Spinal Cord Injury

Question 1

What is the most common cause of traumatic SCI?

Answer 1

MVA (40.4%)

Question 2

How are they classified?

Answer 2

Traumatic or non-traumatic

Question 3

Mechanisms of injury

Answer 3

Flexion (most common in lumbar injury)
Flexion-rotation (most common in cervical injury)
Axial compression
Hyperextension
Penetrating injuries

Question 4

Spinal shock

Answer 4

A transient period of areflexia immediately following SCI
Approximately 24 hours
Hypotension, loss of control of sweating
Goosebumps
Will eventually lead to hyper reflexia (UMN S&S)

Question 5

Tetraolegia

Answer 5

All four extremities
Lesions of Cx SC
56%

Question 6

Paraplegia

Answer 6

Tx Lx L2 (caudal equina)
46%

Question 7

How is SCI standardized

Answer 7

international standards for neurological classification of SCI *ISNCSCI

Question 8

Neurological level of injury

Answer 8

Most caudal level of SCI level with INTACT motor and sensory fxn

Question 9

Motor and sensory level

Answer 9

Most caudal level Intact

Question 10

Complete and incomplete SCI

Answer 10

Complete is every paralysis below neurological level
Incomplete are those with some persevered function (zones of partial preservation)

Question 11

ASIA impairment scale

Answer 11

A- complete
B- incomplete: has sensory
C- incomplete: has sensory and motor but muscle grade is less than 3
D- incomplete: has sensory and motor but muscle grade is more than 3
E- normal

Question 12

Clinical syndromes

Answer 12

Incomplete
- brown-sequard
- anterior cord
- central cord
- posterior cord

Other
- conus medullaris
-caudal equine

Question 13

Brown- Sequard syndrome

Answer 13

Damage to one half of the spinal cord (usually penetrating injury)
Ipsilateral loss of:
- all sensory modalities at the level of lesion
- motor function (descending: lateral corticospinal tract)
- proprioception, discriminative touch, and vibratory sense (ascending- dorsal column)

Contrateral loss:
- pain and temperature (spinalthalamic tract)

Question 14

Anterior cord syndrome

Answer 14

Commonly due to flexion injuries
Loss of motor fxn, pain and temp below level of lesion

Question 15

Central cord syndrome

Answer 15

Hyperextension in Cx- compressive forces cause edema
Loss of motor > sensory
motor loss UL>LL

Question 16

Posterior cord syndrome

Answer 16

Loss of proprioceptions, pressure, and vibratory sense
NO motor loss

Question 17

Caudal Equina

Answer 17

Damages to the nerve roots below L1
Flaccid paralysis
LMN injury, areflexive bowel/ bladder, and sacral anesthesia

Question 18

Autonomic Dysreflexia

Answer 18

Sympathetic over activity in the body
Typically in lesions above T6
EMERGENCY SITUATION

Question 19

Pathophysiology of autonomic dysreflexia

Answer 19

Noxious stimulus, increased sympathetic outflow, wide spread vascoconriction (Increase HR an BP), basorecetirs stimulate increase in fatal output causing decreased HR, but insufficient to counteract Increased BP

Question 20

Most common triggers of AD

Answer 20

Bladder and bowel distenson/irritation
Lots more

Question 21

AD S&S

Answer 21

Hypertension
Initial tachycardia but then bradycardia
Severe headache
Profuse sweating
Increased spasticity/ hypertonia
THERES MORE

Question 22

AD interventions

Answer 22

Sit patient up to decrease BP
Notify nearby nurse or doc
Check catheter for kink, block or fullness
Loosen tight clothing
Look for other potential noxious stimulus below NLI
Document

Question 23

Functional outcomes: NLI C1-4

Answer 23

Most severe
Paralysis of arms, hands, trunk and legs
Require assistance with breathing and secretion clearance
Dependent in all ADLs
Dependent in transfers
Power wheelchair

Question 24

Functional outcomes: NLI C5

Answer 24

Can breathe but labored because lack of abdominal tone so no diaphragm counterpressure
Dependent in transfers
Manual wheelchair with propulsion aids for short distances
Can drive a van using adaptive hand controls
Power wheelchair with adapted joystick for communities

Question 25

Functional outcomes: NLI C6

Answer 25

Tenodesis grasp allows for limited self-care activities Independent to min assist with sliding board Independent with manual cough Wheelchair propulsion possible with the use of hand rim projections for short distances Power wheelchair for community Independent with pressure relief maneuvrss in wheelchair Can drive a car or van using adaptive hand controls Capable of living independently

Question 26

Functional outcomes: NLI C7

Answer 26

Easier for sliding board transfers Most ALDs are possible Manual wheelchair with friction surface hand rims

Question 27

Functional outcomes: NLI C8

Answer 27

Independent more No wheelchair adaptions needed

Question 28

Functional outcomes: NLI T1-T12

Answer 28

The Lower the lesions level the better the trunk control HKAFO and KAFO for short distances Wheelchair for comminutit

Question 29

Functional outcomes: NLI L1-3

Answer 29

Same as previous

Question 30

Functional outcomes: NLI L4-S1

Answer 30

AFO with assistive device. NLI L4 may choose to use wheelchair for long distances

Question 31

Respiratory management

Answer 31

- IPPV - deep breathing exercises - Glossophryngeal breathing (frog breathing) - Respiratory muscle strengthening - Assisted cough - Abdominal binder

Question 32

Skin care

Answer 32

Positioning - every two hours Pressure relief - maneuvers every 15 ins Skin inspection Education Wound care

Question 33

Early strengthening and ROM

Answer 33

Perform daily (except for areas that are contraindicated) Pelvis should be let in neutral LSP injury- SLR >60 deg and hip flex ion > 90 degs Tetraplegic- mvmt of the head/neck, and shoulder flex ion/abduction >90 deg is contraindicated until given orthopedic clearance Selective stretching - tightness in certain muscles can enchanted function - adequate length in certain muscles can enhance function Splinting (intrincsic plus splint- hamburger hands)

Question 34

Early mobility

Answer 34

May experience postural hypotension Focus on transfers and functional mobility

Question 35

Active rehab

Answer 35

Continue with resp care, skin and ROM Strengthin Cardiovascular endurance training Wheelchair skills Bed mobility skills Balance Transfers Gait training