SCI

Question 1

what are nontraumatic sources of SCI

Answer 1

RA, spina bifida, AVM, tumors, demyelination (MS), and infections (transverse myelitis)

Question 2

how far down does the spinal cord travel

Answer 2

down to L2 vertebral level

Question 3

where do spinal segments receive their vasculature

Answer 3

ASA and PSA from the VA

Question 4

what does the SC dorsal column control

Answer 4

sensory ascending light touch and proprioception

Question 5

how is the DCML organized

Answer 5

from medial to lateral

1. fasciculus gracilis (S - L/T)
2. fasciculus cuneatus (U/T to C)

Question 6

what does the CST control

Answer 6

descending motor control

Question 7

how is the CST organized

Answer 7

lateral column from deep to superficial C, T, L, S

Question 8

how is the ALS controlled

Answer 8

anterolateral from deep to superficial C, T, L. S

Question 9

what are the three components of SCI classification

Answer 9

vertebral level of lesion, tetra/paraplegia, and ASIA functional classification

Question 10

how does ASIA determine the sensory level of injury

Answer 10

most caudal dermatome to have NORMAL senation for BOTH pinprick and light touch on BOTH sides

Question 11

how does ASIA determine the motor level of injury

Answer 11

most caudal key muscle group (out of 10 myotomes) graded 3/5 or better with segments above 5/5

Question 12

which segments are tested for ASIA sensation? motor?

Answer 12

sensation C2 - S4/5

motor: C5-T1 and L2-S1

Question 13

what is the ASIA definition of complete?

Answer 13

absence of sensory and motor function at the lowest sacral level S4/5

Question 14

what does ASIA definite as incomplete

Answer 14

sacral sparing

Question 15

what is sacral sparing

Answer 15

voluntary external anal reflex OR light touch/pin prick at S4/5

Question 16

what is the zone of partial preservation

Answer 16

segments below the neuro level of injury with some or both sensation and motor ONLY applying to complete injuries

Question 17

what is the grading range for ASIA testing

Answer 17

0 = absent
1 = altered
2 = normal
NT = not tested

Question 18

define ASI-A

Answer 18

complete - no sensory or motor function preserved through S4/5

Question 19

define ASI-B

Answer 19

sensory incomplete - sensory is preserved through S4/5 AND no motor more than three levels below level of injury on either side

Question 20

define ASI-C

Answer 20

motor incomplete - motor function preserved below the level of injury AND more than half of mytomes below the level are graded 0-2

Question 21

define ASI-D

Answer 21

motor incomplete - motor function preserved below the level of injury AND more than half of the myotomes below the level are graded 3-5

Question 22

define ASI-E

Answer 22

normal - history of SCI, previously graded lower, but shows normalcy in all grades throughout

Question 23

T/F: ASIA A-E can all be graded as complete OR incomplete

Answer 23

false: only ASI-A is complete and ASI-B-E are incomplete

Question 24

what are four common incomplete syndromes

Answer 24

anterior cord, central cord, brown-sequard, and cauda equina

Question 25

T/F: surgical decompression for SCIs must be performed early for best outcomes

Answer 25

false/trick question: the jury is out on the best timing for surgical decompression whether it be early or delayed

Question 26

what are two PT considerations for cervical SCI

Answer 26

posterior approaches disrupt neck extensors and iliac bone grafts

Question 27

what are vascular and inflammatory consequences of SCI

Answer 27

1. ischemia/hypoxia 2. hemorrhage 3. toxins/oxidative stress 4. swelling 5. apoptosis

Question 28

how does blood pressure relate to SCIs

Answer 28

SCI patients are vulnerable to systemic hypotension

Question 29

what is typical blood pressure management parameters for SCI patients

Answer 29

maintain MAP above 85-90 for 5-7 days via volume resuscitation and vasopressors

Question 30

what medication is typically administered for secondary effects of SCI

Answer 30

methylprednisolone (MPSS)

Question 31

what is spinal shock

Answer 31

period of areflexia immediately following SCI usually resolving within 24 hours

Question 32

what are the characteristics of spinal shock

Answer 32

areflexia, flaccidity, loss of bowel and bladder, autonomic dysreflexia

Question 33

what is the first and major sign of resolving spinal shock

Answer 33

positive bulbocavernosus reflex

Question 34

what do we expect with sympathetic trunk involvement in SCI patients

Answer 34

bradycardia, dilation of peripheral vasculature below lesion, decreased exercise tolerace, lower SV and CO

Question 35

how to you condition patients to upright

Answer 35

apply TED hose, ace wraps, and abdominal binding prior to beginning upright activities followed by slow accommodation to upright

Question 36

what causes orthostatic hypotension

Answer 36

imbalance between sympathetic and parasympathetic nervous systems, decrease in active muscle contraction, and prolonged bed rest

Question 37

in which SCI population do you expect to see AD

Answer 37

T6 and above injuries and more commonly in complete injuries

Question 38

what are the sxs of AD

Answer 38

1. BP 20-30 mmHg above normal 2. sweating 3. headache 4. flushed 5. blurred vision 6. tight chest and stuffy nose

Question 39

what typically triggers AD

Answer 39

bladder, bowel, skin, and sexual organ noxious stimulus

Question 40

what do you do if a patient experiences AD

Answer 40

sit up and lower the legs

Question 41

what is spastic hypertonia

Answer 41

a long term complication of SCI characterized by hypertonicity, hyperactive stretch reflex, spasticity, spasms, and clonus

Question 42

who gets spastic and flaccid bladders

Answer 42

spastic in UMN and flaccid in LMN

Question 43

how do you prevent pressure ulcers in bed? in a chair?

Answer 43

bed rolling every 2 hours and chair pressure relief every 15-20 min

Question 44

where can osteogenesis occur in SCI patients

Answer 44

soft tissues below the level of injury

Question 45

what are the early sxs of HO

Answer 45

swelling, decreased ROM, erythema, local warmth

Question 46

how do you manage HO

Answer 46

P/AAROM once signs of inflammation have subsided

Question 47

when does the most dramatic return of movement and function occur in SCI patients

Answer 47

first several months

Question 48

what happens to movement and function after the first few months of recovery

Answer 48

plateauing although not uncommon to see improvement

Question 49

what are the general goals of acute care SCI PT

Answer 49

1. prevent joint contracture 2. improve muscles and breathing 3. acclimate to upright 4. prevent secondary complications