can move it with support.
Full range of motion if Gravity is eliminated
57
What does a score of 1 in ISNCSI motor test indicate?
Evidence of muscle contraction, but no observable joint movement.
58
What does a score of 0 in ISNCSI motor test indicate?
No movement.
59
What are we looking for in ISNCSI motor exam?
When things drop below 3.
60
When is the final level of classification determined?
The last level where things were fine.
Do not get confused
61
What is the ASIA Impairment Scale?
Grades degree of impairment and severity of injury.
ABCDE
(Bad to Good)
62
What does Grade A of ASIA scale indicate? (Complete)
Complete lack of motor and sensory function below level of injury (including anal area: S4-S5)
63
What does Grade B of ASIA Scale indicate? (Sensory incomplete)
Some sensation below the level of the injury (including anal sensation) but lack motor.
64
What does Grade C of ASIA scale indicate? (Motor incomplete)
Some muscle movement is spared below level of injury, but 50% of the muscles below the level of injury cannot move against gravity. Muscle Function Grade is 2
65
What does Grade D of ASIA Scale indicate?(Motor incomplete)
Most (>50%) of the muscles that are spared below the level of injury are strong enough to move against gravity.
66
What does Grade E of ASIA scale indicate?(Normal)
All neurologic function has returned.
67
How would you decide between Grade B and C?
You would do additional muscle testing.
(Pronation flexion of wrist at C6)
68
Are sedentary-related conditions more prevalent after SCI compared to general population?
True, highest prevalent if individual has Obesity, Then CVD, Then Diabetes
69
What happens if the injury is at T6?
Heart would be okay but are not getting sympathetic innervation of gut or adrenal glands.Boost of NE and R is not there which should be part of our exercise response.
70
What does a T1 level injury compromise in exercise?
Your sweat response throughout whole body.
71
Why is Total Daily Energy Expenditure lower in people with spinal injuries?
Not being able to generate sweat is reason why TDEE is lower.sweating requires energy consumption
72
T6-T12?
Neural drive to adrenal glands.
73
What happens if the injury is at C8 or above?
Absent of sympathetic CV drive
Absent of SNS mediated redistribution of blood flow
Absent sweat response
Absent activation of adrenal glands
Absent support for respiration
74
What is spinal shock?
Occurs immediately after a spinal cord injury characterized by a loss of sensation, muscle function, and reflexes below the level of the injury. Typically followed by gradual return of these reflexes
75
What is Phase 1 of spinal shock?
Areflexia/ Hyporeflexia; Loss of descending facilitation; 0-1 day after injury
76
What is Phase 2 of spinal shock?
-1-3 days after; Gradual return of some reflexes, but in altered form. Panicky reflex start to come back
77
What is Phase 3 of spinal shock?
1-4 weeks; Hyperreflexia; Initial emergence of exaggerated spinal reflexes.
78
What is Phase 4 of spinal shock?
Final hyperreflexia (e.g spasticity) 1 - 12 months new synapse growth.
80 to 90 percent end up in stage 4
79
What is neurogenic shock?
It is a result of the autonomic nervous system's disruption leading to significant blood pressure drop and heart rate abnormalities. From loss of SNS activity (which normally allows vasoconstriction and HR increases)
Phrase used to describe a constellation of signs and symptoms
(low BP, Bradycardia, thermoregulatory impairments)
80
What is the difference between spasticity and rigidity?
Spasticity is velocity dependent and rigidity is not.
81
What is associated with spasticity?
The stretch reflex.
82
What is spasticity?
a motor disorder characterized by a velocity-dependent increase in the tonic stretch reflex (muscle tone) with exaggerated tendon jerks, resulting from excitability of the stretch reflex as a component of the upper motor neuron
syndrome
83
What is upper motor neuron syndrome?
Lesion to descending motor pathways.
84
If you have damage to upper motor neurons, do you have a high likelihood of experiencing spasticity?
True
85
What is non-problematic spasticity?
If it does not cause pain or difficulty moving.
86
How can spasticity affect body structure?
Can cause contractures and skin breakdown.
87
What else can spasticity affect?
Function, QoL, Cosmesis (perception of one’s self)
88
Is spasticity a muscle cramp?
No
89
Do people typically get spasticity in extensors of arm or fingers or dorsiflexors in ankle?
TRUE
90
What are common joints affected with spasticity?
1. Internal rotation and adduction of the shoulder
2. Flexion at the elbow
3. Forearm pronation
4. Flexed wrist
5. Tight fist
6. Clenched thumb
If held too long, it can cause contractures, doing stretching and splinting can prevent this
91
What do primary endings of muscle spindles do?
make muscle spindle responses dependent on velocity.
92
What do secondary endings of muscle spindles do?
length/stretch responses.
93
What type of information do muscle spindles send?
Information on speed of movement and ROM of movement.
94
What is the stretch reflex arc?
1. Patella tapped (quick stretch)
2. Quad muscle gets stretched and sensory receptors in quads are activated
3. Spindles send signal to spinal cord
4. Sensory info synapses directly with the quads motorneuron
5. Results in a contraction of quads
6. Also causes inhibition of antagonist muscles.
95
What do Group 1a sensory afferents do?
innervate every intrafusal fiber; monitor rate of change.
Most sensitive neuron to velocity
96
How can spasticity implicate exercise?
1. Faster limb movement means faster stretch is applied (greater chance of spasticity)
2. Farther we move a limb means more stretch is applied (greater chance of eliciting spasticity)
Implications during exercise for: Speed of movement & Range of motion
97
What is baclofen?
muscle relaxant to treat spasticity; can be delivered via catheter in spinal cord.
98
What is a limitation of 2011 SCI guidelines?
does not specifically address cardiometabolic health.
99
Why are guidelines that address cardiometabolic health valuable for SCI?
cardiometabolic diseases are among the leading causes of death in adults with SCI.
100
What are the new cardiometabolic health guidelines for SCI?
30 mins of moderate to vigorous intensity aerobic exercise 3x/week.
101
What are the fitness guidelines for SCI?
20 mins of mod-vig aerobic exercise 2x/week; 3 sets of strength exercises for each major muscle group 2x/week.
102
What is being developed for FES?
Hoping to come up with guidelines for FES quickly.
103
Why are there gaps in literature for SCI exercise for acute and subacute phases?
Difficult to do RCT in the clinics.
104
How does bone health affect literature gaps?
Osteoporosis is 100% likely in people with SCI.
105
Is there evidence that exercise increases spasticity?
There are some cases but very little evidence.
106
Does FES reduce spasticity?
Inconclusive.
107
Does physiotherapy aid in spasticity?
1/17 trials found benefits.
17 studies (median PEDro score 6/10) level 1-level 2, Outcome measure: Ashworth scale, SCI spasticity evaluation tool
Only one trial found a benefit on the AshWorth
Physio, no evidence that it will decrease spasticity,
108
What is the conclusion to physiotherapy affecting spasticity?
No high quality evidence to indicate that it decreases spasticity.
109
What is the modified Ashworth scale (gold standard)?
measures the amount of tone/spasticity.
110
What is key to conducting the modified Ashworth scale?
You want to stretch the muscle you think the spasticity is in quickly.
111
What does a score of 0 in MAS indicate?
No increase in muscle tone.
112
What does a score of 1 in MAS indicate?
Slight increase in tone (slight resistance).
113
What does a score of 1+ in MAS indicate?
Slight increase in tone, with a catch.
114
What is the high quality evidence regarding spasticity?
There is high quality evidence to indicate that it decreases spasticity, which may be due to lack of research.
115
What is the modified Ashworth scale (MAS)?
The modified Ashworth scale is the gold standard for measuring the amount of tone/spasticity through passive movement quickly through range of motion.
116
What does a score of 0 in the modified Ashworth scale indicate?
No increase in muscle tone.
117
What does a score of 1 in the modified Ashworth scale indicate?
Slight increase in tone (slight resistance).
118
What does a score of 1+ in the modified Ashworth scale indicate?
Slight increase in tone, with a catch, followed by minimal resistance.
119
What does a score of 2 in the modified Ashworth scale indicate?
More marked increase in tone, but affected part(s) easily moved.
120
What does a score of 3 in the modified Ashworth scale indicate?
Considerable increase in tone and passive movements difficult.
121
What does a score of 4 in the modified Ashworth scale indicate?
Affected part(s) rigid in flexion or extension.
122
How do you test the elbow in the modified Ashworth scale?
Start in flexion then extend them to test the stretch in flexors.
123
Where do we typically see more spasticity in the legs?
In the quads (extensors).
## Footnote
Want to put them in extension and passively put them in flexion quickly to stretch muscle and feel for resistance/tone.
124
What is the Minimally Clinically Important Difference (MCID) for the modified Ashworth scale?
It has to change (decrease) by at least 1 in this scale.
125
How is spasticity managed?
Manage spasticity with Botox.
126
What is the SCI-SET?
Retrospective recall of how spasticity has affected you in the past week.
127
What does a positive score on the SCI-SET mean?
Spasticity has not been problematic but actually helpful.
128
What is the mean score difference for the SCI-SET?
0.47-0.82.
129
How does exercise response depend on the sympathetic nervous system?
The higher the level of injury, the more components of the SNS that are disconnected from descending control systems in the brain and brainstem.
130
Despite similar peak anaerobic power, what do individuals with a cervical level SCI have drastically reduced compared to individuals with paraplegia?
Peak aerobic capacity (VO2max), Peak PO, Serum catecholamine (peak NE).
131
During FES-cycling, why do individuals with tetraplegia reach peak HR that are much lower than people with T3-T5 paraplegia?
Due to more decrease of sympathetic innervation due to cervical injury.
132
Why is resting energy expenditure lower in people with tetraplegia?
It is a side effect of loss of lean muscle tissue mass.
133
Is it true that energy expenditure as a function of activity level after SCI shows that people with cervical level injury do not reach the energy expenditure of non-injured comparison group being sedentary?
True.
134
What is an important barrier to axonal regrowth in chronic SCI?
Astroglial scar.
135
Which nerve mediates reflex mediated bradycardia during neurogenic shock?
Vagus nerve.
136
Is blood pooling in lower limbs beneficial during autonomic dysreflexia?
True. Blood pooling is beneficial. Want to sit them up and not tip them back to avoid high BP in head.
137
At which level is neural mediated release of catecholines during exercise compromised by a SCI?
Every level except for L1 and down.
138
Why is muscle tone important?
Muscles go limp which causes blood pooling.
139
What happens with injury at T1?
It blunts sympathetic HR response.
140
Tethered spinal cord
is a congenital condition where the spinal cord is pulled lower than normal, extending beyond the L1 level.
• This can cause pain or neurological deficits, and it’s an anomaly if found below L1.
141
Upper motor neurons
Located in the primary motor cortex
Stroke can damages the upper motor neurons
Some diseases: Stroke, reduced blood supply, neurodegeneration conditions.
142
Which secondary conditions would you be certain to ask your patient about during your initial interview?
2. Why are each of these conditions is relevant to exercise prescription?
1. Pain
2. Sweat
3. Osteoporosis
4. Breathing issues (ventilation) innervation of our respiratory muscles
Why
1. Alter type of excersise
2. Thermoregulation
3. meditating fracture risk: Resistance training is the best thing you can do for bone health
4. Depending on where the l of injury is will determine the affect on respiratory muscles
